CALENDRIER ET TARIF DE LA CERTIFICATION

Dates limite
Certification Dates de l'Examen Formes Tarif
d'inscription
1) Samedi 11/11/2023 16/10/2023 computer-based
2) Samedi 25/11/2023 17/10/2023 computer-based
3) Samedi 09/12/2023 17/10/2023 paper-based
C1 ADVANCED 4) Samedi 13/01/2024 13/11/2023 paper-based 165.000 FCFA
5) Samedi 20/01/2024 15/12/2023 computer-based
6) Samedi 03/02/2024 04/12/2023 paper-based
7) Samedi 16/03/2024 12/01/2024 paper-based

 Paiement

Le Paiement se fait :
- Soit par chèque libellé à l’ordre de « MLCI- lycée international Jean- Mermoz », soit en
espèces à l’accueil de l’établissement.
- Soit par virement bancaire ou dépôt d’espèces directement auprès de nos banques
partenaires.

Dans ce cas, la copie de l’ordre de virement doit être obligatoirement déposée à l’accueil de
l’établissement avant de déposer le dossier complet au secrétariat Cambridge (Bat S3 3ème étage à
côté de la salle 303) du lycée Mermoz.

ECOBANK BICICI
Référence locale : CI059 01037 141227725301 18 CI006 01552 010493700021 55
IBAN : CI93 CI05 9010 3714 1227 7253 0118 CI93 CI00 6015 5201 0493 7000 2155
SWIFT/BIC: ECOCCIAB BICICIABXXX

Aucune inscription ne pourra être enregistrée après ces dates et seuls les dossiers
complets seront acceptés.
Les sessions ne seront ouvertes que si le nombre minimum de candidats exigé par
Cambridge est atteint.

Sandrine LAUBION
Centre Exams Manager Cambridge - Lycée international Jean Mermoz - Abidjan
sandrine.laubion@mlfmonde.org STD +225 27 22 54 83 83 Poste 2333 /LD +225 27 22 54 83 74
 ENTRY FORM FOR CAMBRIDGE ENGLISH EXAMINATIONS FOR EXTERNAL CANDIDATES

Please write the date you wish to register for:

ALL candidates must

affix a photo here
Certification Date Chosen
(Write the date)
C1 ADVANCED

For the registration, please attached a copy of the ID used it is MANDATORY.

Complete the form in CAPITAL LETTERS.

Write your name as it appears on your identity card, passport, etc….
School of Origin

Family name

Given names

Date of birth

Address

Postcode

Town

Home telephone

Mobile phone

Valid E-mail address Parents:

(Capital Letters) Candidate:
Type of ID used **  Passport  National ID  Consulate registration card
 Resident Permit
ID number

* The confirmation of entry (COE) will be sent to the given email address.
** Photo mandatory + The document you register with is the document to bring on the day of the exam.

Date: ……………..………..………..………..…..

Signature of candidate: ………..………..………..………..………..………..

Signature of parent for candidate under age 18: ………..………..………..………..………..

Lycée international Jean Mermoz - Avenue Jean Mermoz Cocody - 08 BP 3545 Abidjan 08 I Côte d'ivoire - Téléphone : STD
+225 27 22 54 83 83 poste 2333 /LD : +225 27 22 54 83 74 Fax : +225 27 22 441 205 www.lijmermoz.org –
sandrine.laubion@mlfmonde.org
Candidates test day photo registration and consent form

Centre Name : Lycée international Jean-Mermoz

Centre Number : CI 007
Centre Address : Avenue Mermoz Cocody 08 BP 3545 Abidjan 08 Côte d’Ivoire
Centre contact telephone number : STD +225 27 22 54 83 83 Poste 2333 /LD +225 27 22 54 83
74

Use this form if you are 17, or under 17, years of age. You must complete all sections of this
form.

Exam details:

Tick the certification and write the appropriate date for the exam you wish to register for:

Certifications tick Date


C1 Advanced

Identification (ID): If you are taking C1 Advanced in the UK, Asia, Africa and Australasia you must
record the type of acceptable photo ID used to register for the exam and bring the same ID back
for each exam component otherwise you will not be allowed to sit the exam. Your ID must be
current (not expired) and have a photograph.

ID type that you will bring to the exam*

*If you are using your exam result to immigrate, use the
ID required by that country’s immigration authority.
ID number (e.g. if bringing your passport, what
is the passport number):
Expiry date of the ID listed above:

Your details:

First F Family
name(s): n name(s):

These names must be the same as the names on your passport/National Identity Card and must appear
in the same order
Date of
birth: Gender: Male Female
(day/month/year)

Lycée international Jean Mermoz - Avenue Jean Mermoz Cocody - 08 BP 3545 Abidjan 08 I Côte d'ivoire - Téléphone : STD
+225 27 22 54 83 83 poste 2333 /LD : +225 27 22 54 83 74 Fax : +225 27 22 441 205 www.lijmermoz.org –
sandrine.laubion@mlfmonde.org
Email
address:
(capital
letters)
Phone Mobile/cell
number: Phone
number:
City/town:
Address:
Post/zip
code:
Country:

Your certificate will be available at your centre please contact

the centre directly. In which
Why are you taking the test? For studying abroad country?

Other
For work

Do you need any special arrangements? For

example, modified materials for visual
difficulties, or administrative arrangements
because of a medical condition.

Declaration:
I am the parent/legal guardian of the candidate named on this form and I give consent to this person taking
the Cambridge English exam selected above.

I understand that all individuals who want to take a Cambridge English exam are required to agree to all
of the Terms and Conditions (a copy of which has been provided by the centre).

I agree to the candidate being admitted for the selected Cambridge English exam at the centre listed on
this form and for the date listed here. The candidate will bring a valid photo ID with them on the test day,
and I consent to them having their photo taken by the centre on the day of the Speaking test and/or the
written papers. I agree for this photo to be held on the secure Cambridge English Language Assessment
Results Verification site and viewed as set out below if I give my agreement on behalf of the candidate.

The photo shall only be available to organisations/individuals that I agree to Cambridge English Language
Assessment giving the candidate’s details to or authorise to view the candidate’s result.
By signing this form I declare that I am aware of and agree to comply with the Terms and Conditions for
this exam.

Signature Date

Parent/Guardian

Signature of candidate

Lycée international Jean Mermoz - Avenue Jean Mermoz Cocody - 08 BP 3545 Abidjan 08 I Côte d'ivoire - Téléphone : STD
+225 27 22 54 83 83 poste 2333 /LD : +225 27 22 54 83 74 Fax : +225 27 22 441 205 www.lijmermoz.org –
sandrine.laubion@mlfmonde.org
 Candidates test day photo registration and consent form

Centre Name : Lycée international Jean-Mermoz

Centre Number : CI 007
Centre Address : Avenue Mermoz Cocody 08 BP 3545 Abidjan 08 Côte d’Ivoire
Centre contact telephone number : STD +225 27 22 54 83 83 Poste 2333 /LD +225 27 22 54 83
74

Use this form if you are 18, or over 18, years of age. You must complete all sections of this form.

Exam details:

Tick the certification and write the appropriate date for the exam you wish to register for:

Certifications tick Date


C1 Advanced

Identification (ID): If you are taking C1 Advanced in the UK, Asia, Africa and Australasia you must
record the type of acceptable photo ID used to register for the exam and bring the same ID back
for each exam component otherwise you will not be allowed to sit the exam. Your ID must be
current (not expired) and have a photograph.

ID type that you will bring to the exam*

*If you are using your exam result to immigrate, use the
ID required by that country’s immigration authority.
ID number (e.g. if bringing your passport, what
Is the passport number):

Expiry date of the ID listed above:

Your details:

First F Family
name(s): n name(s):

These names must be the same as the names on your passport/National Identity Card and must appear
in the same order

Lycée international Jean Mermoz - Avenue Jean Mermoz Cocody - 08 BP 3545 Abidjan 08 I Côte d'ivoire - Téléphone : STD
+225 27 22 54 83 83 poste 2333 /LD : +225 27 22 54 83 74 Fax : +225 27 22 441 205 www.lijmermoz.org –
sandrine.laubion@mlfmonde.org
Date of
birth: Gender: Male Female
(day/month/year)

Email
address:
(capital
letters)
Phone Mobile/cell
number: Phone
number:
City/town:
Address:
Post/zip
code:
Country:

Your certificate will be available at your centre please contact the centre directly.

In which
Why are you taking the test? For studying abroad
country?

For work Other

Do you need any special arrangements? For

example, modified materials for visual
difficulties, or administrative arrangements
because of a medical condition.

Declaration:
I understand that all individuals who want to take a Cambridge English exam are required to agree to all
of the Terms and Conditions (a copy of which has been provided by the centre).

I wish to be admitted for the selected Cambridge English exam at the centre listed on this form and for the
date listed here. I will bring a valid photo ID with me on the test day, and I consent to have my photo taken
by the centre on the day of the Speaking test and/or the written papers. I agree for this photo to be held
on the secure Cambridge Assessment English Results Service site and viewed as set out below if I give
my agreement.

The photo shall on be available to organisations/individuals that I give my details to or that I authorize to
view my result.

By signing this form I declare that I am aware of and agree to comply with the Terms and Conditions for
this exam.

Signature Date

Lycée international Jean Mermoz - Avenue Jean Mermoz Cocody - 08 BP 3545 Abidjan 08 I Côte d'ivoire - Téléphone : STD
+225 27 22 54 83 83 poste 2333 /LD : +225 27 22 54 83 74 Fax : +225 27 22 441 205 www.lijmermoz.org –
sandrine.laubion@mlfmonde.org