Application Form Nationals

The Government of the Republic of Trinidad and Tobago
MINISTRY OF EDUCATION
#5 St. Vincent Street, Port of Spain, Trinidad and Tobago
Caribbean Examinations Council (CXC)

CARIBBEAN SECONDARY EDUCATION CERTIFICATE (CSEC)
PRIVATE CANDIDATES JANUARY 2018 NATIONAL
Before completing this form, please read the accompanying instructions carefully. This registration form should be completed in
BLOCK LETTERS and taken to the selected registration venue (see schedule in instruction sheet) from 14th to 24th August 2017.
Incomplete registration forms will not be accepted.
SECTION A GENERAL INFORMATION

For NEW Candidates, the name written on the entry form must be the same as indicated on the Birth Certificate. ALL other
Candidates must supply the name(s) that appeared on past CSEC certificates or preliminary result slips.
See Instructions, Section A
First Name:
Place Photograph Here
Other Name:
Surname:
Please PRINT name at the
back of a recent photograph
Sex: Male Female / / of yourself and staple in the
Date of Birth (DD/MM/YYYY) space provided.
Birth Certificate PIN Number:
Birth Certificate PIN Number
Mailing Address:
Street Name
Town/City
Telephone Numbers: - -
Home Mobile
Email Address:
Please provide one (1) form of valid photo identification (i.e. Identification that has not expired)
This ID should be the same provided during the examination.
Identification Card Number:
Drivers Permit Number:
Passport Number:
SECTION B PREFERRED CENTRE LOCATION

See Instructions, Section B
Preferred Centre Location:
SECTION C LISTING OF SUBJECTS
Please list below, the name(s) of the subject(s) which you intend to sit, and indicate by a tick ( ) under the Repeat, Resit, Alternate
and Self-Tutored columns as appropriate.
See Instructions, Section C
NB: If the Resit and Alternate boxes for a subject are left blank, you will automatically be registered as Alternate.
No
Subjects Repeat Resit Alternate Self-Tutored
.
1
2
3
4
5
NB:- If any Resit box is ticked: Enter your May/June 2017 CSEC Registration Number here:
SECTION D FEES
PREVIOUSLY REGISTERED AMOUNT
PRIVATE CANDIDATES FROM FEE NUMBER OF SUBJECTS TOTAL
$
JANUARY 2010 Candidate 130.00
YES NO Administrative 8.00
If YES: Subject 135.00 x =
YEAR JANUARYJUNE Spanish Orals 3.00 x =
2010 Sub-Total
2011 Late Entry 162.00
2012
2013
2014
Total
2015
2016
2017
SECTION E DECLARATION
DECLARATION OF CANDIDATE
I, ...................................................................................................................................................................................................................
(Complete in BLOCK LETTERS) First Name Surname
declare that I make this entry in accordance with the issued instructions which I have read and understood and that I have given all
the information required truthfully and accurately to the best of my knowledge. I understand that I shall be allowed to sit only the
subject(s) indicated on this form. I further understand that my application will not be considered if incorrect information is supplied.
Candidates MUST check ONLINE for the accuracy of their registration during the period 23 rd to 27th October 2017, using the website
ors.cxc.org/studentportal. You will be required to enter your Birth Certificate PIN Number, Surname, Date of Birth and Select 2018
JANUARY CSEC.
Any inaccuracies must be reported by 31 st October 2017 to the Supervisor of Examinations, Ministry of Education, #5 St. Vincent
Street, Port of Spain.
..................................................................................................... .............. .............. ..............
Signature of Candidate Date: yyyy mm dd
FOR OFFICIAL USE ONLY
.......................... ............... ............... ...............

Receipt Number yyyy mm dd
Checked by: ................................................................

Signature & Name in BLOCK LETTERS Ministry of Educations Stamp
LIST OF TTPOST OUTLETS WHERE COURIER STICKERS CAN BE PURCHASED
DO NOT WRITE YOUR NAME OR SIGN ON THE STICKER
DO NOT PEEL OFF ANY STICKER AND AFFIX TO ENVELOPES
AREA ADDRESS
North West Port of Spain Business Centre, #22-24 St. Vincent Street, Port of Spain
#22 Abercromby Street, Port of Spain
#61-63 Western Main Road, St. James
#29 St. Anns Main Road, St. Anns
Belmont Circular Road, Belmont
#546 Western Main Road, Carenage
North East National Mail Centre, #240-250 Golden Grove Road, Piarco
Eastern Main Road, Tunapuna
#5 Eastern Main Road, San Juan
TTPOST Arima,
17 Prince Street, Arima
Central #9 St. Yves Street, Chaguanas
Corner Bryce & La Croix Street, Couva
South CLICO Building, #1 Oropuche Road, Siparia
#2 Lucky Street, La Romain
#5 Seecharan Street, New Grant
Tobago Teal Building, Milford Road, Scarborough
Milford Court, Milford Road, Bon Accord
Envelope 1 Envelope 2
$2.00 $2.00
Stamp Stamp
Name: .................................. Name: ..................................
Address: ............................... Address: ...............................
.............................................. ..............................................
.............................................. ..............................................
Envelope 3 Envelope 4 (if doing Spanish)

$2.00
Stamp
Name: .................................. Name: ..................................
Address: ............................... Address: ...............................
.............................................. ..............................................
.............................................. ..............................................
Contact Number: .................
PLEASE NOTE: No stamp is placed on Envelope 3, which is to be used for the mailing of the certificate by
registered mail.
At registration, the Officer will affix the appropriate sticker to both copies of application forms
and the envelope for the certificate.

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The Government of the Republic of Trinidad and Tobago

Caribbean Examinations Council (CXC)

SECTION A GENERAL INFORMATION

Identification Card Number:

Drivers Permit Number:

SECTION B PREFERRED CENTRE LOCATION

.......................... ............... ............... ...............

Checked by: ................................................................

Envelope 3 Envelope 4 (if doing Spanish)

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