Candidate Photo Consent Form for Cambridge ESOL Exams Use this form if you are 17, or under 17 years of age Exam date: _________________________

Which exam are you registered for?

Cambridge English: Key (KET)

Cambridge English: Preliminary (PET)

Cambridge English: First (FCE)

Cambridge English: Advanced (CAE)

Cambridge English: Proficiency (CPE)

Cambridge English: Business (BEC)

Your details: First name(s): ____________________________ Family 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 (dd/mm/yy): __________________________ Gender: Male Female Passport or national ID number: ____________________ This must be the ID you bring with you the exam day Country of birth: ___________________ Nationality: _______________________ Why are you taking the test?

For studying abroad ----------- --- In which -------------- -country? aaa

For visa purposes For which country? For work Other Declaration:

I am a parent/legal guardian of the candidate named on this form and the candidate and I give consent for the candidate to take the Cambridge English exam mentioned above at the centre CO001 and for the date listed here. I consent to have the candidate’s 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 ESOL Results Verification site, and the photo shall only be available to organisations/individuals that I give the candidate’s details to or that I authorise to view the candidate’s result via a download. I consent that these organisations/individuals can use these details to verify the candidate’s examination result.

Additionally, If the candidate is to use their exam result for a visa/immigration application I agree for the exam result to be available on the other sites shown at http://www.cambridgeenglish.org/cambridge-english-for/visas-and-immigration/ if I give my consent on behalf of the candidate

I hereby authorise the following to access my information (tick if appropriate): UKBA

By signing this form I declare that the candidate and I are aware of and agree to comply with the regulations for this examination.

Paper - Based

Computer -Based

Name Signature Date Parent / Guardian

Candidate