Application Form: Please Write in Block Capitals
Application Form: Please Write in Block Capitals
d d m m y y d d m m y y
11 Preferred date of test second choice
22 Family name 33 Title (Dr/Mr/Mrs/Miss/Ms)
44 Other name(s)
(these names must be the same as the names on your passport/National Identity Card
and must appear in the same order.)
55 Address: please note you will only be sent one copy of your results. Please ensure the correct mailing address is
given, since your results will be sent to this address.
66 Telephone/Mobile number
77 email
d d m m y y
88 Date of birth 99 Gender F M (circle as appropriate)
10 Please indicate which document you will be using as proof of identity and give the number below.
10
Candidates taking the test outside their own country must present a current passport or National Identity Card. You
must bring the ID document indicated below to the test. This is the only form of identity that will be accepted on the
test day. The document must be valid/not expired at registration and on the test day.
1
For questions 11–14 please enter codes and the name of the country and first language.
Codes can be found on pages ii–iv. Please take care and enter this information accurately.
If the codes you enter here are incorrect, the information on your Test Report Form will also be incorrect.
13 Occupation (sector)
13 if other, please specify
17 Which IELTS test are you taking? pen and paper test computerised test (CB IELTS)
(tick one box only) (please check availability with the centre you are applying to)
If you are taking CB IELTS are you taking the Writing Test on paper? (tick one box only) yes no
18 Have you taken IELTS (either Academic or General Training) before? yes no
(go to question 19) (go to question 20)
22 How many years have you been studying English? (tick one box only)
23 Do you have any special needs due to ill health/medical conditions? yes no
If yes, please specify your requirements below. You must attach supporting medical evidence to this form.
2
Institution Applications
24 Please give details below of academic institutions/government agencies/professional bodies/employers you would
like your results sent to. Add your file/case number if known. Results may be sent either electronically or by post to
these institutions. The centre may charge a postal fee for results sent internationally or by courier.
a) Name of person/department
Name of institution/agency/body/employer
File/case number
Address
b) Name of person/department
Name of institution/agency/body/employer
File/case number
Address
c) Name of person/department
Name of institution/agency/body/employer
File/case number
Address
d) Name of person/department
Name of institution/agency/body/employer
File/case number
Address
e) Name of person/department
Name of institution/agency/body/employer
File/case number
Address
3
Your rights
Information we hold on you is very broad and could include information we do not make available. If you wish to view a copy of your
personal details contained in the Application Form contact [email protected]. A charge of £10 will be made for access to this
information. You also have the right to have inaccuracies in your personal details corrected. Please contact us if you find that your
information is inaccurate. Documentation must be provided to verify the correct details.
Declaration
• I certify that the information on this form is complete, true and accurate. I understand that if any other person attempts to take
the IELTS examination in my place (i.e. in place of the person whose details appear on this form), both I and such person will be
liable to prosecution.
• I understand that I will be charged the full test fee if I postpone or cancel my test within 5 weeks of the test date, unless I provide
appropriate medical evidence to support the postponement or cancellation. Only evidence of serious illness will be considered.
I understand that medical evidence must be provided within 5 days of the test date.
• I understand that if I attempt to cheat, copy the work of another candidate, disrupt the test, remove or copy or attempt to remove
or copy any test materials from the examination room or do anything that might damage the integrity and security of IELTS, I will
not receive a result for the test, my test fee will not be refunded and I may be prohibited from taking IELTS tests in future.
• I acknowledge receipt of the document entitled ‘IELTS Information for candidates’.
• I acknowledge receipt of the Notice to IELTS Candidates document, contained on page i of this document and undertake to abide
by the regulations contained within.
• I agree an observer may attend my Speaking Test as part of the monitoring process.
• I agree that a photograph may be taken of me on the test day to confirm identity.
• I acknowledge that the IELTS examination is administered by British Council, IDP:IELTS Australia, and Cambridge ESOL collectively
referred to as the test partners, and I understand and agree that the details on this form are collected for the purposes of the IELTS
test and that these details may be disclosed to, processed and stored by the test partners for the purpose of such administration
and that these details and my examination results may be disclosed by the test partners to those academic institutions or other
entities to whom I submit my enrolment application, for the purpose of allowing such institutions or entities to verify the results of
the test or to carry out an investigation in relation to suspected fraud. If the test partners discover that a false or altered Test Report
Form has been provided to any of these institutions or entities the test partners may inform the same and provide them with my
personal details.
• I understand that my results may not be issued within 13 days of the test day if any of the test partners deem it necessary to
review any matter associated with my test. I understand that in exceptional circumstances I may be required to re-take one or more
IELTS modules.
• I understand that my personal data may be processed in an anonymous form for statistical and research purposes for the
development of Cambridge ESOL examinations. Cambridge ESOL and the centre administering the test confirm that they will not
disclose personal information about candidates to others except as stated in this Declaration or to the extent permitted by law.
• I understand that the work I produce as part of the IELTS test remains the property of the test partners and under no
circumstances will be released to candidates or institutions/organisations.
• I understand that if the details on this form are not completed my application may not be processed.
Disclaimer: The International English Language Testing System (IELTS) is designed to be but one of many factors used by academic
institutions, government agencies, professional bodies and employers in determining whether a test taker has sufficient English skills
to successfully be admitted as a student or be considered for employment. IELTS is specifically designed not to be the sole method of
determining admission or employment for the test taker. IELTS is made available worldwide to all persons, regardless of age, gender,
race, nationality or religion but it is not recommended to persons under 16 years of age.
British Council, IDP:IELTS Australia and Cambridge ESOL and any other party involved in creating, producing, or delivering IELTS shall
not be liable for any direct, incidental, consequential, indirect, special, punitive, or similar damages arising out of access to, use of,
acceptance by, or interpretation of the results by any third party, or any errors or omissions in the content thereof.
d d m m y y
Signature Date
Disqualification warning
If you are caught infringing any of the candidate rules and regulations your test result will
be disqualified and notification sent to any receiving institution or professional body.
Advice and information • Read carefully and follow the instructions printed on the
question paper and on the answer sheet.
Make sure you attend on time • Fill in the details required on the front of your question
• Know the date, time and place of your examination and paper and on your answer sheet before the start of the
arrive before the scheduled starting time. examination.
• If you arrive late for any of the papers, report to the
supervisor or invigilator. You may not be allowed to take Advice and assistance during the examination
the examination. • If you are in doubt about what you should do, raise your
hand to attract attention. An invigilator will come to your
Provide what you need assistance.
• Take into the examination room only the pens, pencils and • You may not ask for, and will not be given, any explanation
erasers which you need for the examination. of the questions.
• Correction fluid and highlighters must not be used. • If on the day of the examination you feel that your work may
• Leave anything which you do not need, or which is not be affected by ill health or any other reason, you must inform
allowed, outside the examination room. the invigilator at the time.
• You may not lend anything to, or borrow anything from,
Leaving the examination room
another candidate during the examination.
• You may not leave the examination room without the
• Do not bring valuables as the test centre cannot be permission of the supervisor or invigilator.
responsible for these.
• You can not leave your seat until all papers have been
Examination instructions collected and you have been told you can leave.
• Listen to the supervisor and do what you are asked to do. • When you leave the examination room you must leave behind
• Tell the supervisor or invigilator at once any paper used for rough work clearly crossed through and
– if you think you have not been given the right any other materials provided for the examination.
question paper. • Do not make any noise near the examination room.
– if the question paper is incomplete or illegible.
i
Important: please read this section (i-iv) and retain for your own records.
Codes to enter for questions 11–14
Refer to the lists below for the codes to enter for your country or region of origin, your first language and
your occupation.
If either your first language or your country or region of origin is not listed, enter '000'. Look for the closest
description of your occupation and proposed area of study. If your work or position is not covered at all,
then enter '00'.
ii
Question 12 – First Language
Taiwan 192 Afrikaans 001 Marshallese 077
Tajikistan 233 Akan 002 Masai 078
Tanzania 193 Albanian 003 Mende 079
Thailand 194 Amharic 004 Mongolian 080
Timor-Leste 222 Arabic 005 Nepali 081
Togo 195 Armenian 006 Norwegian 082
Tokelau 196 Assamese 007 Oriya 083
Tonga 197 Aymara 008 Palauan 084
Trinidad and Tobago 198 Azeri 009 Punjabi 085
Tunisia 199 Baluchi 010 Pashto 086
Turkey 200 Bambara 011 Polish 087
Turkmenistan 234 Basque 012 Ponapean 088
Turks and Caicos Islands 201 Bemba 013 Portuguese 089
Tuvalu 202 Bengali 014 Pushtu 090
Uganda 203 Bihari 015 Quechua 091
Ukraine 204 Bosnian 901 Rajasthani 092
United Arab Emirates 205 Breton 016 Riff 093
United Kingdom 206 Bulgarian 017 Romanian 094
Uruguay 207 Burmese 018 Romansch 095
US Virgin Islands 208 Byelorussian 019 Russian 096
United States of America 209 Catalan 020 Samoan 097
Uzbekistan (Republic of) 210 Chinese 021 Serbian 098
Vanuatu 211 Creole 022 Setswana 099
Venezuela 213 Croatian 023 Shona 100
Vietnam 214 Czech 024 Sindhi 101
Wallis and Futuna Islands 215 Danish 025 Singhalese 102
Western Sahara 216 Dari 026 Slovak 103
Western Samoa 217 Dzongkha 027 Slovene 104
Yemen (Republic of) 218 Dutch 028 Somali 105
Zaire 219 Efik 029 Spanish 106
Zambia 220 English 030 Swahili 107
Zimbabwe 221 Estonian 031 Swazi 108
Other 000 Ewe 032 Swedish 109
Faeroese 033 Tagalog 110
Farsi 034 Tahitian 111
Fijian 035 Tamil 112
Finnish 036 Tatar 113
Flemish 037 Telugu 114
French 038 Tetum 136
Fulani 039 Thai 115
Ga 040 Tibetan 116
Georgian 041 Tigrinya 117
German 042 Tongan 118
Gilbertese 043 Trukese 119
Greek 044 Tulu 120
Gujarati 045 Tupi/Guarani 121
Haitian Creole 046 Turkish 122
Hausa 047 Uighur 123
Hebrew 048 Ukrainian 124
Hindi 049 Ulithian 125
Hungarian 050 Urdu 126
Ibo/lgbo 051 Uzbek 127
Icelandic 052 Vietnamese 128
Igala 053 Wolof 129
Indonesian 054 Xhosa 130
Italian 055 Yao 131
Japanese 056 Yapese 132
Javanese 057 Yiddish 133
Kannada 058 Yoruba 134
Kashmiri 059 Zulu 135
Kazakh 060 Other 000
Khmer 061
Korean 062
Kurdish 063
Lao 064
Latvian 065
Lithuanian 066
Luba 067
Luo 068
Luxemburgish 069
Malagasy 070
Malay 071
Malayalam 072
Malinka 073
Maltese 074
Maori 075
Marathi 076
iii
Question 13 – Occupation
Example
If you are a student enter 08 because the Sector is
Education and 7 because the Level is Student.
0 8 7
Sector
Administrative services 01
Agriculture, Fishing, Forestry, Mining 02
Arts and Entertainment 03
Banking and Finance 04
Catering and Leisure 05
Construction Industries 06
Craft and Design 07
Education 08
Health and Social Services 09
Installation, Maintenance and Repair Services 10
Law and Legal Services 11
Manufacturing and Assembly Industries 12
Personal Services 13
Retail Trade 14
Technical and Scientific 15
Telecommunications and the Media 16
Transport 17
Utilities (gas, water etc) 18
Wholesale Trade 19
Other 00
Level
Self-employed 1
Employer/Partner 2
Employee (Senior level) 3
Employee (Middle or Junior level) 4
Worker in the home 5
Retired 6
Student 7
Other 0
iv
Important: please read this section (i-iv) and retain for your own records.