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Application form
Please return to:Home University:〒169-0075
東京都新宿区高田馬場1-4-15
三井生命高田馬場ビル5F
一般財団法人日本スタディ・アブロード・ファンデーション
IELTS公式テストセンター(JP112)

Student ID:
Code:

PLEASE WRITE IN BLOCK CAPITALS
1 Preferred date of testdd m m ysecond choiceydd m m yy

2 Test city location
3 Last name (family name/surname)
4 Title (Dr/Mr/Mrs/Miss/Ms)
5 First (given) name(s)16		These names must be the same as the names on your passport/National Identity Cardand must appear in the same order.

		 6 Which IELTS test module are you taking? (tick one box only)
Academic
General Training		
Please note that it is the candidate’s responsibility to select the test module that best meets their needs.
The General Training module is not available on every test date.

7 Address: Please note you will only be sent one copy of your results.

Zip/Postal code		
8 Telephone		
Mobile number		
9 Email		
Please provide full and accurate contact information including postal address, phone and mobile number and email which are in constant and valid use.
The test centre or the test partner may contact candidates before or after the test to access the full test registration and administration.

10 Date of birthdd m m yy11 Gender  F  M  

(circle as appropriate)

12 Please indicate which document you will be using as proof of identity and give the number below.
Candidates taking the test outside their own country must use a current passport.
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.

Passport

National Identity Card

Passport or National Identity Card number

For office use only		
scheme		date of payment		test dated

ID checked				 AC

d m m yydd m m yyreceipt number
Administrator’s initials­

GT

Please turn over1For questions 13–16 please enter codes and the name of the country of nationality and first language.
You can find codes 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 Country of nationality (code)
11

12 		

		 Country of nationality (name)		
14 First language (code)				 First language (name)15 Occupation (sector)
13		

if other, please specify

		 Occupation (level)

if other, please specify		
16 Why are you taking the test?
		

if other, please specify

17 Which country are you applying to/intending to go to? (tick one box only)
15		
Australia        Canada        New Zealand        Republic of Ireland        United Kingdom		United States of America        other, please specify

18 Where are you currently studying English (if applicable)?
		

19 What level of education have you completed? (tick one box only)
21		    secondary up to 16 years      secondary 16–19 years       degree or equivalent      postgraduate

20 How many years have you been studying English? (tick one box only)22		

1 (or less than)      2      3      4      5      6      7      8      9 (or more)

23
21 Do you have a permanent disability, such as a visual, hearing or specific learning difficulty, which requires special
arrangements (for example, modified material, extra time, use of technology, etc.)?
		
yes
no
		
		 If yes, please specify your requirements below. You must attach original supporting medical evidence to this form.
The medical evidence must be in the form of a report prepared in a period no more than two years before the test
date. You must submit requests for modified test materials at least three months before the test.

2

Notice to Candidates
IELTS test terms and conditions
You must …
• provide proof of your identity (passport or National Identity Card) at
registration. Contact the test centre to confirm which type of identity
document is accepted. Candidates taking the test outside their own country
must use a passport.
• inform the centre of any changes to your identity document before the test
date. If you do not do this you will not be allowed to take the test and you will
not be eligible for a refund or transfer.
• bring the same identity document on the test day as the one recorded inyour application. If you do not do this you will not be allowed to take the test
and you will not be eligible for a refund or transfer.
• arrive at the centre before the scheduled test start time. If you arrive late, youwill not be allowed to take the test and you will not be eligible for a refund ortransfer.
• leave all personal belongings in the designated belongings area. The only
items you may bring into the test room are your approved identity document,
standard pen(s), pencil(s) and eraser(s), and a bottle of water (label-free).
All electronic devices and all watches must be left in the belongings areaand must be switched off. You may be electronically scanned for devices at
any time during the test day. Any candidate who breaches these conditions
will not receive an IELTS test result or be eligible for a refund or transfer.
While the centre will take all reasonable measures to secure your items in thebelongings area, they cannot be held responsible for any loss.
• consent for your identity to be verified both at test registration and on testday. This may include:– having your photograph taken. You will be required to temporarily remove
any covering from your face. Any candidate who refuses to have aphotograph taken will not be allowed to sit the test and will not be entitledto a refund. The photograph taken by the centre will appear on your Test
Report Form.
– providing a sample of your signature.
– having your finger scan taken.
• keep only the following items on your desk: your identity document, pen(s),pencil(s), eraser(s), and a bottle of water (label-free).

Candidates engaging in malpractice will not be allowed to complete the test
and will not receive an IELTS test result. Candidates who are found to haveengaged in malpractice on test day after their result has been issued will havetheir result cancelled. Candidates engaging in malpractice may be reported toregulatory authorities globally and may be liable to legal action.

Your IELTS test result• Results are issued by centres, usually 13 days after the test.
• You will receive only one copy of your Test Report Form. Replacement
copies are not issued in the event of loss or damage.
• The Test Report Form will be issued in your name as it appears on the identity
document used at registration. If you find that your personal details areincorrect on the Test Report Form, please contact the centre where you took
the test. Documentation must be provided to verify the correct details. If youchange your name after receiving your Test Report Form, the name will not bechanged on the Test Report Form.
• Your result may not be issued 13 days after the test if the IELTS Test
Partners decide that it is necessary to review any matter associated withyour test or the administration of your test. To assist any investigation, you
may be required to provide writing and speaking samples. In exceptional
circumstances you may be required to re-take one or more IELTS
components.
• Your result may be cancelled after it has been issued if any irregularity isidentified. You may be required to re-take one or more IELTS components.
• Your result will be disclosed to the Recognising Organisations which you
nominated in your application or to which you applied with your Test ReportForm, for the purpose of allowing those organisations to verify the result or tocarry out any enquiries in relation to suspected malpractice.
• If any of the data on the Test Report Form provided by you or your agent to
Recognising Organisations has been altered in any way, your original test
result may be cancelled.
• Candidates are not permitted access to the work they produce in the
IELTS test.

• tell the invigilator at once if you think you have not been given the correctquestion paper or if the question paper is incomplete or illegible.

Cancelling your IELTS test o­ r requesting a transfer• raise your hand if you need to ask the invigilator something. Candidates may
not ask for, and will not be given, any explanation of the test questions.

• If you cancel your test or request a transfer five weeks or more before thetest date, the test centre will charge an administration fee of up to 25% of
the test fee.

• attend all four components of the test. If you do not attend all four components,
you will not receive an IELTS test result. Exceptions are possible but must
be requested at registration and written approval must be received fromthe centre.
• inform the invigilator on the day of the test if you believe that yourperformance may be affected by ill health, by the way in which the test
is delivered at the centre or for any other reason. If you have a complaint
relating to the delivery of the test, you must submit your complaint to the test
centre before you leave the centre on test day. Complaints relating to thedelivery of the test will not be accepted after test day.
• leave all test materials in the test room at the end of the test. The test materials
include question papers, Speaking booklets, answer sheets and roughpaper. Any candidate who attempts to remove test materials from the test
room will not receive an IELTS test result.

You must not …
• talk to or disturb other candidates once the test has started.
• lend anything to, or borrow anything from, another candidate during the test.
• eat or smoke in the test room.
• leave the test room without the permission of the invigilator.
• leave your seat until all test materials have been collected and you havebeen told you can leave.
• engage in any form of malpractice which may damage the integrity andsecurity of the IELTS test. Malpractice includes, but is not limited to:– attempting to cheat in any way, including using notes of any kind fromany source.
– helping another candidate to cheat.
– impersonating another candidate or having another candidate
impersonate you.
– copying the work of another candidate.
– disrupting the test in any way.
– reproducing any part of the test in any medium.
– attempting to alter the data on the Test Report Form.

• If you cancel your test within five weeks of the test date for any reason apartfrom medical ones, you will not be eligible to receive a refund. If you cancel
your test or request a transfer within five weeks of the test date for medical
reasons, you must provide supporting medical evidence within five working
days of the test date. Only evidence of serious illness will be considered.
Only original medical certificates will be accepted and must state inability toappear for the test on the scheduled test date.

How IELTS uses your information• The IELTS Test Partners recognise and support the right of IELTS test
candidates to privacy.
• When you provide your identity information the IELTS Test Partners link that
information to your IELTS test and test result on the Test Report Form. This
enables you to submit your Test Report Form to Recognising Organisations
and for them to verify your result.
• Test Report Forms will only be sent to those Recognising Organisations
nominated by the candidate in their application or at the request of thecandidate after the issue of results. When a candidate submits a Test Report
Form to a Recognising Organisation they consent to the verification of theresult by that organisation.
• The IELTS Test Partners or their authorised representatives may sharecandidate personal data including without limitation test performance orscore data or photographs taken by the centre with educational institutions,
governments (including visa processing authorities), professional bodies
and commercial organisations that recognise IELTS scores (‘Recognising
Organisations’) or law enforcement agencies and regulatory authorities
where required for verification purposes or other purposes to protect the
IELTS test and its stakeholders against any form of malpractice. Finger-scandata, where obtained, will not be disclosed to any entity except the IELTS
Test Partners.
• The IELTS Test Partners will retain work produced by candidates in the
IELTS test and may use it for quality control purposes and for investigations
into suspected malpractice. Test score data and test responses, in ananonymous form, may also be used for informational, research, statisticalor training purposes.

*Important: Please detach this section (pages i–iv) and retain for your own records.

iCodes to enter for questions 13–16
Refer to the lists below for the codes to enter for your country of nationality, your first language andyour occupation.
If either your first language or your country of nationality 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’.
Question 13 – Country of nationality
AfghanistanÅland Islands
Albania
Algeria
American Samoa
AndorraAngolaAnguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
BahamasBahrain
Bangladesh
Barbados
BelarusBelgium
BelizeBenin
BermudaBhutanBolivia, Plurinational State of
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
BrazilBritish Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
BurundiCambodia
Cameroon
CanadaCape Verde
Cayman Islands
Central African Republic
Chad
Chile
China (People’s Republic of)Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, Democratic
Republic of the
Cook Islands
Costa Rica
Côte d’Ivoire
Croatia
Cuba
Curaçao
CyprusCzech Republic
DenmarkDjibouti
Dominica
Dominican Republic
Ecuador
Egypt

ii

001
237
002
003
004
005
006
238
239
007
008
009
223
010
011
012
013
014
015
016
017
018
019
020
021
022
023
240
024
025
241
026
242
027
028
029
031
032
033
034
036
038
039
040
041
042
243
244
043
044
045
219
046
047
096
048
049
245
050
051
052
053
054
055
056
057

El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
FinlandFranceFrench Guiana
French Polynesia
French Southern Territories
Gabon
GambiaGeorgia
Germany
Ghana
Gibraltar
GreeceGreenland
GrenadaGuadeloupe
Guam
GuatemalaGuineaGuinea-Bissau
GuyanaHaiti
Heard Island and
McDonald Islands
Holy See (Vatican City State)
HondurasHong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
IrelandIsraelItaly
JamaicaJapan
JordanKazakhstan
Kenya
Kiribati
Korea, Democratic People’s
Republic ofKorea, Republic of
KosovoKuwaitKyrgyzstan
Lao People’s Democratic
Republic
LatviaLebanonLesothoLiberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao

058
059
060
061
062
224
063
064
065
066
067
068
246
069
070
071
072
073
074
075
076
077
078
079
080
081
082
083
084
247
212
085
086
087
088
089
090
091
092
093
094
095
097
098
099
100
101
102
103
104
235
105
226
106
107
108
109
110
111
112
113
114
115

Macedonia, the Former Yugoslav
Republic ofMadagascar
MalawiMalaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
MayotteMexicoMicronesia, Federal States ofMoldova, Republic of
MonacoMongolia
Montenegro
Montserrat
MoroccoMozambique
MyanmarNamibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
NorwayOman
Pakistan
Palau
Palestine
PanamaPapua New Guinea
Paraguay
Peru
Philippines
Pitcairn
PolandPortugal
Puerto Rico
Qatar
RéunionRomania
Russian Federation
RwandaSaint BarthélemySaint Helena, Ascension andTristan Da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French Part)Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal

225
116
117
118
119
120
121
122
123
124
125
227
126
228
128
129
130
131
132
133
134
135
136
137
138
139
141
142
143
144
145
146
229
230
147
148
149
231
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
248
180
181
182
249
183
184
217
165
166
167
168

Question 14 – First Language
SerbiaSeychelles
Sierra Leone
Singapore
Sint Maarten (Dutch Part)
Slovakia
Slovenia
Solomon Islands
SomaliaSouth Africa
South Georgia and theSouth Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
SwedenSwitzerland
Syrian Arab Republic
TaiwanTajikistan
Tanzania, United Republic ofThailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
TurkeyTurkmenistan
Turks and Caicos Islands
TuvaluUgandaUkraineUnited Arab Emirates
United Kingdom
United States of America
United States Minor
Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Western Sahara
Yemen
ZambiaZimbabwe
Other

169
170
171
172
250
173
174
175
176
177
251
252
178
179
185
186
232
187
188
189
190
192
233
193
194
222
195
196
197
198
199
200
234
201
202
203
204
205
206
209
253
207
210
211
213
214
236
208
216
218
220
221
000

Afrikaans
Akan
Albanian
Amharic
ArabicArmenian
Assamese
AymaraAzeri
BaluchiBambaraBasqueBemba
Bengali
Bihari
Bosnian
BretonBulgarianBurmese
Byelorussian
CatalanChineseCreoleCroatian
Czech
DanishDari
Dutch
Dzongkha
Efik
EnglishEstonian
Ewe
Faeroese
Farsi
FijianFilipino
FinnishFlemishFrenchFulaniGa
GalicianGeorgianGermanGilbertese
Greek
Gujarati
Haitian Creole
Hausa
Hebrew
Hindi
Hungarian
Ibo/lgbo
Icelandic
Igala
Indonesian
Irish
ItalianJapanese
Javanese
KannadaKashmiri
KazakhKhmer
KoreanKurdishLao
LatvianLithuanian
Luba
Luo
Luxemburgish
Macedonian
Malagasy
Malay
MalayalamMalinka

001
002
003
004
005
006
007
008
009
010
011
012
013
014
015
901
016
017
018
019
020
021
022
023
024
025
026
028
027
029
030
031
032
033
034
035
904
036
037
038
039
040
903
041
042
043
044
045
046
047
048
049
050
051
052
053
054
137
055
056
057
058
059
060
061
062
063
064
065
066
067
068
069
902
070
071
072
073

MalteseMaori
MarathiMarshallese
Masai
Mende
Mongolian
Nepali
Norwegian
Oriya
Palauan
PashtoPolishPonapean
Portuguese
Punjabi
PushtuQuechuaRajasthani
Riff
RomanianRomanschRussianSamoanScottish Gaelic
Serbian
Setswana
Shona
SindhiSinghalese
SlovakSloveneSomali
SpanishSwahili
Swazi
SwedishTagalog
Tahitian
Tamil
Tatar
TeluguTetum
Thai
Tibetan
TigrinyaTonganTrukese
Tulu
Tupi/Guarani
TurkishUighur
UkrainianUlithian
Urdu
Uzbek
Vietnamese
Welsh
Wolof
Xhosa
Yao
YapeseYiddishYoruba
Zulu
Other

074
075
076
077
078
079
080
081
082
083
084
086
087
088
089
085
090
091
092
093
094
095
096
097
138
098
099
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
136
115
116
117
118
119
120
121
122
123
124
125
126
127
128
139
129
130
131
132
133
134
135
000

Please turn overiii

Question 15 – Occupation
ExampleIf you are a student, enter 08 because the sector
is Education and 7 because the level is Student.
087SectorAdministrative Services
Agriculture, Fishing, Forestry, Mining
Arts and Entertainment
Banking and Finance
Catering and LeisureConstruction Industries
Craft and Design
Education
Health and Social Services
Installation, Maintenance and Repair Services
Law and Legal Services
Manufacturing and Assembly Industries
Personal Services
Retail Trade
Technical and Scientific
Telecommunications and the Media
Transport
Utilities (gas, water etc.)
Wholesale Trade
Other

01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
00

Level
Self-employed
Employer/Partner
Employee (Senior level)
Employee (Middle or Junior level)
Worker in the home
RetiredStudent
Other

1
2
3
4
5
6
7
0

Checklist
I have signed the Application Form.
		 I have provided all the information required.
		 I have paid the test fee.
(Please note that your application will not beprocessed ­without this.)		I have attached a photocopy of my passport /National Identity Card (pages showing
personal identification details and expiry date).

Question 16 – Why you are taking the test
For higher education extended course(three months or more)
For higher education short course(three months or less)
For other education purposes
For registration as a doctor
For immigration
For employment
For professional registration (NOT medical)
For personal reasons
For registration as a nurse (including CGFNS)For registration as a dentist
Other

iv

1
2
3
4
5
6
7
8
9
10
0

* Important: Please detach this section (pages i–iv) and retain for your own records.

Applications to Recognising Organisations
22 Please give details below of academic institutions/government agencies/professional bodies/employers you would
24
like your result sent to. Add your file/case number if known. Results may be sent either electronically or by post tothese organisations. Please complete all details below for the centre to correctly identify Recognising Organisations.
The centre may charge a postal fee for results sent i­nternationally or by courier. The Test Report Form will not besent to migration or education agents. Please note that organisations you have listed below may access your results
before you have received or viewed them.
a)		 Name of person/department
		 Name of institution/agency/body/employer
		 File/case number
		Addressb)		 Name of person/department
		 Name of institution/agency/body/employer
		 File/case number
		Addressc)		 Name of person/department
		 Name of institution/agency/body/employer
		 File/case number
		Addressd)		 Name of person/department
		 Name of institution/agency/body/employer
		 File/case number
		Addresse)		 Name of person/department
		 Name of institution/agency/body/employer
		 File/case number
		Address

Please turn over3

Declaration
1. 		I acknowledge that the IELTS test is jointly owned by British Council, IELTS Australia Pty Ltd (ABN 84 008 664 766), which is wholly owned by IDP
Education Ltd (‘IDP:IELTS Australia’) and Cambridge English Language Assessment (part of the University of Cambridge), collectively referred to as
the IELTS Test Partners.
2. 		I certify that the information in my application is complete, true and accurate.
3. 			I understand that the personal data in my application is collected for the purposes of the IELTS test, and I consent for this data to be disclosed to,processed and stored by the IELTS Test Partners for the purpose of such administration. I further consent for this data, including, without limitation,
test performance or score data and my test result to be disclosed by the IELTS Test Partners to those Recognising Organisations to which I apply andto governments (including visa processing authorities) for the purpose of allowing these organisations to verify my test result or to carry out enquiries
in relation to suspected malpractice. If the IELTS Test Partners discover that a false or altered Test Report Form has been provided to any of these
Recognising Organisations or government authorities I further consent that the IELTS Test Partners may inform the same and provide them with mypersonal data and any relevant details relating to the work I produce as part of my test taking, including, without limitation, test performance or score data.
4. 		I understand that my personal data may be processed in an anonymous form by the IELTS Test Partners for statistical and research purposes. The
IELTS Test Partners 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.
5. 		I understand that I may view a copy of my personal data contained in the Application Form by contacting ielts@cambridgeenglish.org. I understandthat a fee will be charged for access to this information.
6. 		I understand that if I want a copy of my finger scan it can only be provided as a Binary Large Object (BLOB) and the request must be made toielts@idp.com or ielts@britishcouncil.org. I understand a fee will be charged for access to this information.
7. 		I understand that if the details on this form are not completed my application may not be processed. I further understand that completing andsubmitting this Application Form does not guarantee registration on my preferred test date or at my preferred test location. I understand that myregistration will be confirmed in writing from the centre.
8. 		I understand that any personal data collected during the identity verification process by the centre either at test registration or on test day will beprocessed and securely stored by the IELTS Test Partners for the purpose of the IELTS test. I acknowledge that the photograph taken of me by thecentre will be provided to any Recognising Organisations or government authorities (including visa processing authorities) to which I apply for the
purposes of allowing these organisations to verify my test results or to carry out enquiries in relation to possible malpractice or test integrity issues.
I understand that where finger-scan data is obtained it will not be disclosed to any entity except the IELTS Test Partners.
9. 		I understand that I will have my photograph taken by the centre to allow the Test Report Form to be released. If I have not had my photograph takenby the centre no result will be issued.
10. 		I acknowledge that I have read the IELTS Notice to Candidates on page i and agree to abide by the rules and regulations contained therein.
11. 		I understand there may be local terms and conditions I must comply with and that the centre will provide details of these on request.
12. 		I understand that I must attend all four test components in order to receive an IELTS test result and that any exception to this must be approved inadvance by the centre.
13. 		I understand that the IELTS Test Partners have a responsibility to all candidates and Recognising Organisations to ensure the highest confidence
in the accuracy and integrity of test results and that the IELTS Test Partners therefore reserve the right to withhold test results temporarily or
permanently, or to cancel test results which have been issued, if they consider those results to be unreliable for reasons of suspected malpracticeor any other irregularity in the test process.
14. 		I understand that my result may not be issued 13 days after the test if any of the IELTS Test Partners deem it necessary to review any matter associatedwith my test or the administration of my test, including making enquiries as to whether any rules or regulations have been breached. I understand that I
may be required to provide additional samples of my writing and speaking for the purposes of assisting any investigation before or after the test.
I understand that in exceptional circumstances I may be required to re-take one or more IELTS components.
15. 		I understand that if I am suspected of engaging in any form of malpractice, or do anything that might damage the integrity and security of IELTS, I
may not receive a test result, my test fee will not be refunded and I may be prohibited from taking the IELTS test in the future. Despite and without
limiting any of the terms of this Declaration, I understand that details of any malpractice (including evidence of suspected malpractice) that has been
established, is suspected, or is being formally investigated may be provided to Recognising Organisations, including visa processing authorities andappropriate regulatory authorities, or otherwise disclosed in accordance with the law, where required for verification purposes or other purposes toprotect the IELTS test and its stakeholders against any form of malpractice. I further understand that suspected malpractice will be reported centrally
to the IELTS Test Partners and to any relevant test centre by the centre where the suspected malpractice occurred.
16. 		I understand that if any other person attempts to take the IELTS test in my place, both I and such person will be liable to prosecution. Details relating to
the situation will be provided to the relevant authorities, including visa processing authorities and appropriate regulatory authorities.
17. 		I understand that the work I produce in the IELTS test remains the property of the IELTS Test Partners. It will not be released to candidates or to
institutions or organisations, except in the investigation of suspected malpractice whereby my work may be provided to relevant authorities.
18. 		I understand that my Speaking test will be recorded. I understand that in the event the test does not record I will be required to re-take the Speaking
test. I also agree that an observer may attend my Speaking test as part of the monitoring process.
19. 		I understand that I will be charged the full test fee if I cancel my test or request a transfer within five weeks of the test date, unless I provide
appropriate medical evidence, within five days of the test date, to support the cancellation or transfer.
20. 		I acknowledge that I have read the IELTS Information for Candidates booklet.
Disclaimer: The International English Language Testing System (IELTS) is designed to be one of many factors used by academic institutions, government
agencies, professional bodies and employers in determining whether a test taker can be admitted as a student or be considered for employment or for
citizenship purposes. IELTS is not designed 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.

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© UCLES 2016 | CE/4949/6Y01*6514681328*

British Council, IDP: IELTS Australia and Cambridge English Language Assessment 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.