The London Exam Centre
Tuition House
27-37 St George’s Road, London SW19 4EU 
Tel: 020 8971 9342    Fax: 020 89440275
exams@wimbledon-school.ac.uk
www.londonexams.co.uk

BULATS - Registration form for online-based exam

Exam session  				Reading &Listening (£50)	
Please tick for which one of the test(s) you would like to register

Reg. closing date	At least 1 week prior to the test day			Writing (£60)		
				Speaking (£60)		

All three modules are £150

Gender (Male/Female)		

These names must be the same as the names on your passport/national Identity card.  You must list all your names in the correct order.
Surname(s)	 	

First name(s)	 	
Date of birth	D	D	M	M	Y	Y	Y	Y	

You must have acceptable non-expired original photographic ID for all the tests (e.g. passport or national ID card) otherwise you will not be allowed to take the exam.
	 	
Type of ID		
Your Postcode	 	
Mobile number	 	
Email	 	

This form must be completed and returned to us with the correct registration fee. 

I wish to be admitted to the above examination. I will bring a valid original photo ID with me on the test day. 
By signing this form I declare that I accept and will comply with the Terms and Conditions for this exam. I have told the exam centre if I have special requirements of any kind. I accept that once I am registered and it is passed the registration closing date, withdrawal is possible on medical or compassionate grounds and based on a transfer to another exam session.

Signature 	   If you returning this form by email please tick here [   ]

THE LONDON EXAM CENTRE       -      CARD PAYMENT
The London Exam Centre, Tuition House, 27-37 St George’s Road, SW19 4EU

Please complete this form and return it with your application to the above address.  Please note that we do not accept American Express or Diners Club International.

Candidate name

																										

Please debit the card below in the sum of £				
(add £3 handling charge for credit card and non-UK cards)

Cardholder name as printed on the card 

Cardholder billing address 

																										

Card Number (the 16- or 18-digit number across the middle of the card)

Start date	M	M	Y	Y	Expiry date	M	M	Y	Y	Security code				

						Issue number  (if applicable)				

Signature		Date	D	D	M	M	Y	Y	

Once we have received your application form and your payment has been processed, a confirmation of registration will be sent to you to the email address given on your application form.