IELTS Application Form

Codes to enter for questions 13–16Refer 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 closestdescription 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 nationalityAfghanistan 001Åland Islands 237Albania 002Algeria 003American Samoa 004Andorra 005Angola 006Anguilla 238Antarctica 239Antigua and Barbuda 007Argentina 008Armenia 009Aruba 223Australia 010Austria 011Azerbaijan 012Bahamas 013Bahrain 014Bangladesh 015Barbados 016Belarus 017Belgium 018Belize 019Benin 020Bermuda 021Bhutan 022Bolivia, Plurinational State of 023Bonaire, Sint Eustatius and Saba 240Bosnia and Herzegovina 024Botswana 025Bouvet Island 241Brazil 026British Indian Ocean Territory 242Brunei Darussalam 027Bulgaria 028Burkina Faso 029Burundi 031Cambodia 032Cameroon 033Canada 034Cape Verde 036Cayman Islands 038Central African Republic 039Chad 040Chile 041China (People’s Republic of) 042Christmas Island 243Cocos (Keeling) Islands 244Colombia 043Comoros 044Congo 045Congo, the DemocaticRepublic of the 219Cook Islands 046Costa Rica 047Côte d’Ivoire 096Croatia 048Cuba 049Curaçao 245Cyprus 050Czech Republic 051Denmark 052Djibouti 053Dominica 054Dominican Republic 055Ecuador 056Egypt 057El Salvador 058Equatorial Guinea 059Eritrea 060Estonia 061Ethiopia 062Falkland Islands 224Faroe Islands 063Fiji 064Finland 065France 066French Guiana 067French Polynesia 068French Southern Territories 246Gabon 069Gambia 070Georgia 071Germany 072Ghana 073Gibraltar 074Greece 075Greenland 076Grenada 077Guadeloupe 078Guam 079Guatemala 080Guinea 081Guinea-Bissau 082Guyana 083Haiti 084Heard Island andMcDonald Islands 247Holy See (Vatican City State) 212Honduras 085Hong Kong 086Hungary 087Iceland 088India 089Indonesia 090Iran, Islamic Republic of 091Iraq 092Ireland 093Israel 094Italy 095Jamaica 097Japan 098Jordan 099Kazakhstan 100Kenya 101Kiribati 102Korea, Democratic People’sRepublic 103Korea, Republic of 104Kosovo 235Kuwait 105Kyrgyzstan 226Lao People’s DemocraticRepublic 106Latvia 107Lebanon 108Lesotho 109Liberia 110Libya 111Liechtenstein 112Lithuania 113Luxembourg 114Macao 115Macedonia, the Former YugoslavRepublic of 225Madagascar 116Malawi 117Malaysia 118Maldives 119Mali 120Malta 121Marshall Islands 122Martinique 123Mauritania 124Mauritius 125Mayotte 227Mexico 126Micronesia, Federal States of 228Moldova, Republic of 128Monaco 129Mongolia 130Montenegro 131Montserrat 132Morocco 133Mozambique 134Myanmar 135Namibia 136Nauru 137Nepal 138Netherlands 139New Caledonia 141New Zealand 142Nicaragua 143Niger 144Nigeria 145Niue 146Norfolk Island 229Northern Mariana Islands 230Norway 147Oman 148Pakistan 149Palau 231Palestine 150Panama 151Papua New Guinea 152Paraguay 153Peru 154Philippines 155Pitcairn 156Poland 157Portugal 158Puerto Rico 159Qatar 160Réunion 161Romania 162Russian Federation 163Rwanda 164Saint Barthélemy 248Saint Helena, Ascension andTristan Da Cunha 180Saint Kitts and Nevis 181Saint Lucia 182Saint Martin (French Part) 249Saint Pierre and Miquelon 183Saint Vincent and the Grenadines 184Samoa 217San Marino 165Sao Tome and Principe 166Saudi Arabia 167Senegal 168ii

Serbia 169Seychelles 170Sierra Leone 171Singapore 172Sint Martin (Dutch Part) 250Slovakia 173Slovenia 174Solomon Islands 175Somalia 176South Africa 177South Georgia and theSouth Sandwich Islands 251South Sudan 252Spain 178Sri Lanka 179Sudan 185Suriname 186Svalbard and Jan Mayen 232Swaziland 187Sweden 188Switzerland 189Syrian Arab Republic 190Taiwan 192Tajikistan 233Tanzania, United Republic of 193Thailand 194Timor-Leste 222Togo 195Tokelau 196Tonga 197Trinidad and Tobago 198Tunisia 199Turkey 200Turkmenistan 234Turks and Caicos Islands 201Tuvalu 202Uganda 203Ukraine 204United Arab Emirates 205United Kingdom 206United States of America 209United States MinorOutlying Islands 253Uruguay 207Uzbekistan 210Vanuatu 211Venezuela 213Viet Nam 214Virgin Islands, British 236Virgin Islands, U.S. 208Western Sahara 216Yemen 218Zambia 220Zimbabwe 221Other 000Question 14 – First LanguageAfrikaans 001Akan 002Albanian 003Amharic 004Arabic 005Armenian 006Assamese 007Aymara 008Azeri 009Baluchi 010Bambara 011Basque 012Bemba 013Bengali 014Bihari 015Bosnian 901Breton 016Bulgarian 017Burmese 018Byelorussian 019Catalan 020Chinese 021Creole 022Croatian 023Czech 024Danish 025Dari 026Dzongkha 027Dutch 028Efik 029English 030Estonian 031Ewe 032Faeroese 033Farsi 034Fijian 035Filipino 904Finnish 036Flemish 037French 038Fulani 039Ga 040Galician 903Georgian 041German 042Gilbertese 043Greek 044Gujarati 045Haitian Creole 046Hausa 047Hebrew 048Hindi 049Hungarian 050Ibo/lgbo 051Icelandic 052Igala 053Indonesian 054Italian 055Japanese 056Javanese 057Kannada 058Kashmiri 059Kazakh 060Khmer 061Korean 062Kurdish 063Lao 064Latvian 065Lithuanian 066Luba 067Luo 068Luxemburgish 069Macedonian 902Malagasy 070Malay 071Malayalam 072Malinka 073Maltese 074Maori 075Marathi 076Marshallese 077Masai 078Mende 079Mongolian 080Nepali 081Norwegian 082Oriya 083Palauan 084Punjabi 085Pashto 086Polish 087Ponapean 088Portuguese 089Pushtu 090Quechua 091Rajasthani 092Riff 093Romanian 094Romansch 095Russian 096Samoan 097Serbian 098Setswana 099Shona 100Sindhi 101Singhalese 102Slovak 103Slovene 104Somali 105Spanish 106Swahili 107Swazi 108Swedish 109Tagalog 110Tahitian 111Tamil 112Tatar 113Telugu 114Tetum 136Thai 115Tibetan 116Tigrinya 117Tongan 118Trukese 119Tulu 120Tupi/Guarani 121Turkish 122Uighur 123Ukrainian 124Ulithian 125Urdu 126Uzbek 127Vietnamese 128Wolof 129Xhosa 130Yao 131Yapese 132Yiddish 133Yoruba 134Zulu 135Other 000Please turn overiii

Question 15 – OccupationExampleIf you are a student, enter 08 because the sectoris Education and 7 because the level is Student.0 87SectorAdministrative services 01Agriculture, Fishing, Forestry, Mining 02Arts and Entertainment 03Banking and Finance 04Catering and Leisure 05Construction Industries 06Craft and Design 07Education 08Health and Social Services 09Installation, Maintenance and Repair Services 10Law and Legal Services 11Manufacturing and Assembly Industries 12Personal Services 13Retail Trade 14Technical and Scientific 15Telecommunications and the Media 16Transport 17Utilities (gas, water etc.) 18Wholesale Trade 19Other 00LevelSelf-employed 1Employer/Partner 2Employee (Senior level) 3Employee (Middle or Junior level) 4Worker in the home 5Retired 6Student 7Other 0Question 16 – Why you are taking the testFor higher education extended course 1(three months or more)For higher education short course 2(three months or less)For other education purposes 3For registration as a doctor 4For immigration 5For employment 6For professional registration (NOT medical) 7For personal reasons 8For registration as a nurse (including CGFNS) 9For registration as a dentist 10Other 0ChecklistI have signed the Application Form.I have provided 2 passport-sizedphotographs (signed on the back).Photographs must: are clearly distinguishable 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(pages showing personal identification detailsand expiry date).iv* Important: Please detach this section (pages i–iv) and retain for your own records.

Applications to Recognising Organisations24 22 Please give details below of academic institutions/government agencies/professional bodies/employers you wouldlike 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 resultsbefore you have received or viewed them.a) Name of person/departmentName of institution/agency/body/employerFile/case numberAddressb) Name of person/departmentName of institution/agency/body/employerFile/case numberAddressc) Name of person/departmentName of institution/agency/body/employerFile/case numberAddressd) Name of person/departmentName of institution/agency/body/employerFile/case numberAddresse) Name of person/departmentName of institution/agency/body/employerFile/case numberAddressPlease turn over 3

Declaration1. I acknowledge that the IELTS test is jointly owned by British Council, IDP: IELTS Australia and Cambridge English Language Assessment, collectivelyreferred to as the IELTS Test Partners.2. I certify that the information on this Application Form is complete, true and accurate.3. I understand that the personal data on this Application Form is collected for the purposes of the IELTS test, and I consent for this data to bedisclosed 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 or photographs taken by the IELTS test centre and my test result to be disclosed by the IELTS TestPartners to those Recognising Organisations to which I apply and to governments (including visa processing authorities) for the purpose of allowingthese organisations to verify my test result or to carry out enquiries in relation to suspected malpractice. If the IELTS Test Partners discover that afalse or altered Test Report Form has been provided to any of these Recognising Organisations or government authorities I further consent that theIELTS Test Partners may inform the same and provide them with my personal data and any relevant details relating to the work I produce as part ofmy test taking, including, without limitation, test performance or score data or photographs taken by the IELTS test centre.4. I understand that my personal data may be processed in an anonymous form for statistical and research purposes for the development of CambridgeEnglish Language Assessment examinations. Cambridge English Language Assessment and the centre administering the test confirm that they will notdisclose 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 enrolment on my preferred test date or at my preferred test location. I understand that myenrolment will be confirmed in writing from the test 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 thepurposes of allowing these organisations to verify my test results or to carry out enquiries in relation to possible malpractice or test integrity issues. Iunderstand 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 test centre to allow the Test Report Form to be released. If I have not had my photographtaken by the test centre no result will be issued.10. I acknowledge that I have read the IELTS Notice to Candidates contained on page i of this document and agree to abide by the rules and regulationscontained therein.11. I understand there may be local terms and conditions I must comply with and that the test centre will provide details of these on request.12. I understand that the IELTS Test Partners have a responsibility to all candidates and Recognising Organisations to ensure the highest confidencein the accuracy and integrity of test results and that the IELTS Test Partners therefore reserve the right to withhold test results temporarily orpermanently, or to cancel test results which have been issued, if they consider those results to be unreliable for reasons of suspected malpractice orany other irregularity in the test process.13. 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 matterassociated with my test, including making enquiries as to whether any rules or regulations have been breached, as outlined in the IELTS Notice toCandidates. I understand that in exceptional circumstances I may be required to re-take one or more IELTS components.14. 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, Imay 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 withoutlimiting any of the terms of this Declaration, I understand that details of any malpractice (including evidence of suspected malpractice) that has beenestablished, 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 centrallyto the IELTS Test Partners and to any relevant test centre by the centre where the suspected malpractice occurred.15. I understand that if any other person attempts to take the IELTS test in my place (i.e. in place of the person whose details appear on this form), both I andsuch person will be liable to prosecution. Details relating to the situation may be provided to the relevant authorities, including visa processing authoritiesand appropriate regulatory authorities.16. I understand that the work I produce as part of the IELTS test remains the property of the IELTS Test Partners. Under no circumstances will it bereleased to candidates or to institutions or organisations, except in the investigation of suspected malpractice whereby the work I produce as part ofthe IELTS test may be provided to relevant authorities.17. I agree that an observer may attend my Speaking test as part of the monitoring process.18. 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 provideappropriate medical evidence, within five days of the test date, to support the cancellation or transfer.19. 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, governmentagencies, professional bodies and employers in determining whether a test taker can be admitted as a student or be considered for employment or forcitizenship purposes. IELTS is not designed to be the sole method of determining admission or employment for the test taker. IELTS is made availableworldwide 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 English Language Assessment and any other party involved in creating, producing, or deliveringIELTS 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.SignatureDated d m m y y*3696616335*4© UCLES 2013 | CE/1633/3Y06