Basic Details

Title *

First name(s) *

Last Name *

Date of Birth (DD/MM/YYYY)*


Phone Number

Mobile Number*




Post code*


Online Payment

1[multiform "name_course"][multiform "price_course"] NZD
Total : [multiform "price_course_total"] NZD

*including GST

Application Details

Why are you taking the test? *

[group group-taking-test]

If Other, please specify reason *


Which country are you applying/intending to go to? *

[group group-country-applying]

If Other, please specify country *


Passport or National Identity Card Number*

Country of Nationality*

First Language*

Occupation (Sector)

Occupation (Level)

Education Level

How many years have you been studying English?

Required Exam Type

Required Exam Date (DD/MM/YYYY)

Other Personal Details

Do you have a permanent disability, such as visual, hearing or specific learning difficulty, which requires special arrangements (for example, modified material, extra time, use of technology, etc.)?

If yes, please specify your requirements and other details below. You must attach origial 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. Requests for modified test materials must be submitted at least 3 months before the test.

[multistep "2-2"]