Name
: *
Date of Birth
:   ,  [dd],[yyyy] *
Identity
: KTP / SIM / KITAS      Passport
 
   *
Address
: *
Phone
: [xxx-xxxxxxxx] *
HP
:
Email
:
Company / School Name
:
 
  Address :
 
  Phone :     Fax :




Terms & Condition :
1. Price could be changed without prior notice, please contact us for confirmation.
2. Test payment must be made at least 3 (three) days before the test date (FOR TOEIC, TOEIC BRIDGE and TFI only).
3. Cancellation without prior notice will be subject to a 50% of test fee charged (FOR TOEIC, TOEIC BRIDGE and TFI only).
4. A maximum of 2 (two) times is allowed for postponement within a month (FOR TOEIC, TOEIC BRIDGE and TFI only).
5. Confirmation/notification must be made in written. Phone correspondence upon confirmation/notification/cancellation will not be acknowledged.
6. Registration is valid and confirmed only upon the receipt of payment.
7. Agree to ETS's Privacy Policy and the conditions concerning test administration, fee payment, and score reporting in the Information and Registration Bulletin (TOEFL).
8. Please re-fax this Form along with the payment / transfer slip to INTERNATIONAL TEST CENTER ( 62 21-5711944 ).
I hereby, accepted the regulation and confirm my registration to take the test.


  
 
   

Design by PT. Interaksi Intimedia - Hosted@aksimedia.com