Alliance française de : Chandigarh FICHE D'INSCRIPTION DELF/ DALF (Kindly fill in block letters 1. Code Candidat (candidat déjà immatriculé) if you have already appeared for any of the DELF/DALF exams earlier, please use the same candidate number : Please attach photocopies of all your previous DELF/DALF certificates, your photo ID proof + signed rules and regulation form for DELF/DALF 0 - 2. Sexe : F M 3. Nom Candidat (Surname) : 4. Nom du père (Father’s Name ) : 5. Prénom Candidat (Name) : 6. Nationalité (Nationality) : 7. Date de naissance (dd/mm/yyyy) (Date of Birth) : 8. Pays de naissance (Country of birth) : 9. Lieu de naissance (Place of Birth) : 10. Adresse candidat (Address) : 11. Code postal (Pin code) : 12. Téléphone / Mobile : 13. Adresse e-mail (email) : 14. Inscription à quel examen : (Registration for which exam) A1 Junior A1 A2 B1 B2 C1 C2 15. Mentionnez le domaine pour le C1/C2 : Lettres et sciences humaines Sciences Please note : All candidates will have to carry their PHOTO Identity Card in ORIGINAL on the day of the examination without which entry will not be permitted inside the Examination Hall. Unsigned forms, unsigned rules and regulation for DELF/DALF, signature with discrepancy or Incomplete forms will be rejected. IMPORTANT: I UNDERSTAND THAT IF I COME LATE FOR THE EXAM, I WILL NOT BE ALLOWED TO ENTER THE HALL Teacher’s name (if you are a student of AF de Chandigarh):_____________ Signature of candidate:____________ Level Date Exam fee for current AF Chd. Students Fee + S. Tax Exam fee for external students Fee+S. Tax A1 Monday, 8 th Dec 2014 Rs.1500/- +186=Rs.1686/- Rs.3700+458= Rs.4158/- A2 Tuesday, 9 th Dec 2014 Rs.1500/-+186=Rs.1686/- Rs.3700+458=Rs.4158/- B1 Wednesday, 10th Dec 2014 Rs.1500/-+186=Rs.1686/- Rs.3700+458=Rs.4158/- B2 Thursday, 11th Dec 2014 Rs.2700/-+334=Rs.3034/- Rs.5400+668=Rs.6068/- C1 Friday, 12th Dec 2014 Rs.2700/-+334=Rs.3034/- Rs.5400+668=Rs.6068/- Receipt no._____________ Dated____________ Cash/Draft____________ Total Amount___________ if exam fee is paid by draft please make the draft in favour of Alliance Francaise payable at Chandigarh. The DELF/DALF forms sent by post should reach before the last date of registration, otherwise they will not be accepted at the following address:. Alliance Française de Chandigarh, next to Hibiscus Garden, Sector 36-A, CHANDIGARH-160036. Telephone: 0172-2668627, 2647894, email: [email protected] , website: www.chandigarh.afindia.org Page 1 of 2 Photo
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Alliance française de : Chandigarh FICHE D'INSCRIPTION DELF/ DALF (Kindly fill in block letters 1. Code Candidat (candidat déjà immatriculé) if you have already appeared for any of the DELF/DALF exams earlier, please use the same candidate number :
Please attach photocopies of all your previous DELF/DALF certificates, your photo ID proof + signed rules and regulation form for DELF/DALF
0 -
2. Sexe : F M
3. Nom Candidat (Surname) :
4. Nom du père (Father’s Name ) :
5. Prénom Candidat (Name) : 6. Nationalité (Nationality) : 7. Date de naissance (dd/mm/yyyy) (Date of Birth) :
8. Pays de naissance (Country of birth) :
9. Lieu de naissance (Place of Birth) : 10. Adresse candidat (Address) :
11. Code postal (Pin code) : 12. Téléphone / Mobile : 13. Adresse e-mail (email) :
14. Inscription à quel examen : (Registration for which exam)
A1 Junior
A1 A2 B1 B2 C1 C2
15. Mentionnez le domaine pour le C1/C2 :
Lettres et sciences humaines Sciences
Please note : All candidates will have to carry their PHOTO Identity Card in ORIGINAL on the day of the examination without which entry will not be permitted inside the Examination Hall. Unsigned forms, unsigned rules and regulation for DELF/DALF, signature with discrepancy or Incomplete forms will be rejected. IMPORTANT: I UNDERSTAND THAT IF I COME LATE FOR THE EXAM, I WILL NOT BE ALLOWED TO ENTER THE HALL Teacher’s name (if you are a student of AF de Chandigarh):_____________ Signature of candidate:____________
Level Date
Exam fee for current AF Chd.
Students Fee + S. Tax
Exam fee for external
students Fee+S. Tax
A1 Monday, 8th Dec 2014 Rs.1500/- +186=Rs.1686/- Rs.3700+458= Rs.4158/-
A2 Tuesday, 9th Dec 2014 Rs.1500/-+186=Rs.1686/- Rs.3700+458=Rs.4158/-
B1 Wednesday, 10th Dec 2014 Rs.1500/-+186=Rs.1686/- Rs.3700+458=Rs.4158/-
B2 Thursday, 11th Dec 2014 Rs.2700/-+334=Rs.3034/- Rs.5400+668=Rs.6068/-
C1 Friday, 12th Dec 2014 Rs.2700/-+334=Rs.3034/- Rs.5400+668=Rs.6068/- Receipt no._____________ Dated____________ Cash/Draft____________ Total Amount___________ if exam fee is paid by draft please make the draft in favour of Alliance Francaise payable at Chandigarh. The DELF/DALF forms sent by post should reach before the last date of registration, otherwise they will not be accepted at the following address:. Alliance Française de Chandigarh, next to Hibiscus Garden, Sector 36-A, CHANDIGARH-160036. Telephone: 0172-2668627, 2647894, email: [email protected], website: www.chandigarh.afindia.org Page 1 of 2
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