Certifying Statement Application Form

APPLICATION FORM

To be used by all applicants requiring a certifying statement of results, results verification or authentication by a Notary Public. Please complete this form in the spaces provided. If you have any queries, please phone +263-4-307815 or fax +263-4-302288. For security reasons we cannot communicate results by FAX, Telephone OR Internet.

Current full name (including Mr, Mrs, Miss, Ms)

Full name at the time of the examination

Date of birth

ID Number

Current address (Including postcode)

Daytime telephone number

Fax number

E-mail address

Examination level taken (e.g. O , A-Level GCE, ZJC, Std 6, Grade 7

Year of the examination

Month of examination if known

Centre number

Index or candidate number

Name of school or centre (Please indicate town and Province/Region

Proof of Payment

CERTIFYING STATEMENT FORM

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