Registration form DELF DALF - Alliance Francaise de Chandigarh

FICHE D'INSCRIPTION DELF/ DALF
(Registration form DELF DALF)
PHOTO
Alliance française de Chandigarh
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 +photo ID proof + signed rules and
regulation form for DELF/DALF
0
F
2. Sexe:
3. Nom Candidat
M
(Surname) :
4. Nom du père
(Father’s Name ) :
5. Prénom Candidat
6. Nationalité
(Name):
(Nationality):
7. Langue maternelle (Mother tongue) :
8. Date de naissance
(jj/mm/aaaa)
(Date of Birth) : (dd/mm/yyyy)
9. Pays de naissance (Country of birth):
10. Lieu de naissance (Place of Birth):
11. Adresse candidat
(Address) :
12. Code postal
(Pin code):
13. Téléphone / Mobile:
14. Adresse e-mail
(email) :
A1
A1
Junior
15. Inscription à quel examen:
(Registration for which exam)
16. Mentionnez le domaine pour le C1/C2
A2
B1
B2
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: _______________
DELF /
DALF
DAY
DATE
Exam fee for currently enrolled
Alliance Française students
Fee + service tax
Exam fee for external students
Exam Fee + service tax
A1
Tuesday
A2
Wednesday
8 March 2016
9 March 2016
Rs 1900 + Rs 276 = Rs 2176/-
Rs 4400- + Rs 638 = Rs 5038/-
Rs 1900 + Rs 276 = Rs 2176/-
B1
Rs 4400- + Rs 638 = Rs 5038/-
Thursday
10 March 2016
Rs 2800 + Rs 406 + Rs 3206/-
Rs 5500- + Rs 798 = Rs 6298/-
B2
Friday
11 March 2016
Rs 2800 + Rs 406 + Rs 3206/-
Rs 5500- + Rs 798 = Rs 6298/-
C1
Saturday
12 March 2016
Rs 3300 + Rs 479 + Rs 3779/-
Rs 6600- + Rs 957 = Rs 7557/-
C2
Monday
14 March 2016
Rs 3300 + Rs 479 + Rs 3779/-
Rs 6600- + Rs 957 = Rs 7557/-
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, please send form 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
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