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(external
Examination Form
candidates only)

(Please fill in the form in CAPITAL LETTERS. Any changes after submission will attract a penalty of Rs. 1500. Note:
Examination Fee payable by cash or Demand Draft in favour of “Max Mueller Bhavan”)

(Mr./ Ms.) Surname: ____________________________________ First Name: ______________________________________________________

Date of Birth: __________________________________________ Place of birth: __________________________________________________

Nationality: _____________________________________________ Mother tongue: _________________________________________________

Address: _______________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________

Email ID: ________________________________________ Res.: ____________________________Mob.: _______________________________

Name of the school/institution you learn German at: ____________________________________________________________

Which class/standard are you currently in? ______________________________________________________________________

Name of your teacher: _____________________________________________________________________________________________

How long have you been learning German? ______________________________________________________________________

What is the name of your textbook? ______________________________________________________________________________

What are your reasons for learning German? ____________________________________________________________________

International Examination:  Fit in Deutsch 1 (A1)  Fit in Deutsch 2 (A2)

Date of exam: _______________________ Timing: _____________________________

I have seen the examination schedule and I am paying herewith Cash/Demand Draft of
₹: ________________________ (DD no :____________________________________) as examination fee.

(The candidate must carry the examination receipt and a valid photo ID proof at the time of the exam and produce the same on
demand.)

I hereby confirm that I have taken note of the applicable “Exam Guidelines“ and “Terms & Conditions for
Exam Administration“ and agree to abide by the same.

__________________________ _________________________
Signature of the student Signature of the parent
 Declaration of consent
Surname, First Name: ______________________________________________________________________________________________

On executing my signature below, I consent to the transmission and storage by Goethe-Institut / Max
Mueller Bhavan of my personal data (“data”) provided under the terms of my registration and in conjunc-
tion with the performance of future agreements to its headquarters in Munich, Germany (“GI-HQ”) and
there to combine in its central customer database said data with any other of my personal data previously
provided and stored there, if applicable.

Furthermore, I consent to the use of my data by Goethe-Institut / Max Mueller Bhavan and GI-HQ not only
for performing the contractual agreement, but also for the purposes of market research, advertising and
marketing associated with the range of services offered by Goethe-Institut / Max Mueller Bhavan and, in
particular, for providing relevant advertisements or surveys (“Information”), e.g., about new courses of-
fered by Goethe-Institut / Max Mueller Bhavan to me at the contact address I have provided, either by
post or – at my special request – also by telephone, fax, email, or text message.

Data concerning examinations I have taken, may also be transmitted to GI-HQ for storage and use in the
central examination archives (for a maximum period of 10 years) for verification purposes and for issuing
replacement certificates, as required.

Goethe-Institut / Max Mueller Bhavan will not use my data for any other purpose than those specified in
this consent agreement or provide any data to a third party, unless there is a reasonable suspicion of
abuse concerning the data.

I have been informed that I may revoke my permission to use my data for market research, advertising
and marketing purposes at any time.

___________________________________________________________

Place, Date, Signature

 Yes, I would also like information sent to me by email/text message/telephone/fax.

____________________________________________________________

Place, Date, Signature

Right of Revocation

You may exercise your right to revoke by completing the section below, either now or at some future
time:

 I hereby revoke my permission, effective immediately, for the use of my data for advertising and
marketing purposes.

____________________________________________________________

Place, Date, Signature