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ENTRY FORM FOR THE PROFESSIONAL QUALIFYING EXAMINATIONS
 
INSTITUTE OF CHARTERED SHIPBROKERS
85, Gracechurch Street, London EC3V 0AA, Telephone : +44(0)20 7623 1111, Fax: +44(0)20 7623 8118,
Email: examinations@ics.org.uk
I wish to enter for the Professional Qualifying Examinations to be held in   
To confirm that I have registered with the ICS as a student Yes No
Please forward completed form to your local branch or head office if no local branch
PERSONAL DETAILS
Title :
Surname :
Given Name :
Date Of Birth :  
Age :
Nationality :
Home Address :
Address 1 [Optional] :
Address 2 [Optional] :
City :
Country :
Post Code :
Telephone No
 :
E-mail :
BUSINESS/EMPLOYER DETAILS
Company Name :
Address 1 :
Address 2 [Optional] :
City :
Country :
Post Code :
Telephone No :
Fax [Optional] :
E-mail :
Please direct all my communications to this address  
Chosen Exam Centre :     
How/where are you studying
:     [e.g. Tutorship]
Total Entry Fee Due : £  [Fees, £32.00 per subject must be pre-paid in sterling]
SUBJECTS I WOULD LIKE TO SELECT
Group I Group II Group III
Remittance, payable to INSTITUTE OF CHARTERED SHIPBROKERS, must be in Sterling, no other currency will be accepted.
Remit either by Cheque drawn on a Bank with a U.K. Branch or by a Bank Transfer ensuring that ICS receives the Gross Amount (i.e. ALL CHARGES FOR YOUR ACCOUNT).
Bank Details : National Westminster Bank PLC. (Bishop’s Gate Branch)
Bank Sort Code : 50-00-00 BIC NWBK GB 2L IBAN GB55 NWBK 5000 0015 4792 34 
Account Number : 15479234
Institute of Chartered Shipbrokers 
Payment also accepted by credit card (Visa, Mastercard) or debit card (Delta or Switch) Please note 3% will be added to all card transactions. AMEX not accepted.
METHODS OF PAYMENT
Payment details
Cheque
Bank Transfer
Credit/Debit Card
Credit/Debit Card Details
Name on card :
Number :
Security No :
Expiry Date : (MM/YY)
Issue Number (Debit card only) :
3% commission will be charged on all card transactions.(AMEX not accepted)

 
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