Candidate's Record form

NZART Regulations and Theory Examination

Please print all information clearly.

 

 

Candidates's name..................................................................................ERN number...................

Residential address.........................................................................................................................

.............................................................................................................................................................

Phone numbers: Home...................................................Business:...................................................

Email address (if applicable)..........................................................................................................

If you do not wish to receive details regarding membership and services provided by the NZART, please indicate by entering a cross in the box below:
     

The following information is required by the MED for Audit purposes:

Gender (M/F)..........Colour of hair..................Complexion..........................Height................m

Date of Birth...............................................Place of birth.............................................................

I certify that the information given above is true in every particular

Candidate's signature.........................................................................Date..................................

Examination result:

Number of questions correctly answered:.....................Fail / Pass (circle one)

Witnessed by examiner:...........................................................................................Date....................................

Witnessed by examiner:...........................................................................................Date....................................

 

This answer sheet and record form must be mailed promptly to the NZART Examination Co-ordinator in the envelope provided. It is recommended that examiners keep a copy for their records.


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