Candidate's Record formCandidate's Record form
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..................................
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.