CAA International

Examination Payment Form

Please complete the form in BLOCK CAPITALS using type, black or dark blue ink

1. Personal Details

CAA Personal Reference number (if known)

107656

Surname Title

ASHARAF

Forename Date of birth

AASHIQ ALI

MR

23/03/1991

All fees must be paid in advance of examination booking, failure to do so will delay your application. The fees for CAA International Exams are detailed on examination application forms and are listed on our website - www.caainternational.com I am paying by: (Please tick appropriate box)

Mastercard

Maestro

Visa

Cheque

Other

Cheques MUST be made payable to CAA INTERNATIONAL LTD Please note that we do not accept AMERICAN EXPRESS or DINERS CARD If paying by credit card please complete the following (BLOCK CAPITALS)

Cardholders Name

Amount Security Code Expiry date Valid from

Card number (last 3 digits on signature strip on reverse of card) (month / year) Card issue number (Maestro)

(16 digits)

Address of cardholder if dierent from applicant

3. FOR CI USE ONLY Date Received: Receipt No.

Cheque/Card

Enclosures

Amount Paid:

Fax: +44 (0) 1293 573992 Click here to print