Goethe-Zentrum Hyderabad – Exam Application Modular
Exam Level   :
Date of Exam:
Institute Where Learnt German
This portion will be retained for Official Use Only:
(To be filled by the student in BLOCK letters)
Goethe-Zentrum Kooperationspartner / Goethe Institut
Surname :
Name :
Date of Birth :
Place of Birth :
Mother Tongue :
Nationality :
Mobile No. :
Email ID (write clearly) :
PTN NR:
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I would like to write the following examination:

Goethe B1 Modular
Internal (Rs.4,838/- each module)
External (Rs.4,838/- each module)
Goethe B2 Modular
Internal (Rs.5,300/- each module)
External (Rs.5,300 /- each module)

* Above charges inclusive of 18% of GST.

Details on certificate:
GOETHE-ZENTRUM HYDERABAD HALLTICKET
Goethe-Zentrum Kooperationspartner / Goethe Institut
PHOTO
Surname :
Name :
Date of Birth :
Place of Birth :
Mother Tongue :
Nationality :
Mobile No. :
Email ID (write clearly) :

I would like to write the following examination:

Goethe B1 Modular
Internal (Rs.4,838/- each module)
External (Rs.4,838/- each module)
Goethe B2 Modular
Internal (Rs.5,300/- each module)
External (Rs.5,300/- each module)

* Above charges inclusive of 18% of GST.

Have you already appeared exam? Yes / No
Signature of the Student:
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Date:
If Yes, Date of Exam  :    Signature of the Teacher:
(Not applicable in case of External)
FOR OFFICE USE ONLY PTN NR: