Teacher assessment Form 1

Cambridge IGCSE Accreditation for Coursework Assessment

Read the guidance notes at the end of the form before you fill it in.
Centre number
Exam series
(e.g. June 2015)

Syllabus
code

November 2015

Component

Centre name

Bososwa Bina Insani School

Contact name

Munawara Sultana Tampubolon

Syllabus title

Name of teacher

0 5 1 0

0 5 1 0

Reference no.
(printed on bottom
of the teachers
accreditation
document)

I certify that the teachers named in the above table hold accreditation from Cambridge.
Signed

Date
(DD/MM/YY)

Name

23 APRIL 2015

MUNAWARA SYULTANA TAMPUBOLON

If you submit this form electronically please tick the check box as an alternative to signing the form.

Returning this form

Return this form to info@cie.org.uk. Please include your Centre number and the form name and number (found at
the top right-hand corner of the form) in the email subject line. Save a copy of the form for your own records.

Guidance notes
Background
In order for a Centre to assess certain Cambridge IGCSE subject components, at least one teacher of the subject
must hold the appropriate accreditation from Cambridge.
Completing the form
Complete this form for all the teachers who hold certificates or letters of accreditation in the syllabus and
component you wish to internally assess in your Centre this exam series.
The exams officer or Head of Centre must sign the form.
Teachers who were accredited before April 2004 were not issued with reference numbers. The teachers name
is enough in these instances.
Deadline
June series 15 October
November series 30 April

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