INTERNATIONAL ENGLISH LANGUAGE TESTING SYSTEM

ACADEMIC
Test Report Form
Reading and Writing Modules
NOTE Admsslon to undergraduate and post graduate courses should be based on the ACADEMIC required for academic purposes.
Cilfn\t frutrVlrVC Reading and Writing Modules are not designed ta test the full range of language skills
two years from the date of the test.
li e"on.eraua that the caididate'slanguage ability as indicatecl in this Test Reporl Farm be re-assessed after

Centre Nunber I toO6o Date 21tJUL:2j15 Candidate Number 000440

Candidate Details ',,

Family Name RAFIMAWAT!

First Nairte

lD
CandL'late

Date of Birlh 13/0t/1983 Sex (M/F) Scheme CodePrivate Candidate

Country or First
Region of INDONESIA Language INDONESIAN
Origin

Repeating Previous
rELTS (Y/N) Test Date

Test Results
ListeningreIReadlngffiWritingruSpeakingffi?:;f'l".,"H

Administrator Comments Centre stamp Validation stamp

r r IDP Education PtY !-ld ,l..ilfroil

If,lD eantrng 0ifice, lndon
Centre Number I lD

Writing Examiner Administrator's \

Number [',* ] Signature

Speaking Examiner
['-,I Test Report Form
Date 03t08t2015 1.2 I E'000440R4HY0 6 0A- :
Number Number

OO BRITISH UNIVERS ITY O/ CAMBRIDCE

oo couNcll &,iHp ESOL Examinations

The validity of this IELTS Test Report Form can be ve|ified online by recognising organisations at http://ielts.ucles.org.uk