REGISTRATION FORM IKMC 2015

INSTRUCTIONS & IMPORTANT DEADLINES.

I.

Please fill all the columns with Black/Blue permanent ink in Capital letters
only.

II.

A separate registration page (Page 05 of registration form) may be used for

each participating class. (Dont register the Names of students from multiple
classes on one page).

III.

Minimum Participation of 10 students from a participating class is MUST.

There is no maximum limit; institutions can register as many students from a
class as they wish.

IV.

The last date of submitting registration form is December 15, 2014 with
normal fee, after this date the institutions can register by paying late fee of
Rs. 5,000 (per institution) till
December 31, 2014 and by paying
double late fee of Rs. 10,000 (per institution) till
January 15, 2015.
Thereafter no registration will be accepted.

V.

The Contest will be held on March 19, 2015. (10:00 AM.)

VI.

The participation fee is Rs. 600 per participant, which can be paid only
through Bank Draft/Pay Order, drawn in favour of KSF-Pakistan. The
registration will not be accepted if the fee is sent in any other form

VII.

The registration fee once paid is non-refundable and non-transferable.

VIII.

The registration forms complete in all respect should be sent to the following
Postal Address:
KANGOUROU SANS FRONTIERES - PAKISTAN
International Kangaroo Mathematics Contest
2nd Floor, 302 Y / Commercial Area, Phase III,
Defence Housing Authority,
Lahore Cantt. 54660

IX.

All particulars in the registration form must be filled as illustrated below.

Variation from the format can result into the rejection of registration.

S.NO
STUDENTS
FATHERS

STUDENTS PARTICULARS
First Name
H A S S A N
Middle Name
B I N
Last Name
W A L E E D
First Name
W A L E E D
Middle Name
A H M E D
Last Name
M A S H W A N

For any further assistance, you can contact KSFPAKISTAN office by e-mail at
info@kangaroo.edu.pk, phone: +92-42-35744666 and cell: +92-324-4219999.

1.

INSTITUTIONS DETAILS

1 | Page

Registration Form IKMC 2015

INSTITUTIONS NAME:

INSTITUTIONS POSTAL ADDRESS:

HOUSE NO
STREET NO
OTHER
DETAILS
CITY
TEHSIL
DISTRICT
PHONE : 01
PHONE : 02
FAX
E-MAIL
OFFICIAL BANK TITLE OF THE INSTITUTIONS ACCOUNT:

2.

PRINCIPALS CONTACT DETAIL (FIRST CONTACT POINT)

*All columns are mandatory.
FIRST NAME
MIDDLE NAME
LAST NAME
CELL PHONE
OFFICE PHONE
E-MAIL

3.

COORDINATORS CONTACT DETAIL (SECOND CONTACT POINT)

Institution must nominate an official to coordinate and to correspond in the
absence of principal.
FIRST NAME
MIDDLE NAME
LAST NAME
CELL PHONE
OFFICE PHONE
E-MAIL
4.
COURIER & MAIL OPTIONS:
The Examination material & other correspondence will be sent out to
participating institution by using the mailing options chosen by them. Please
indicate your choice by ticking the appropriate box. Please re-assure from the

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Registration Form IKMC 2015

service providers (TCS/PAKISTAN POSTAL SERVICES) that your institution is

located in a serviceable area of service provider.
1 1. Courier Service TCS.
2

3 2. Pakistan Postal services (Registered or UMS mails).

5.

DETAIL OF REGISTRED STUDENTS.

Class-wise summary of students to be registered:
LEVEL
PREECOLIER
ECOLIER

BENJAMIN

CADET

JUNIOR

STUDENT

CLASS
01

ONE

02

TWO

03

THREE

04

FOUR

05

FIVE

06

SIX

07

SEVEN

08

EIGHT/O LEVEL-I

09

NINE/O LEVEL-I & II

10

TEN/O LEVEL-II & III

11

ELEVEN/O LEVEL III & A LEVEL-I

12

TWELVE/A LEVEL-I & II

NO. OF STUDENTS
(in figures)

TOTAL NO OF STUDENTS
6.

UNDERTAKING.
I hereby certify that:
1. I undertake the full responsibility to act as a Chief Examiner for the written
test of IKMC and to conduct the exam following the IKMC code of conduct
and by making all necessary examination arrangements at our institution
maintaining the international standards and ensuring the secrecy &
transparency of the written test.
2. I also assure that my institution will fully abide by IKMC code of conduct, all
rules, regulations and instructions of the International Kangaroo
Mathematics Contest being enforced time to time.
3. I also certify that I have enclosed Bank Draft/Pay Order in original bearing
No: __________________________________ Dated: ___________________ amounting
to
Rs. (in figures) ____________________ as a
registration fee for total number of ____________ students as mentioned in
above summary @ Rs.600 per student in favour of KSF-PAKISTAN.

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Registration Form IKMC 2015

SIGNATURES & STAMP

PRINCIPAL /HEAD OF THE INSTITUTION

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Registration Form IKMC 2015

STUDENTS REGISTERATION SHEET

FOR THE CLASS__________

A separate registration page may be used for each participating class. Dont register the Names of students from
multiple classes on one page. Please fill the particulars of students very carefully according to your institutions
office record using capital letters. These particulars will appear on the certificates/mark sheets. Any change
requested therein after the issuance of result/certificates will be subject to the payment of a fee of Rs. 1,000 per
document.

S.NO

STUDENTS PARTICULARS
STUDENT
S

FATHERS

STUDENT
S

FATHERS

STUDENT
S

FATHERS

STUDENT
S

FATHERS

STUDENT
S

FATHERS
5 | Page

First Name
Middle
Name
Last Name
First Name
Middle
Name
Last Name
First Name
Middle
Name
Last Name
First Name
Middle
Name
Last Name
First Name
Middle
Name
Last Name
First Name
Middle
Name
Last Name
First Name
Middle
Name
Last Name
First Name
Middle
Name
Last Name
First Name
Middle
Name
Last Name
First Name
Middle
Name
Last Name
Registration Form IKMC 2015

STUDENT
S

FATHERS

6 | Page

First Name
Middle
Name
Last Name
First Name
Middle
Name
Last Name

Registration Form IKMC 2015