Score Report Reprint Request Form

Full name:

Family name (If applicable):

Email:

NRIC / Passport No:

Date of Birth (DD/MM/YYYY):

Country of Birth:

Nationality:

Gender:

Home Address:

Postcode:

State:

Mobile Phone:

Type of test:

Test Date:
/

Test Reservation Number:

Number of Reprints Requested:
Please note that each score report reprint is charged at RM 21.20

Note:
a) Each report is RM 21.20
b) For courier within Malaysia, the courier charge is RM 10.00
c) For courier outside Malaysia, we use FedEx courier services and once we get the quotation from FedEx, we will inform you for the courier charges.

I agree to the policies set by Eshia & Associates Sdn Bhd. I also hereby agree to pay Eshia & Associates Sdn Bhd through its Maybank Account Number 562188127187 the amount I select below.

Attach Payment / Deposit Slip :