Application Form For Kukkiwon Certificate Only
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1
2
3Date of most recent
Please attach 2
Dan grading
separate passport
photos. Print your name
on the back of each
photo and fix them
APPLICATION FORM FOR KUKKIWON CERTIFICATE ONLY
here with a paper clip.
Complete all the details below in CAPITALS.
APPLICANT’S PERSONAL DETAILS
Surname
Forename(s) First
Middle
Nationality
Date of Birth
Day
Month
Year
Gender
(Click in the correct box.)
Male
Female
Address
Postcode
Tel. Nº
Age
Email.
Your Kukkiwon Cert No
Please paste a copy of British
Taekwondo licence slip here.
If your licence has expired and
Date on your most recent
Kukkiwon Certificate
has been applied for, fix a copy
Grade on your most recent
of your old licence here.
Kukkiwon Certificate
Without a licence we cannot
(click to choose)
apply for a certificate for you.
Your Current Grade
(click to choose)
Also the details on this slip are
Date of most recent grading
the details recorded on our
database. Please notify us
Candidates who are 14 years old or younger should apply for a
immediately if there are any
Poom grade.
Candidates who are 15 years old and above should apply for a Dan
errors on your slip.
.
grade
Grade applied for
(click to choose)
I confirm I have read and understood the enclosed notes. Where the applicant is below 18 years of age, the parent
or guardian should sign this form.
Signature
Date
Candidate
BT Member
Grade
M
recommended
Nº
(Click to choose)
by (print)
Signature
Exp Date
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