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Forename *: Surname *: Email Address *: Phone No (numbers + spaces only) *: Date of Birth (DD/MM/YYYY) *: Where will you be sitting the LNAT? * in the EU (voucher price GBP50)
outside the EU (voucher price GBP70)

Paying by internet banking

Because of payment tracking problems, you should not execute an electronic transfer from your bank branch. You should execute the transfer via your bank's internet banking facility. To do so please log on to internet banking and make a transfer (with all fees and/or costs for the transfer prepaid by you, that means that £70 must be received into our account and not less) to the following account:

Lloyds TSB
Account Name: LNAT Consortium Ltd
Sort code: 30-92-13
Account number: 03359516

Please execute this transfer on the same day you submit this form and include your bank details here so we can confirm your transfer.

Name of person whose bank account the money is transferred from: Sort Code: Account No: Amount transferred £GBP:

Declaration: I hereby apply for an LNAT voucher at the price indicated above. I understand that applying for a voucher is not the same as registering for the LNAT or booking an LNAT sitting. I understand that on receipt of the voucher I must return to the LNAT website at http://www.lnat.ac.uk to book an LNAT sitting. I understand that each LNAT voucher is valid for one booking only and that the same conditions regarding cancellation and rebooking apply to voucher bookings as to all other bookings. I understand that the voucher will be delivered to me by email at the email address shown above and that it is my responsibility to ensure that the email address is working. I understand that the voucher will be sent only once my payment has cleared. I understand that payment clearance and voucher delivery may take up to ten working days for cheque payments and up to five working days for internet payments. I understand that my personal information above will be used for the purpose of this voucher application only.*

I have read and accept the declaration

* The information supplied on this form will be securely held and treated confidentially in accordance with the Data Protection Act. It will be used by LNAT Consortium Ltd for the purpose of processing your voucher application and will then be retained on a database to enable LNAT Consortium Ltd to conduct statistical analyses and for accounting purposes. The information will not be made available outside the LNAT Consortium Ltd.