Black Belt Test Information Form

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PLEASE READ – Guidelines From The IUKF Test Administrator

September 18, 2019

Fellow IUKF Members,

It is my pleasure to serve the IUKF as Test Administrator/Vice President.  I entered these positions in 2019.  I have trained in Uechi-Ryu Karate since 1996 at East Bay Karate-Do under John A. Felipe in Pittsburg, California, US. I continue to assist Sensei Felipe in operating his dojo in an administrative capacity.  

Maintaining the credibility and legitimacy of your certifications is my highest priority.  We are consistently revising procedures so that we may modernize and be able to handle the needs of all our members around the globe.

If you, or your teacher (applying on your behalf) is applying for Black Belt Test Certification, please complete the form.  Once your form has been submitted, due diligence will take place based on the current  IUKF Promotion Strategy.  This may include reaching out to the IUKF-Member Sensei which essentially endorses the application for the purposes of verification.

If you would like to guarantee that your certificates are received by the APPLICANT’S TEST DATE, you must submit your application at least 60 days in advanceUnfortunately, I cannot guarantee that your certificates will be received by a specific date if I am not given at least 60 days to complete due diligence.

PLEASE TYPE APPLICANT’S NAME EXACTLY HOW YOU WOULD LIKE IT TO APPEAR ON THE CERTIFICATE

The application fee paid via PayPal will be required only after I have completed due diligence.  Please await my response before submitting payment.

ific date if I am not given at least 90 days to complete due diligence.

PLEASE TYPE APPLICANT’S NAME EXACTLY HOW YOU WOULD LIKE IT TO APPEAR ON THE CERTIFICATE

The application fee paid via PayPal will be required only after I have completed due diligence.  Please await my response before submitting payment.

The following application fees apply:

Standard Application Fee:  $100 US$

Applications From Bermuda & Canada:  $150 US$ (note that Canada has a link to a different form)

If you require assistance of any kind, you are welcome to reach out to me.

Email:  ian@eastbaykarate-do.com

Text:  925-238-3139

Sincerely,

Ian Rey P. Quitilen

IUKF Test Administrator

Please fill out and submit this Black Belt Test Information Form for review and approval by the International Black Belt Test Administrator and the President of IUKF.

Teacher's Name*
Teacher's Mobile Number*
Teacher's Email Address*
Dojo Address (where certificate will be sent)*
Dojo City,State*
Dojo ZIP Code
Applicant's Full Name*
Applicant's Date Of Birth*
Applicant's Email Address*
Applicant's Last Promotion*
Rank Being Tested For*
IUKF Registration # (if any)*
Applicant's Test Date*
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  • Please use this PayPal button to pay the test administration fee once you have been instructed to do so.

  • Please select the correct dollar amount and select “Certificates” from the drop-down menu.

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    Membership Prices:

    • Ten Members and Over – $400.00
    • Up to Ten Members – $200.00
    • Home/Garage dojos with less than 5 students – $100.00



Video Instructions for Payment