Form No.
06
Copy No. Uncontrolled
Course Enrollment Issue date
Originator
Revised by
Jan, 8th, 2016
Administrator
Tech Exec TL
Approved By Dr. Yassin Darwish
Please send back completed form with your payment:
PLEASE USE CAPITAL LETTERS THROUGHOUT Declaration:
Training Date: I understand that HSSE Solutions LTD
Training Title: and its associated trading companies
Location :
(and companies, organizations or
Exam only Option (for Paper 1 Paper 2
agents processing data on its behalf)
IGC re-sits only)
Nebosh IGC Assessment 1 Assessment 2 will hold and use personal data
supplied by me for administration
Name: (as it appears on your ID photo / passport) – (Family Name,
Given Names): purposes. These purposes I have
been notified under the Data
Date of Birth (dd/mm/yy): Protection Act 1998. The data may
Gender and Nationality also be used to send separate
Permanent Private Address: unsolicited mailings containing
details of events, new services,
Private phone No.: products, etc. You have the right to
Cellular phone No.:
ask HSSE Solutions LTD NOT to send
Email Address:
such mailings.
Second address:
Company Name:
Contact Name:
Telephone No.: Fax No.
Email Address:
METHODS OF PAYMENT
Invoice Address
(if different from the above): (Please indicate)
Do you have any learning difficulty? Full payment and/or Company Order
Do you have any disability? No must accompany this booking
Items in yellow are mandatory to record data in form. Bookings received without
PLEASE READ CAREFULLY: payment/order number will be treated
as provisional that does not guarantee
All cancellations must be in writing and cancellation fees shall apply: a place.
cancellations made 4 weeks prior to the course start date shall be Cheque
charged 50 USA Dollars as administration fee; 50% of the total fees for Cash
cancellations made 2 to 3 weeks before the start of the course; 100%
of the total fees if less than 2 weeks before the course start date. HSSE Made payable to
Solutions LTD reserves the right to cancel the event in case of QNB Heliopolis branch
insufficient registration or illness of lecturers. HSSE Solutions LTD Swift Code:
office will ensure maximum possible notice is given to the attendees Account No.:
and reserves the right to substitute lecturers and modify the course Company Order (PO)____________
details as required. In case of need to postponement the course I Approving Mgr. Name___________
agree to pay the difference of the announced fee by HSSE Solution. Title: ______________________
I hereby acknowledge the above information and agree about.
Signature:_____________________
You can visit Nebosh website through the below link
https://www.nebosh.org.uk/home/
Learner Signature:__________________________
Egypt, Cairo, 65 Hassan El Sherif, El manhal, 8th, district, Naser City, Cairo, Egypt
Tel: +201000072148 / +201220800254
[email protected]
www.hsse-ltd.com
