Scribd Logo
Upload

Welcome to Scribd!

  • 157 views

    Candidate Details:: Official Use Only

    Uploaded by

    francis
    This document is an invoice for a NEBOSH course from Syed Omar Shah. It requests candidate details like name, gender, date of birth, and contact information. It lists the course fees, payment methods including credit card information, and installment payment details if applicable. The candidate must agree to SHEilds terms, conditions, and payment terms by checking boxes before submitting the form.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Candidate Details:: Official Use Only

    Uploaded by

    francis
    157 views1 page
    This document is an invoice for a NEBOSH course from Syed Omar Shah. It requests candidate details like name, gender, date of birth, and contact information. It lists the course fees, payment methods including credit card information, and installment payment details if applicable. The candidate must agree to SHEilds terms, conditions, and payment terms by checking boxes before submitting the form.

    Original Description:

    form

    Original Title

    nebosh

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document is an invoice for a NEBOSH course from Syed Omar Shah. It requests candidate details like name, gender, date of birth, and contact information. It lists the course fees, payment methods including credit card information, and installment payment details if applicable. The candidate must agree to SHEilds terms, conditions, and payment terms by checking boxes before submitting the form.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    157 views1 page

    Candidate Details:: Official Use Only

    Uploaded by

    francis
    This document is an invoice for a NEBOSH course from Syed Omar Shah. It requests candidate details like name, gender, date of birth, and contact information. It lists the course fees, payment methods including credit card information, and installment payment details if applicable. The candidate must agree to SHEilds terms, conditions, and payment terms by checking boxes before submitting the form.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    Official use only: Date invoice sent:

    INVOICE Number: Payment Method:


    Date Logged on: Photo ID Received:
    Course Advisor: Syed Omar Shah Enquiry From: Please Select

    Candidate details: (please input names only as printed in your official legal documentation, example; Passport )
    First Name(s): Surname:
    Gender (Please tick one): Male: Female: Date of Birth: DD/MM/YY
    Date of application: NEBOSH Candidate Number:
    Course(s) required:
    Correspondence address:
    Telephone:
    Invoicing name/address:
    Telephone:
    Candidate email address:
    Invoicing email address:
    Additional information
    including details of any additional support you may require: for example: Dyslexia / English not being your first language / Disabilities

    Course fees:
    Course(s): AED
    Other Course(s): AED
    Exam registration(s): AED
    Exam sitting fee (s): AED
    Instalment fee(s): AED : Number of instalments at AED 85 per instalment
    Sub Total: AED
    UK VAT: AED Select payment method
    Total: AED : Official company purchase order number

    Instalment information:
    Amount to be debited £:
    Date DD/MM/YY:
    Full payment / Deposit Installment 2 Installment 3 Installment 4

    Credit Card Payment:


    Name (as on card):
    Address:
    Post Code:
    Country:
    Telephone Number:
    Card type: Please Select Issue number:
    16 Digit card number: 3 Digit security number
    Card expiry date: (MM/YY) Card valid from date: (MM/YY)
    Please tick this box to confirm you have read and accept SHEilds terms and conditions.

    Please tick this box to confirm you have read and accept SHEilds payment terms and authorise SHEilds to debit your selected
    credit/debit card on the dates agreed on the instalment information.

    S-013 FZ Enrolment Form Issue 1 26th Sep 2012 PMF Page 1


    www.sheilds.org

    You might also like