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
IGC re-sits only) agents processing data on its behalf)
 Nebosh IGC Assessment 1 Assessment 2 will hold and use personal data
Name: (as it appears on your ID photo / passport) – (Family Name, supplied by me for administration
Given Names): Some One purposes. These purposes I have
been notified under the Data
Date of Birth (dd/mm/yy): 01/01/1995 Protection Act 1998. The data may
Gender and Nationality Pakistani also be used to send separate
Permanent Private Address: Islamabad, Pakistan unsolicited mailings containing
details of events, new services,
Private phone No.: +92 344 552 6654
products, etc. You have the right to
Cellular phone No.: NA
ask HSSE Solutions LTD NOT to send
Email Address: [email protected]
Second address: such mailings.
Company Name: NA
Contact Name: NA
Telephone No.: NA Fax No. NA
Email Address: NA
Invoice Address NA METHODS OF PAYMENT
(if different from the above): (Please indicate)
Do you have any learning difficulty? NO Full payment and/or Company Order
Do you have any disability? NO 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
All cancellations must be in writing and cancellation fees shall apply: guarantee 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 office Swift Code:
will ensure maximum possible notice is given to the attendees and Account No.:
reserves the right to substitute lecturers and modify the course details Company Order (PO)____________
as required. In case of need to postponement the course I agree to pay Approving Mgr. Name___________
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