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SAFETY. HEALTH. ENVIRONMENT

Training & Education

NEBOSH INTERNATIONAL GENERAL CERTIFICATE

BOOKING FORM
NEBOSH IGC course is delivered in association with the lnternational HSE Council LLC

Location:

Training Date:

Exam only option

(for re-sit only)

tccl E

NEBOSH candidate no.

tcc2 n

tcc3 E

Date of last exam

(if any)
CENTRE

where you last

sat the IGC exam

Title

Dr./ Mr./ Mrs./ Ms./ Miss

Family Name

Gender

MlF

Tel. No. (R)

Company Address

Mailing Address

Course Fee

Payment

Cash / Cheque No.:

Bank Draft:

Amount Paid

Balance

Signature
Note:
Payment by cheque or bank draft, please make payable to CONSIST CENTRE 5DN BHD
Upon submission ofform, please attach photocopy of i.c/passport and Employment Contract.
All cancellations must be in writing and cancellation fees shall apply: cancellations made 4 weeks prior to the course start date shall be charged RM500.00 as
administration fee;5070 of the total fees for cancellations made 2 to 3 weeks before the start of the course; 1 00% of the total fees if less than 2 weeks before the
course start date. CONSIST reserves the right to cancel the event in case of unsufficient registration or illness of lecturers. CONSIST will ensure maximum possible
notice is given to the attendees and reserves the right to substitute lecturers and modiry the course details as required.