hse registration form
DESCRIPTION
educaionTRANSCRIPT
REGISTRATION FOR ENROLMENT INTO THE BRITISH HSE LEVEL 1-3 TRAINING & EXAMINATION
The information required will help in assessing your suitability for the admission into BRITISH INTERNATIONAL HSE LEVEL 1 – 3 training program and will be treated as strictly confidential. You should therefore complete this form carefully
Please read this instructions carefully before you fill this form:
1. Please ensure this form is filled and submitted at least 2 weeks before the commencement of the training. Confirm from the
course time table.
2. The cost of this 3 levels is N35,000. This fee covers the training, course materials and the exams for the 3 levels.
3. Interested Candidates can pay this fee in 2 installments in this order: N20,000 before your training commences; another
N15,000 before your exam comes up (exam usually comes up 2 weeks after training ends).
4. Please complete this form and email it back to this address: [email protected] or [email protected]
5. if you wish please note that you can also submit this form in hard copy to our training centers (PH center – Suite 21 Opus
plaza 21 Afam street D/line) (Lagos center – 3rd Floor, AA Plaza, 2 Akin Osiyemi Street Off Allen Avenue Ikeja)
6. When we receive your form, we will send you an invoice containing the payment instruction.
7. If you require further clarification please reach us on 08166081719 (Port Harcourt & Delta); 08064842655 (Lagos & Osun);
07083911259 (Akwa Ibom & Cross Rivers & Abuja); 07031801844 (Bayelsa & Imo).
PERSONAL DETAILS
Surname
Forenames
Date of Birth (dd/mm/yyyy)
Gender
Marital Status
Contact Address
City Nationality:
Mobile number:
Email:
EDUCATIONHighest Qualification obtained Institution Attended Year of Passing
TRAINING SCHEDULE
Choose location of trainingPH
Indicate Date of trainingJan Feb Mar
Lagos Apr May Jun
Abuja Jul Aug Sept
Accra Oct Nov Dec
DECLARATION
I, Mr/Mrs/Miss
hereby declare
(a) that the infomation given in this form is, to the best of my knowledge accurate in every detail;
(b) that if I am shortlisted for the training & examination, I shall keep the rules and regulations of Novelle Innovation Center Ltd
(c) and if at any time it is discovered that the information I have given is false or incorrect, I will be made to forfeit writing all examinations
and(or) possible admission
ADDITIONAL INFORMATION
How did you hear about Novelle Center?Facebook Twitter Google
(please indicate with either a YES or NO)News paper Word of mouth Safety conference
Ukhse.org site Other online sites Nairaland
PAYMENT OPTION
Please choose preferred payment plan 1 time full payment
2 instalment payment
Candidate: PRINT NAME HERE
Insert Date here:
BANK DETAILSAccount Name: Novelle Innovation Center
Bank: First Bank of Nigeria (FBN) Account Number: 2021183555
Bank: Guaranty Trust Bank (GTB) Account Number: 0128813556
Are you a serving NYSC Corp member? If yes
To receive automatic discount for this certification course insert your State code here
State Code: