GREENWICH TRAINING & CONSULTING

COURSE BOOKING FORM

PERSONAL INFORMATION

Please write your name as per your legal document(s)

Given Name(s): (as per ID proof)
Surname: (as per ID proof)
Please note in certain circumstances changes to your name or spelling after registration may incur extra charge.
Date of Birth: (DD/MM/YY)
Nationality:
CNIC / Passport No.
Occupation:
Sex:

CONTACT INFORMATION
House No. Street No.
Main Address:
City:
Country:
Work Telephone:
Mobile:
Email:

COURSE DETAILS
Please tick where appropriate
Course Title: NEBOSH INTERNATIONAL GENERAL CERTIFICATE (2018/2020 Specification)
Method of Study: Full time/block-release Part Time Open & Distance Learning

NEBOSH Exam
Fresh or Resit/s*: Fresh Re-sit
Course Location:

NEBOSH EXAM RESIT/S*

Are you a Greenwich learner? Yes No
If no, please provide the learning partner name:
What is your NEBOSH Learner Number?
When did you take the exam?
Please indicate by tick () the box(es) below, the unit of examination/s for which you are registering
IG1: Management of health and safety
IG2: Risk assessment
Date of completing this form:

Please note:

1. This form will not be accepted without complete information, legal signature and course payment.
2. We treat all the information according to our privacy policy. Your information will not be shared with
any third party without your prior consent.

Learner’s Signature: _______________________________