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Course Admission Form for DGR Training

Student Information graph

Date Name of Applicant (as shown in Passport)

25/12/2023 Rashin Hashim Rejilabeevi

Telephone Mobile Email Address

0562183012 rashinh@miccologistics.com

Address
KEZAD A5, Al Mamourah
City State ZIP Code
Abu Dhabi United Arab Emirates

Organization Name Individual  Company 

NOATUM LOGISTICS MIDDLEAST

LLC OPC
Date of Birth
07/08/1989

Contact Person: Noora Almheiri Select Courses

Tel No: FIT 4.1.A/D  FIT 4.1.C 
E mail: noora.almheiri@adports.ae
FIT 4.1.E  FIT 4.1.F/J/K 

FIT 4.1.G  FIT 4.1.B

Course Name: Dangerous Goods Initial  Refresher 

Regulations GCAA FIT 4.1
Did you attend any other courses previously? If Yes, please provide course details
No

Declaration:

I, Rashin Hashim .............................................................. certify that I have read and understood the questions in this form.
The information I have provided in this application is true and accurate.

Applicant’s Signature Date 25/12/2023

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Course Admission Form for DGR Training

Terms & Conditions

1. If the candidate has taken DGR Initial course earlier, provide proof of certificate before being admitted to refresher
course
2. DGR Manual is solely property of Immaculate Training Services. It should be returned after the examination. Any
damage the candidate has to pay to the training Center.

3. It is mandatory that all the documents need to be validated before starting a course. Failure to produce any
documents required by the institute / regulatory authorities will lead to rejection of application.

4. In the event of cancellation, Immaculate Training Services shall not be liable for any other loss or expense arising.
In case of discontinuation of class by candidate once the course is started, no refund will be allowed.

5. Candidate must attend the classes as per the given schedule and loss of class due to no show of candidate,
Immaculate will not be responsible for the lost session.

For Immaculate Training Services Use Only:

Course Details:

Course Name: Duration:

Date of Joining: Date of Completion:

Passport/Visa Copy : 
Emirates ID : 
Photograph : 
Any Other (specify) :

Documents Received:
Yes / No 

Approved Status Approved by Signature

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