You have the right to ask Emirates Technical & Safety Development Centre

NOT to send such mailings.

METHODS OF PAYMENT (Please indicate)
Full payment and/or Local Purchase Order (LPO) must accompany this
booking form. Bookings received without payment/LPO will be treated as
provisional which does not guarantee a place.

QCI TRAINING BOOKING FORM

Please send back completed form with your payment:
PLEASE USE CAPITAL LETTERS THROUGHOUT

Training Date:

Cheque

DD/MM/YYYY

Cash .

Bank Draft

Training Title:

Payments by cheque, please make payable to:

Location :

Emirates Technical & Safety Development Centre

Please indicate the following information when making payments:
*Invoice Number
*Your Complete Company Name
*IBAN Account Number: AE280330000019000007347 AED
AE830330000019000012177 USD
Payment Details:

Examination
Date
Exam only Option (for IGC re-sits
only)

Paper 1

Paper 2

(for IOSH re-sits only)

Assessment 1

Assessment 2

Title:

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

Family Name:

Masreq Bank , P.O. Box 858

Abu Dhabi, United Arab Emirates
Account No. : 019000007347 AED
019000012177 USD

Payment by cash, please pay in person to Accounts Office at ETSDC office.

Given Name/s:
OR
Date of Birth
(dd/mm/yy):

Local Purchase Order

(LPO) No.:
Approving Manager's Name

Gender:

Title

Nationality:
Telephone No.:
Email Address:
Mailing Address:

PLEASE READ CAREFULLY:

All cancellations must be in writing and cancellation fees shall apply:
cancellations made 4 weeks prior to the course start date shall be charged
AED 180 as administration fee; 50% of the total fees for 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. ETSDC reserves the right to
cancel the event in case of insufficient registration or illness of lecturers.
ETSDC will ensure maximum possible notice is given to the attendees and
reserves the right to substitute lecturers and modify the course details as
required.
FOR OFFICE USE ONLY
Date

Booking No.

Company Name:

Amount paid

Invoice No.

Company Address:

Date of Exam

JI Sent

Emirates Technical & Safety Development Centre

Mussafah Industrial Area, M2, Sector-8, Plot No. 23, Corniche Road
Abu Dhabi, United Arab Emirates
Company Contact No:

Declaration:
I understand that Emirates Technical & Safety Development Centre and its
associated trading companies (and companies, organizations or agents
processing data on its behalf) will hold and use personal data supplied by me
for administration purposes. These purposes have been notified under the
Data Protection Act 1998. The data may also be used to send separate
unsolicited mailings containing details of events, new services, products, etc.

P.O. Box #: 35450

Tel #: +971 02 555 2034
Fax #: + 971 2 5547717
Email: qcico@etsdc.com
Website: www.etsdc.com

Trainee Printed Name & Signature

Date