bizSAFE Level 3 Registration Form PART A: COURSE INFORMATIONCourse Title BizSAFE L3 - Risk Management Awareness Course Start Date *27 Dec 201324 Jan 201421 Feb 201421 Mar 201425 Apr 201423 May 201420 Jun 2014 Time 1400hrs to 1600hrs Venue No. 6 Ubi Road 1 #02-10 Wintech Centre Singapore 408726 PART B: CONTACT PERSONCompany Name * Contact Person * Contact Number * Designation * Email * Billing Address *AddressAddress Line 2CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountry PART C: PARTICIPANT DETAILSName (as in NRIC/Fin) * Nationality NRIC/FIN No * Designation Email Address * File Upload *Upload the Group Registration Form here (.doc or .docx format) Terms and Conditions International Safety Resource Centre Pte Ltd (ISRC) is committed on maintaining the confidentiality of the applicant’s personal information and undertakes not to reveal any of the applicant’s information to any 3rd party without prior written consent of the applicant. The registration form and payment must be submitted personally or by post at least 2 weeks before the commencement of the course. • Post address: No. 6, Ubi Road 1, #02-10 Wintech Centre, Singapore 408726 • Cheque Payable: International Safety Resource Centre Pte Ltd The course schedule selected is subjected to confirmation. ISRC reserves the rights to withdraw, re-schedule or cancellation of the class without prior notice. ISRC reserves the rights to collect full course fee (without refunding), based on the followings: - Trainee achieve less than the minimum attendance required by the course - Trainee fails to sit for the required examinations / assessment where applicable Request of Deferment / Transfer / Replacement / Withdrawal of Courses: - For deferment of courses, a written notice must be submitted and received by ISRC at least 7 working days before course commencement - For replacement of courses, a written notice, together with the full particulars of the new participant, must be submitted and received by ISRC at least 3 working days before the course commence - An administrative fee of $50 will be imposed on such changes. Cancellation Charges - 5% % of course fee will be imposed if Notification of Cancellation is received in writing at least 7 working days prior to the program. - 100% of course fee will be imposed if Notification of Cancellation is received in writing less than 7 working days prior to the program. For Trainees: - Must bring along safety boots / safety shoes for the practical lesson throughout the duration of the course. - Please bring along a copy of the course confirmation notification and NRIC/Fin card at all times when attending the course. - Trainees are advised to be punctual for the course duration and during the day of assessment. Late participants may be barred from entering or taking the assessment. - If trainee is found cheating, trainee will be barred from the assessment and ISRC will reserve the rights to take necessary actions. - Trainee who passes the assessment is to collect the certificate within 1 month after notifying for collection. If the certificate is not collected, it will be destroyed without prior notice. - Trainee who has lost or damaged their certificate will need to write in to ISRC for replacement and an administrative fee of $20 will be imposed. ISRC endeavors to provide a safe training centre for their trainees, staff and all visitors. However, ISRC will not be responsible for any injury, loss, damaged of property belonging to trainees within ISRC premises. ISRC reserves the right to accept or reject or terminate candidates applying / during the course duration PART D: DECLARATION Upon submission, I affirm that all information given in this registration form is true and accurate to the best of my knowledge, and that I have not deliberately omitted any relevant fact. I understand any false or misleading declaration shall make me liable for disqualification, or if already admitted, for expulsion from the program without any refund of fees paid. I have understood all the terms and conditions as stated above. I agree to comply and abide by the decision of International Safety Resource Centre Pte Ltd concerning this application. *Yes, I Agree.