1) Participant's Full Name

df Mobile Phone/ :

2) Company

Branch / Tax ID /

3) Profession

4) Course Title

5) Course Date

Start Date ( ) End Date ()

6) Course Price (Not inc VAT 7%)

7) Form Completed by

Name ( ) Date ( )

8) Request Approved by

Date ( )

9) Address for invoicing

Phone Fax Email

10 ) Address to send documents

10) Food

Thai Food/ Halal Food /

Western Food/

Food Allergies / 11) Transportation

Yes, at/ .......................................... No /

12) This training for working in..

" " Inside Thailand /

Outside Thailand /

Remark/ :Agency : Direct to MOG TPTI

Remark : When returning this completed form to MOGIT , please ensure that you also include the following documents with your booking :

1.One copy of the Participants current Offshore Medical Certificate

2.One copy of the Participants (photo) Proof of Identify (Passport or Identify Card)

! : 1. 2. *Please note that the booking cannot be confirmed unless MOGIT has received the above documents.

* MOGIT !

MOG Industry Training Co.,Ltd 98 Moo 11 T.Tungsukhla

A.Sriracha Chonburi 20230, THAILAND

T: +66 33-006158, +66 33 006159

F: +66 33-006160

E: booking@mogit.org

W: www.mogit.org

Tax ID : 0 2 0 5 5 4 3 0 0 1 5 4 0

STAFF ONLY

Print FormSubmit by Email

Bureau Veritas (Thailand) Ltd. 16th Floor, Bangkok Tower, 2170

2 014-08-22

2 014-08-22

2 014-08-27 2014-08-29

New Petchburi Road, Bangkapi, Huaykwang, Bangkok 10310

+66(02) 670 4800 +66(02) 718 1940

Same as invoice