APPLICATION FORM Please fill in the required details for registration along with 2 passport size photographs.

Please write or type clearly: Please Tick () in the appropriate: PERSONAL INFORMATION
Title (Please Tick () in the appropriate column) Mr Mrs Miss Dr Others

Given Name(As Per Id Proof ) Surname(As Per Id Proof ) House Number : Street Name & Address:

City:

Country :

Postal Code:

Country of Residence :

Date of Birth:(DD / MM / YY)

.

Gender: Please Tick () Male Female

Nationality:

Passport Number :

Landline:

Mobile Number:

Official Number:

E-Mail_ID:

SPECIAL NEEDS OF CANDIDATES If YES() provide appropriate Proof If NO() mention Not Applicable
Do you have any permanent or long term disabilities or temporary disability in performing certain types of work? YES NO Do you have any medical condition or specific learning need? YES NO Is English your second language? What is your first language? YES NO Please Specify:

Please Specify: Please Specify:

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Salmiya Block 12, Building No: 12,Opp. to Yiaco Apollo Hospital, Mughaera Bin Shoba Street, Salmiya, Kuwait. Contact No: 25612657 / Mobile no:+965 67792509. www.nistgulf.com, info@nistgulf.com
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APPLICATION FORM

PROFESSIONAL INFORMATION OUR PRODUCTS Please select the courses you are applying for
CAPITAL SAFETY IOSH NEBOSH CIEH FALL PROTECTION MANAGING SAFELY INTERNATIONAL GENERAL CERTIFICATE (IGC) TRAIN THE TRAINER RISK ASSESSMENT OIL&GAS (IOGC) FIRE SAFETY FIRST AID

COURSE MODE() E-LEARNING CLASSROOM TRANING

EXAMINATION DETAILS (NEBOSH IGC ONLY)

Please indicate the unit examination/s for which you are registering. [Please Tick ()] IGC 1 IGC 2 IGC 3

Please tick the appropriate ID proof to be enclosed ( )

Passport Copy Driving License Others Please Specify:

TO BE FILLED BY NEBOSH IGC & IOGC RE-SIT CANDIDATE ONLY

Course Provider Student Number Date/s of Previous Sitting

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Salmiya Block 12, Building No: 12,Opp. to Yiaco Apollo Hospital, Mughaera Bin Shoba Street, Salmiya, Kuwait. Contact No: 25612657 / Mobile no:+965 67792509. www.nistgulf.com, info@nistgulf.com
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APPLICATION FORM
PRESENT EMPLOYMENT(Name of the Company) DESIGNATION TOTAL YEARS OF EXPERIENCE OTHER HEALTH & SAFETY QUALIFICATION ACADEMIC QUALIFICATION NAME OF THE COLLEGE MONTH OF JOINING HOW DO YOU KNOW ABOUT NIST(Mail/SMS/Internet/Reference/Others) SELF SPONSORED (Yes/No) SPONSORING COMPANY(Name of Company & Address to be mentioned)

BANK DETAILS Account Name: Mohammed Althob Mahaboob Basha Name of the Bank: National Bank of Kuwait (NBK) Location Kuwait Card Number 4644520167446300 Account Number 1005259434 Branch WATYA Country Kuwait

Payment Mode: (Please tick the appropriate box)

Cheque Payment Details: Online Transfer DD Cash

Cheque/DD shall be provided in the name of NIST Institute Private Limited. Online transfer could be done to any of the bank accounts given below.

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Salmiya Block 12, Building No: 12,Opp. to Yiaco Apollo Hospital, Mughaera Bin Shoba Street, Salmiya, Kuwait. Contact No: 25612657 / Mobile no:+965 67792509. www.nistgulf.com, info@nistgulf.com
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APPLICATION FORM

TERMS AND CONDITIONS: Prior registration is required as there are only limited seats. Registration forms, copy of passport, passport size photos should be submitted on or before the last date of every batch. Cancellation should be confirmed in mail as scanned copy duly signed by the candidate or as a hard copy. Cancellation made 2 weeks before the commencement of training will not be refunded at any cost. Cancellation made 3 weeks prior to the commencement of training shall be returned 50% of the registration charges paid. Cancellation made before 4 weeks (and above) prior to the commencement of training will be deducted 15% (admin cost) of the registration charges paid. Any change in schedule must be informed before 2 weeks to the commencement of training to our institute either by e -mail or as a hardcopy duly signed by the candidate. NIST Gulf will cancel the training due to unavoidable situation. However, we will bring the rescheduled course to delegates notice in much advance without any additional charges and if necessary we have rights to change the tutor for any critical situation.

I declare that the information herein is true and correct to the best of my knowledge, I accept the Terms and Conditions within the application document and I understand that this application is subject to approval by NIST. Signature:
OFFICE USE ONLY Reference No:_____________________________ Reviewed by :______________________________Date:_______________________ Month of joining: _________________

Date:

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Salmiya Block 12, Building No: 12,Opp. to Yiaco Apollo Hospital, Mughaera Bin Shoba Street, Salmiya, Kuwait. Contact No: 25612657 / Mobile no:+965 67792509. www.nistgulf.com, info@nistgulf.com
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