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NEBOSH Course Registration Form
Enrolment Type
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New Enrolment
Transfer
Student No.
Please select the course
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NEBOSH HSE Certificate in PSM
NEBOSH International General Certificate in OHS(IGC)
Course Mode
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e learning
Live Online
Classroom
In-Company
Date of Birth
Gender
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Male
Female
Part A- Personal Details
Name
Email Id
Telephone Number
Mobile Number
Pan Card
Country
State
Pin Code
Mailing Address
Permanent Address
Part B- Organization Details
Name of Organization
Address of Organization
Highest Qualification details
Email Address
Landline Number
Mobile Number
Country
State
Pin Code
Name to be Appear on Certificate (CAPITAL LETTERS)
Part C- Exam Details
Exam Type
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Fresher
Resit
IGC Type
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IGC 1
IGC 2
Month
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Feb
April
June
August
October
December
PSM Type
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PSM 1
Payment Details
Discount Amount
Total Amount (Tax 18.00 %)
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Registration Confirmation
Thankyou for registering with us.
Your account will be activated after payment confirmation.
Your access details will be sent to your registered Email Id after payment confirmation
