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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

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 ()
2014-08-29

2014-08-27

6) Course Price (Not inc VAT 7%)

7) Form Completed by

Name ()

Date ()
2014-08-22

Date ()

8) Request Approved by

9) Address for invoicing

2014-08-22
Bureau Veritas (Thailand) Ltd. 16th Floor, Bangkok Tower, 2170
New Petchburi Road, Bangkapi, Huaykwang, Bangkok 10310

Phone

Fax

10 ) Address to send documents

10) Food

11) Transportation

12) This training for working in..

" "

Email

+66(02) 718 1940

+66(02) 670 4800

Same as invoice

Thai Food/ Halal Food /

Western Food/
Food Allergies /
Yes, at/ .......................................... No /
Inside Thailand /
Outside Thailand /

Remark/
STAFF ONLY

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
!