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APPLICATION FORM CEP-2

The document is a registration form for the Rig Tech Oil Field Training Center, requiring personal details, academic qualifications, and payment information. It includes terms and conditions for trainees, emphasizing attendance, discipline, and non-refundability of fees. The form must be filled out and submitted via email along with required documents and payment confirmation.

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safetyofficernafaco
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10 views

APPLICATION FORM CEP-2

The document is a registration form for the Rig Tech Oil Field Training Center, requiring personal details, academic qualifications, and payment information. It includes terms and conditions for trainees, emphasizing attendance, discipline, and non-refundability of fees. The form must be filled out and submitted via email along with required documents and payment confirmation.

Uploaded by

safetyofficernafaco
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 3

Please affix your

passport size
photograph here.
REGISTRATION FORM
(Please read instructions on the third page BEFORE filling up this form)

For office use only


Application No : Dt :
Admission No :
SELECT CHOICE OF DATE: From To

Name of candidate ( FULL NAME ) :


Peer Mohamed A
Age/Date of birth: Age: D.O.B (dd-mm-yyyy) 25-12-1999
Name of parent/guardian/spouse: Amuthu
Contact number of Father/guardian/spouse: 9944778891
CORRECT PERMANENT ADDRESS Pin Code :627807
Address: 8/70, Kpm nagar Nationality : Indian
Address :Manaloor saalai Religion :Muslim
Address :panpozhi Land line with STD code :
District :Tenkasi Mobile No :7010393274
State :Tamilnadu Email
ID :[email protected]

ADHAAR CARD NUMBER:


ACADEMIC QUALIFICATIONS
Year of Percentage
Sl No Name of Certification Board/University
Institution passing Marks

1 SSLC MKVK matric Hr. Sec State Board 2015 92

2 XII / PLUS TWO MKVK matric Hr. Sec State Board 2017 80

3 Subject :
Choose an item.

4 Subject :

DETAILS OF PAYMENT MADE BY APPLICANT FOR REGISTERATION


OUR BANK ACCOUNT DETAILS Mode of payment Online (Google Pay)
Google Pay : 9952878891
NAME : RIGTECH OIL FIELD TRAINING CENTER PVT LTD Payment details :
STATE BANK OF INDIA
PERUMANOOR BRANCH ,KOCHI- 682015
A/C No: 31415705444, Rs Pc
IFSC - SBIN0008660 Amount transferred
5000
s

TERMS AND CONDITIONS F/EDU/001

1. Trainees are required to be present at the stipulated time on all class days.
2. Any unauthorized absence will not be allowed and adequate written explanation will have to be provided before the next attendance into
the class.
3. Indisciplined trainees will have to face penal measures, including expulsion from the institute. Trainees expelled on penal grounds will not
be eligible to receive refund of the course fee.
4. Trainees, who discontinue from the course on their own, shall do it at one’s own risk and responsibility and, they will not be eligible for any
claim for refund of the course fee.
5. All trainees will be subject to new rules and regulations laid out by management of the institute from time to time as deemed fit for changing
scenarios and circumstances. They will be intimated to the students through mail
6. The director board of the institute reserves the right to alter the syllabus, the timings of the courses, its duration, fee structure and other
charges as deemed fit for changing requirements of the oil & gas industry.
7. The director board of the institute, reserves the right to reject any application for admission, without stating any reasons.
8. Any dispute, arising out of the rules and regulation laid down by this institute, will be considered and decided by the director board of the
institute.
9. Kochi will be the jurisdiction for all legal matters pertaining to this institute.
10. The institute will have the right to use photographs of its trainees for publication in journals/brochures.
11. The medium of instruction will be English.
12. I have read and understood all the above Terms and conditions and I agree to abide by them, in the true spirit of righteousness and self
discipline.

Declaration

I...............Peer mohamed ......................................................son of ......................................Amuthu.................................hereby declare


that I am an applicant for the above course at Rig Tech Oil Field Training Center. I have fully studied the course details, contents, fees
and related details. I am also aware of that the fees once paid is not refundable. I undertake to abide by all the rules and regulations
of the institute.

Signature of the applicant ...........................A.Peer Mohamed..............................

Place ..........Panpozhi............................................. Date:18-02-


2021 ...............................................

For Office use only

Certificate verified : ID proof 10 th certificate Educational certificate Vision Certificate

Received Rs. ................................................( in words ) ...........................................................................................

.........................................................................................................by Cash / DD / Online transfer on ......................

Towards ......................................................................................................................................................................

Authorised Signatory :

Sign ............................................. Date : ..............................................


1. This form has to be filled up and mailed back to [email protected]
2. Drop down selections are given on cells showing “Choose an item”.
3. Do not alter the alignment of cells or font sizes in this form.
4. The contact number of parent/guardian/spouse is important for emergency
purposes as and when required. Please furnish accurate details only.
5. Electronic transfers of cash for registration can be done by crediting the
registration amount, directly into our account
6. Very briefly describe the type/nature of work if you are a person with experience.
7. Applicants are required to furnish the following documents

1. Scanned copy of your 10th and 12th certificate


2. Scanned copy of your last educational certificate
3. Scanned copy of your Aadhar card
4. 3 Latest passport size photograph with WHITE back ground

CONFIRMATION OF PAYMENT CREDITED TO OUR BANK BY YOU, CAN ONLY BE GIVE AFTER WE HAVE RECEIVED
INTIMATION OF DEPOSIT OF THE AMOUNT, BY CALLING UP DIRECT TO OUR OFFICE OR OVER OUR MAIL. THE WRITTEN
CONFIRMATION OF RECEIPT OF YOUR PAYMENT AND ADMISSION INTO THE COURSE, IS ALWAYS GIVEN OVER YOUR
MAIL. SO KINDLY FURNISH ONLY A VALID AND ACTIVE EMAIL ID.

FOR FURTHER CLARIFICATIONS


CONTACT
RIG TECH OIL FIELD TRAINING CENTRE PVT LTD
COCHIN-15

9946439394
E MAIL : [email protected] ; [email protected]

Updated on April 2020

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