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    Registration Form

    Uploaded by

    Rusell Tanega
    This document contains a registration form for Engine Cadet Russel Tanega to attend a Cyber Risk course at the Philippine Center for Advanced Maritime Simulation and Training from August 11, 2022 to August 11, 2022. It includes his personal details, emergency contact information, medical attestation, billing information, admission slip, and course policies. Upon completion, his training records will be forwarded to the Central Register and made available to potential employers to verify.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Registration Form

    Uploaded by

    Rusell Tanega
    106 views2 pages
    This document contains a registration form for Engine Cadet Russel Tanega to attend a Cyber Risk course at the Philippine Center for Advanced Maritime Simulation and Training from August 11, 2022 to August 11, 2022. It includes his personal details, emergency contact information, medical attestation, billing information, admission slip, and course policies. Upon completion, his training records will be forwarded to the Central Register and made available to potential employers to verify.

    Original Title

    REGISTRATION FORM (1)

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    This document contains a registration form for Engine Cadet Russel Tanega to attend a Cyber Risk course at the Philippine Center for Advanced Maritime Simulation and Training from August 11, 2022 to August 11, 2022. It includes his personal details, emergency contact information, medical attestation, billing information, admission slip, and course policies. Upon completion, his training records will be forwarded to the Central Register and made available to potential employers to verify.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    106 views2 pages

    Registration Form

    Uploaded by

    Rusell Tanega
    This document contains a registration form for Engine Cadet Russel Tanega to attend a Cyber Risk course at the Philippine Center for Advanced Maritime Simulation and Training from August 11, 2022 to August 11, 2022. It includes his personal details, emergency contact information, medical attestation, billing information, admission slip, and course policies. Upon completion, his training records will be forwarded to the Central Register and made available to potential employers to verify.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    PHILIPPINE CENTER FOR ADVANCED MARITIME SIMULATION AND TRAINING, INC.

    REGISTRATION FORM

    DATE ENROLLED: 11 AUG 2022


    ___________________ 9603110107
    SRN/Vantage Number :____________________________

    CYBER RISK 11AUG 2022 FEE: ______________


    11AUG 2022 TO: _________________
    COURSE: _________________________________________________ FROM: ________________

    RANK/NAME: Engine Cadet TANEGA RUSELL ZUNIEGA


    _____________________________________________________________________________________________________________
    RANK SURNAME FIRST NAME MIDDLE NAME

    09565935179 ruselltanega@gmail.com
    CONTACT NO. : _________________________________________ EMAIL ADDRESS: ________________________________________________

    ADDRESS : LOT 9 MAGTANONG SUBDIVISION CALAYLAYAN ABUCAY BATAAN


    ______________________________________________________________________________________________________________
    NO./STREET BRGY./TOWN CITY/PROVINCE

    DATE OF BIRTH: MAR 12 1996


    _________________________ PLACE OF BIRTH: BALANGA BATAAN
    _________________________________ AGE: _________________________ 26
    (MONTH / DAY / YEAR)

    ROSEMARIE TANEGA/ALFREDO TANEGA


    PERSON TO CONTACT IN CASE OF EMERGENCY :_________________________________RELATIONSHIP:______________________________ PARENTS
    09614293546
    CONTACT NO: ________________________________

    Data Privacy Clause


    Any personal information provided by enrollee will be used in processing requirement with STCW MARINA, TESDA, Trainee Insurance
    and record purposes only, in compliance with “Data Privacy Act of 2012”.
    I hereby gives consent to the collection, processing, transmission and storage of personal data by PHILCAMSAT Inc.

    Medical Attestation
    I hereby state that I have not undergone any major surgical operation for the past 12 months and don’t have any medical condition that
    may limit my participation in the practical activity required by the course and PHILCAMSAT (including its employee) is not liable if I
    withheld the information which resulted to any injuries that may happen.

    ________________________________________ ( I have read, understood and consented the Data Privacy Clause, Medical Attestation, Policies at
    SIGNATURE OF TRAINEE the back page of Admission slip and for OPITO learner, this also includes the clause at the back of
    Registration form)

    ________________________________________
    REGISTRAR
    Form No. 108-01 14 February 2022- 08

    BILLING SLIP
    ENGINE CADET RUSELL TANEGA
    RANK/NAME: ______________________________________________________________________ 09565935179
    CONTACT NO. : ________________________
    JEBSENS PTC (DOUBLE FANTASY) CYBER RISK
    COMPANY/PRINCIPAL :______________________________________________________ COURSE:______________________________________

    CP (CHARGE TO PRINCIPAL) CREWING MANAGER/MPA : _______________________________ ASSIGNED VESSEL: __________________

    SD (SALARY DEDUCTION) ASSIGNED VESSEL : ___________________________ MPA /CREWING MANAGER: _______________________


    11 AUGUST 2022
    CR (CHARGE TO CREW) CASH OR NO. : _____________________ DATE: _____________________ AMOUNT: ______________________

    ADMISSION SLIP

    CYBER RISK 11 AUGUST 2022 11 AUGUST 2022


    COURSE: _________________________________________________ FROM: ________________ TO: _________________ FEE: ______________

    RANK/NAME: ENGINE CADET TANEGA RUSELL


    ______________________________________________________________________ 09565935179
    CONTACT NO. : ________________________

    _________________________________________ ( I have read and understood the Policies at the back page of Admission slip)
    SIGNATURE OF TRAINEE

    ________________________________________
    REGISTRAR

    Note: Please see policy and other guidelines at the back for reference.
    FOR OPITO COURSES ONLY

    Upon Completion of the course, the details you provided will be forwarded by the Philippine Center for Advanced Maritime Simulation and Training, Inc.
    (PHILCAMSAT) to the Central Register with the issue date, expiry date and your course certificate.

    Offshore Petroleum Industry Training Organization and PHILCAMSAT confirm that the information on this form will be entered in a computerized
    register, which will be available to employers or prospective employers in the offshore petroleum industry so that they may verify your training records. At
    all times, use of this data will be strictly in accordance with the principles laid down in the Data Privacy Act of 2012.

    ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

    We verify that the registered person completed the course indicated above with CERTIFICATE NUMBER: ___________________________

    ENCODED BY: ____________________________________ _______________________________


    (Signature over printed name) DATE (DD/MM/YYYY)

    POLICIES
    1. Trainees are given a fifteen (15) minutes grace period. When a trainee is late for more than 15 minutes, he/she will not be accepted at the class.
    2. Trainees are required to present the admission slip of the registration form to the instructor on the first day of the class.
    3. PHILCAMSAT may cancel such course due to force majeure or if minimum number of participants is not met. The center shall reschedule and
    communicate the same to client representative (ie. Crewing manager, marine personnel assistant ) within one (1) business day.
    4. Non appearance on the first day without notification from client representative will forfeit the payment made for cash and charge the sponsor if
    charge to principal.
    5. Trainee and/or client representative shall inform PHILCAMSAT of the cancellation by phone or e-mail at least three (3) working days prior to start
    of the training. Corresponding fee and charges may apply.

    Duration of Course Cancellation Period Corresponding Charges /Fees


    All courses Two (2) working days before the training schedule 25% of the course fee
    One (1) working day before the first day of the training
    All courses 50% of the course fee
    schedule.
    All courses During the first day of the training schedule 100% of the course fee

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