New Course Booking Form

FORM 4.1 SCI MARITIME TRAINING INSTITUTE POWAI, MUMBAI COURSE BOOKING FORM PARTICIPANT’S NAME : __________________________________________________________________________________ RANK : _________________COMPANY ________________ DATE OF BIRTH ______________________________________ P.C.NO. ______________ C.D.C.NO.______________ INDIAN PASSPORT NO.______________________________________ (For SCI only) CONTACT ADDRESS _____________________________________________________________________________________ PHONE NO.:_____________ Email ID:_______________ COURSE BOOKED BY ______________PHONENO_______________ CONTROL NO.

COURSE NAME

Res. / Non.Res

FROM

TO

FEES (RS.)

ELIGIBILITY

SEAMEN’S PACKAGE 101

PSSR

102

PERSONAL SURVIVAL TECHNIQUES

103

PROF.IN ELEMENTARY FIRST AID

104

FIRE PREVENTION AND FIRE FIGHTING

105

PROF.IN MEDICAL FIRST AID

106

ADVANCED FIRE FIGHTING

121

OIL TANKER FAMILIARIZATION

122

CHEMICAL TANKER FAMILIARIZATION

123

LPG TANKER FAMILIARIZATION

124

LIQUEFIED GAS TANKER OPERATION

126

SPECIALIZED TANKER SAFETY

127

MEDICAL CARE

140

TFI ( GENERAL )

141

TOTA

142

TFI ( MARINE ENGINEERING )

160

GMDSS -GOC

183

PASSENGER SHIP FAMILIARIZATION

188

SHIP SECURITY OFFICERS

309

ISM

Part Payment Paid vide receipt No:____________ Dtd : _______

DD.NO._______________

BALANCE / TOTAL Rs:

DATED________________ DRAWN ON _________________________________________________________ SIGNATURE ( Candidate / Representative )

COURSE BOOKING OFFICE PARTICIPANT’S ELIGIBILITY FOR THE COURSES CHECKED : COURSE BOOKING OFFICER’S SIGNATURE _______________________ FEE RECEIPT NO .______________________DATE ____________

24.10.2007 / 04

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CASHIER’S SIGNATURE_________________________