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 [email protected]
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.
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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
