SECTION 01: TO BE COMPLETED BY TRAINING AFFAIRS OFFICE
CENTRE NO. 2835 COURSE CODE
START DATE END DATE
COURSE TITLE
SECTION 02: LEARNER INFORMATION [PLEASE USE BLOCK LETTERS]
LEARNER FULL NAME
COMPANY NAME
CONTACT NO.
DATE OF BIRTH
DO YOU HAVE VANTAGE NO. ☐ YES ☐ NO
LEARNER VANTAGE NO.
PLACE OF BIRTH
TOWN / CITY
COUNTRY / STATE
EMAIL ADDRESS
EMERGENCY CONTACT NAME
EMERGENCY CONTACT NUMBER
OPITO Confirms that the information given on this form will be entered in a computerized
register which will be available to employees’ prospective employers, and training
providers 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 principles laid down in the
Data Protection Act, 1998.