REGISTRATION

FORM K3 Listrik
Public Training Program :

Date : 16 – 20 Januari 2017

Time : 09:00 am – 17:00 pm

Company Name : PT SINGA MAS INDONESIA
Venue : Tentative
Address : Dusun Rajeg, Sumber Gedang,
Pandaan, Sumber Gedang, Pandaan,
Pasuruan, Jawa Timur
Contact Person : Pak Agusto Sandi Phone/ HP :
Fax Number :
e-Mail Address :

Name of Participants/ Delegates :

1. 4.
2. 5.
3. 6.

SURABAYA – INDONESIA
CONFIRMATION OF REGISTRATION
Signed by :
INVESTMENT : (Name & Position)

IDR 4.200.000,-/participant

Public Training
NOT Include : Accommodation & Transportation
Please fax and Copy
NPWP and REGISTRATION form
Cash Payment to (031) 5039034
Payment by transfer to :
PT. MITRA KUALITAS UTAMA, For more information regarding this public
BCA Oakwood Mega Kuningan, Jakarta training, just email us at:
No acc. 501.503.2488 safii@gosafeacademy.com
or
Note : Cancellation fee within one week before
 Call : safii
the training commencement is 50% from
at (031) 5020203 or 08113601522
investment

Gra ha As ri Blok K – 12B jl . Ngagel 179 – 183 Sura baya, 60246

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