NEBOSH IGC

VIRTUAL CLASS ENROLMENT FORM

Student Details

Full Name YEOUN Dimitri Doris Stane

Address Cote d'ivoire, Abidjan, Koumassi Sogefiha

Mobile phone number(s) +225 07 49 31 42 50

WhatsApp number +225 07 49 31 42 50

Email syddimitri@gmail.com

Date of Birth 17/12/1988

Candidates Personal Information

Terms and Conditions.

1. I confirm I have a reliable internet connection for the virtual class

2. I confirm I have a backup internet connection just in case my internet connection fails
3. I can confirm I have a reliable and a stable power supply for the virtual class
4. I can confirm that I have a backup power supply for my laptop or tablet just in case I get a power
failure.

I hereby declare that I have read, understand and agree to Ebecks Systems Terms and Conditions listed above.

Student Signature:
Date:

, Please return completed forms to info@ebeckssystems.com as soon as possible

FOR.EBS.IGCV-001 Rev.:01 (01/04/2021)

. P. O. Box TK 348, Tarkwa www.ebeckssystems.com info@ebeckssystms.com mobile: 0244172201