e-form

Workplace Health and Well-being Course

Duration: 14 hours (including coffee breaks)
Venue: 17, Edgar Ferro Street, Pietà PTA 1533

Date from:

Date to:

Please complete & submit this application form, enclosing the relative fee of €85 incl. VAT

COMPANY DETAILS

Agency / Department / Company

Address

VAT Number

Telephone

Contact Person

Position

E-mail

Application Date

PERSONAL DETAILS

Name and Surname

E-mail

Designation

ID Card Number

Age

Gender

Telephone

Mobile

METHOD OF PAYMENT

Issuing Bank & Cheque Number

Purchase Order Number

Note: A cancellation fee amounting to half of the participation fee, may, at the discretion of the Authority, be charged when a participant who has confirmed attendance fails to turn up for the course. However, substitute candidates will be accepted. The FULLY COMPLETED application form with the appropriate remittance should be forwarded and made payable to Awtorità Saħħa Sigurtà Post tax-Xogħol, 17 Triq Edgar Ferro Pietà PTA 1533.

You may also fax an advance copy of your application on 21232909 or via email on courses@ohsa.mt.

Applicants are to ensure that proof of Departmental Head approval is attached to the relevant application

The information supplied to OHSA on this form shall be treated in the strictest confidence in terms of the Data Protection Act XXVII, 2001 and subsequent amendments.