PHILIPPINE CENTER FOR ADVANCED MARITIME SIMULATION AND TRAINING, INC.
REGISTRATION FORM
DATE ENROLLED: SRN/Vantage Number :
COURSE: FROM: TO: FEE:
RANK/NAME:
RANK SURNAME FIRST NAME MIDDLE NAME
CONTACT NO. : EMAIL ADDRESS:
ADDRESS :
NO./STREET BRGY./TOWN CITY/PROVINCE
DATE OF BIRTH: PLACE OF BIRTH: AGE:
(MONTH / DAY / YEAR)
PERSON TO CONTACT IN CASE OF EMERGENCY : RELATIONSHIP:
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
RANK/NAME: _ CONTACT NO. :
COMPANY/PRINCIPAL : COURSE:
CP (CHARGE TO PRINCIPAL) CREWING MANAGER/MPA : ASSIGNED VESSEL:
SD (SALARY DEDUCTION) ASSIGNED VESSEL : MPA /CREWING MANAGER:
CR (CHARGE TO CREW) CASH OR NO. : DATE: AMOUNT:
ADMISSION SLIP
COURSE: FROM: TO: FEE:
RANK/NAME: _ 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.
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 schedule. 50% of the course fee
All courses During the first day of the training schedule 100% of the course fee
