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An ISO 9001:2015 & ISO 45001:2018 Certified Training Institute
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Course registration form
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Full Name
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Date of Birth
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Select Gender
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Select Course
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Post Graduate Diploma in Industrial Safety and Management (PGDISM)
Diploma in Industrial Fire Safety Management
Post Graduate Certificate in Industrial Safety and Management (PGCISM)
Industry-Specific Training
Work at Height & Rescue Training
Scaffolding Training
Confined Space Entry & Rescue Training
First Aid Training
Electrical Safety Training
Environmental, Social & Governance (ESG)
Leadership Training Certification
Disaster Management
Defensive Driving Training
Food Safety Training
Forklift Training
Process Safety Management
Highest Qualification
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Bsc
BE
Mtech
ME
MSc
AMIE
Diploma (Department of Technical Education & Industrial Experience)
Name of Institution
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Year of Graduation
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Current Job Title
Have you undergone any Safety Certification or Course?
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Years of Work Experience
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0-2 Years
2-5 Years
5-10 Years
10+ Years
Purpose & Expectation
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DECLARATION
I certify that the foregoing information is correct, and I understand that any false or misleading statement made on this form, or failure to disclose information relevant to this application being rejected/registration being terminated and/or may lead to legal proceedings. I agree to supply information that I am asked for in relation to this application. I understand that this information will be treated in confidence.
CONSENT
"I agree to the terms and conditions of the PGCISM application and understand that incomplete" applications may not be considered."
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