Onsite Booking Form

Person REsponsible for payment

First Name

Surname

Email Address

Group Options

Delegate Information

Select Course

Starting Date

Please add Delegate/s information.

Full Name as will be printed on the Certificate
Date of Birth and ID Number are optional if client wants it represented on certificate.

Please note:
We are not responsible for spelling mistakes or incorrect information.

Full Name and Surname

Date of birth (optional see note above)

ID Number (optional - see note above)

Cell Number

Email Address

Remarks

In accepting this the booking, we hereby indemnify Top Compliance (Pty) Ltd, its affiliated companies, directors, shareholders, agents (whether authorised or not), employees, servants, representatives and officers (“Top Compliance (Pty) Ltd”) for any claim that may arise against Top Compliance (Pty) Ltd for any loss, damage (including direct, indirect and consequential damages and/or loss of profits), costs (including legal costs on the scale as between attorney and client and any additional legal costs), expenses and/or liability (whether actual, contingent or otherwise) of whatever nature and however arising or caused (including liability in terms of section 60 and 61 of the Consumer Protection Act, 68 of 2008), which Top Compliance (Pty) Ltd or any third party may suffer, incur or sustain or which may arise, directly or indirectly as a result of the personal injury or death of our employees and/or representatives whilst they undertake training presented by Top Compliance (Pty) Ltd.

I have read and hereby agree to the above Terms and Conditions.

Thank you for your application

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