Course Details Contact Person Name BCLS+AED Certification (0800 1700hrs) – Course Title BCLS+AED Re-Certification (0800 1300hrs) – Organisation & Department Others (Please indicate):__________________________ Course Date Email Address Remarks Contact No. Participant Details (Please complete all sections and attach copy of current BCLS+AED certificate, if any) Latest BCLS+AED Certificate Employee (For BCLS+AED Re-certification Department & NRIC / FIN / SNB / No. S/N Full Name Contact No. Email Address application only) Designation Passport No. MCR No. (For SGH Issue Date staff only) Institution (DD/MM/YYYY) SGH-IAN 1 Others SGH-IAN 2 Others SGH-IAN 3 Others Payment Method (Please select one option only) Attention To _________________ SGH COST CENTRE: Billing Organisation (For SGH only) (Please write in full) Billing Department By CASH By INVOICE Billing & Mailing By CHEQUE (Payable to: General Hospital Pte Ltd”) “Singapore (All Address institutions) By INVOICE (MOHH) Purchase No. (For doctors employed under MOHH) (if any) By providing the information set out in this form and submitting the same to you, I confirm that I have read, understood and consent to the SingHealth Data Protection Policy, a copy of which is available at .
Course Details Contact Person Course Title BCLS+AED Certification (0800 – 1700hrs) BCLS+AED Re-Certification (0800 – 1300hrs) Others (Please indicate):__________________________ Name Organisation & Department Course Date Email Address Remarks Contact No. Participant Details (Please complete all sections and attach copy of current BCLS+AED certificate, if any) S/N Employee No. (For SGH staff only) Full Name Department & Designation NRIC / FIN / Passport No. SNB / MCR No. Contact No. Email Address Latest BCLS+AED Certificate (For BCLS+AED Re-certification application only) Issue Date (DD/MM/YYYY) Institution 1 SGH-IAN Others 2 SGH-IAN Others 3 SGH-IAN Others Payment Method (Please select one option only) SGH COST CENTRE: _________________ (For SGH only) By INVOICE (All institutions) Attention To Billing Organisation (Please write in full) By CASH Billing Department By CHEQUE (Payable to: “Singapore General Hospital Pte Ltd”) Billing & Mailing Address By INVOICE (MOHH) (For doctors employed under MOHH) Purchase No. (if any) By providing the information set out in this form and submitting the same to you, I confirm that I have read, understood and consent to the SingHealth Data Protection Policy, a copy of which is available at .