Vehicle Accident Damage Assessment and Claim Submission Procedure Registration Form Fill in Information Select training course date* ---9 & 10 December 2020 Name as in NRIC / Passport* NRIC / FIN NO.* Date Of Birth (dd/mm/yyyy)* Nationality* Race* Gender* MaleFemale Email* Contact No* How did you get to know about this course?* ---EmailFacebookGoogleRecommended by Friend/AcquaintanceRecommended by IA StaffIABN (Impact Analysis Business Networking)Others Billing Email Address* (The invoice will be sent to this email) Billing Address* Zip / Postal Code* Country* AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe I declare that the above information and the supporting documents attached are true and correct to the best of my knowledge. I have read and agreed to the Terms and Conditions and I understand that any false or misleading that may cause Impact Analysis Consulting Pte Ltd not being able to claim the course funding will make me liable to pay for the full course and assessment fee. I agree to comply and abide by the decision of Impact Analysis Consulting Pte Ltd regarding this application. I am aware that this is only indication of my interest for the course and does not guarantee me a seat till I complete my registration at Impact Analysis Consulting Pte Ltd. Personal Data Protection Act (PDPA) - Customer Consent* I hereby agree and consent that Impact Analysis Consulting Pte Ltd may collect, use and disclose my personal data, which I have provided in this form, for one or more of the purpose as stated in Impact Analysis Consulting Pte Ltd Personal Data Protection Terms and Conditions, which in summary includes but is not limited to the following: i) Processing my course registration and ii) Sending me marketing, advertising and promotional information about other products/services the Impact Analysis Consulting Pte Ltd may be offering by way of Email/Call/Message. In case you may want to withdraw from further receiving updates and marketing messages from Impact Analysis Consulting Pte Ltd, you may either: a) write a letter of withdraw of consent and send to our office address. b) send an SMS to +65 63851171 or email to email@example.com.