PUBLIC OFFICERS� WELFARE COUNCIL - Excursion � �Gorge View ... - DOC

							                                                                                                                                                    Annex B
                                      PUBLIC OFFICERS’ WELFARE COUNCIL
                   Excursion – Le Pétrin Nature Park and St Felix Public Beach
                                                         APPLICATION FORM
Applicant’s Name: *Mr/Mrs/Miss……………………………….…………………………………………………………………….……………
                                                     (* Delete as appropriate and SURNAME in block letters)

Designation:………………………………………………….Tel Off:………………………….…….(Cell):………….................................

                                                                     Tel (Res):………………………. Fax:…………………..…………………

Ministry/Department: ………………………………………………………………………………………………………………………………..

Office Address: ………………………………………………………………………………………………………………………………………

Residential Address:………………………………………………….……….

Tick as appropriate your option for the Collecting Points below:
            Port Louis                                                                   Réduit, University of Mauritius
            [Government Centre – Nr Queen Victoria Statue] (08 00 hrs)                   (Auditorium) (08 20 hrs)
            St Jean, Quatre Bornes                                                       Curepipe
            [Nr St. Jean Church] (08 20 hrs)                                             [Nr Municipality of Curepipe, opp. St Thérèse Church] (08 30 hrs)

            Pamplemousses
            [Parking-SSR Botanical Garden ] (07 45 hrs)
Accompanied By:
                                                                                             Date of                Lunch                  Amount
                             Name                                    Relationship
                                                                                              Birth            Please Specify*               Rs
  1.
  2.
  3.
  4.
  5.

            Self
                                                                                                                     TOTAL

Note:
(i)          Please produce copies of recent payslip and birth certificates of children below 12 years participating in this excursion.
(ii)         All safety measures for the excursion have been taken by the organisers. However, the Council will not assume any
             responsibility in case of negligence or non-compliance with safety instructions.
(iii)        In case of cancellation, refund will only be considered if the request is made one week prior to the date of excursion.
(iv)         Be assured that all information in the form will be kept confidential.

            *Lunch options:
                 o Fried Noodles (Veg or Chicken); or
                 o Rice with Curry and Salad (Veg or Chicken or Fish))


Date: ………………..…………………………………...                                                     Signature: ………………………….……………………….
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                                                                    For office use only
Amount Paid             ___________________                                                       Receipt No.            _________________