Enrolment Form


    HydroChloroFluoroCarbon (HCFC) Phase-out Management Plan (HPMP) – Stage III, India
    Refrigeration and Air Conditioning (RAC) Servicing Sector


    Two days RAC Technicians Training, organized by GIZ Proklima India, in collaboration with the Ozone Cell,
    Ministry of Environment, Forest and Climate Change (MoEFCC), Government of India


    Theme: Good Service Practices during installation and repair of room air conditioners with
    HFC-32, HCFC-22 and flammable refrigerants.


    Participant Information Sheet

    Name of Training Partner/ Training Provider*

    Place / Venue of RAC technician training with name of City, District, State/ Union Territory, Pin Code*

    Day and Dates of 2 days RAC Technicians Training (DD/MM/YYYY)*


    To be filled by participants (IN CAPITAL LETTERS)

    Name of Participant*

    Gender

    Your mobile number*

    Email*

    Age (Years)

    Work experience in RAC (Years)*

    Your highest qualification*

    Your current Designation*

    Name of your Organisation*

    Address of your Organisation including City, District, State/UT, Pin Code, company Telephone/Mobile and Email*

    Equipment Information

    An estimated number of equipments installed, serviced and assembled by your organisation* (Per Year)

    Equipment

    Installed

    Serviced

    Assembled

    Commercial appliances (Bottle Coolers, Water Coolers, Visi Coolers etc.)

    Air conditioners (Window)

    Air conditioners (Split)

    Others (e.g. Chillers) please specify

    Number of technicians in your organisation*

    Refrigerant and quantity used, Per year, in your work* (Tick one or more)





    Do you recover and recycle (R&R) refrigerants?*

    If Yes

    R22

    kg/year

    R32

    kg/year

    Equipment used for service and specify*

    Evacuation

    Workshop

    On-site

    Single Stage Vacuum Pump

    Double Stage Vacuum Pump

    Are you Franchisee of any manufacturers?

    If yes, list company/brand

    How did you learn about HPMP?*

    In which language do you prefer to receive newsletter / information?

    Declaration by Participant*

    [acceptance* declaration]

    I hereby consent to take and publish my photographs and videos regarding this training on relevant media as deemed fit by the Ozone Cell, MoEFCC, Government of India and GIZ Proklima India.

    [/acceptance]

    Name

    Date

    Signature