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Primary and Secondary Studies
Primary and Secondary Studies
Step
1
of
3
33%
Personal Details
Title
Gender
Male
Female
Date Of Birth
MM slash DD slash YYYY
Surname/Family:
Name First/Given Name(s):
(Required)
Home Address:
(Required)
Postal/Zip Code:
Country:
Telephone (including country code):
(Required)
Mobile:
(Required)
Personal Email Address: (Essential)
(Required)
Emergency Contact
Name:
(Required)
Tel:
(Required)
Email:
(Required)
Relationship:
Referee (Please underline as appropriate)
Name:
(Required)
Title:
Work Email:
(Required)
How long has the person know you:
(Required)
Tel:
(Required)
Relationship:
Name of Institution:
Address of Institution:
Country of permenent residence
Country of Birth
Who is paying your fees?
Myself/family
Gov’t Aid
An official sponsor(state name of organisation)
Criminal Convictions If you have a relevant criminal conviction, enter an X in the box. See International Application Guidelines for details.
Disabled Students- (Do not leave this box blank) If you do not have a disability please enter an A in the box
Immigration History
Have you previously visited the UK?
Yes
No
If YES you must provide copies of all previous visas and other related permits with your application.
Have you had visa refusal before?
Yes
No
If YES you must provide copies of the refusal letters.
School/ College and University Education (from age 11, starting with the most recent) (Including any period of study undertaken in the UK).
Date From/T0
Subject
Qualification (e.g Bsc, GCSE Others)
INSTITUTION School College
Result Garde
Complete (C) Or Currently Studying (CS)
Add
Remove
English Language Proficiency
Was English the language of instruction in your previous institution?
Yes
No
Partly
Number of years you have studied in English
Which Institution
Decleration
If you are completing this form electronically, please read the declaration below and .tick this box. (Required)
I confirm that the information given on this form is correct and complete and that I have completed this form myself. I accept that the Agent does not have the right to influence the admission outcome. I am aware that the partner University has the right to cancel my application if found that I have provided false or inaccurate information. I have read the instructions, in particular, those regarding this section. I understand what they say, and I agree to abide by the conditions set out there, which I accept as a condition of this application. I also agree with the details of my admission and enrolment and any Confirmation of Acceptance for Studies to be passed to the representative, agent or institution for which I submitted my application. By submitting your information, you are consenting to your data to be processed by the designated University. Your data will be used to handle your enquiry and sending you information about the University which is relevant to your query. None of our partner institutions will pass your details on to any third party. As a Data Subject, you can opt-out of communications from EKlaz Profit Ltd/Partner Institution at any point by writing to Client's Information Department, E-Klaz Profit Ltd. 189 Marsh Wall, London, E14 9SH or emailing info@eklaz.com'
If you are completing this form by hand, please sign here.
Signature
Date
MM slash DD slash YYYY
What Happens Next
Once you have completed this application please send it with copies of all relevant documentation to the Clients Services by email: info@eklaz.com or send via the postal system to E-Klaz Profit Ltd, Victory Way, Admiral Park, Crossways, Dartford, Kent, DA2 6QD.
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