Name of the Marketing Officer : Darren Tan (016-2339174)

darren.tan@lsclondon.co.uk

AGENT DETAILS FORM

Name of agency / :
organisation

Contact Person in the :

agency / organisation

Designation of the contact :

person in the agency /
organisation

Address of agency / :
organisation

CONTACT DETAILS
Telephone :

Fax :

Mobile :

E-Mail ID :

Web address :

Is the agency / organisation : YES / NO

registered as a service
provider
If YES, please provide evidence i.e. copy of licence

Have you been recruiting : YES / NO

students to study in
MALAYSIA
Since when have you been :
recruiting students to study
in MALAYSIA
Are you accredited by the :
British Council / British
Embassy as a
recognised/preferred agent
How many students each : < 10 students per year
year do you successfully
recruit to study in the > 10 students per year
MALAYSIA
Names of :
institutions/Universities that
you have been recruiting
students for

Do you charge students any : YES / NO

fees
Do you provide visa : YES / NO
counselling service and
check student
documentation prior to
student applying for visa

REFERENCES
(Please provide contact details i.e. address/phone
number/email address)
Reference 1 :

Reference 2 :
Signed :

Date :