AGENT OF

CH
CHANGE REQUEST FORMFORM
AGENT REQUEST

I am requesting a change of agent for providing me with counseling/advice regarding my

university application.
When completed, this form must be submitted to the college I am seeking enrolment at.

First Name
Last Name
Date of Birth:
Country of Nationality:
Your Current Agent or ‘Applied
Direct’

Address of Your Current Agent:

Your Proposed Agent: SI-UK

Suite 8-13, 1st Floor, Indra Palace, Middle Circle, Block

H, Connaught Place,
New Delhi – 110001
Address of Your Proposed Agent:
Email: delhi@studyin-uk.com
Tel: +91-11-4202-8200
Fax: +91-11-4202-8212

Through SI-UK I have been able to obtain expert

information on UK universities, courses, degree
Reason(s) for change of Agent: requirements, pre-sessional, application procedures,
funding, visas and accommodation.

Upon receipt of my completed form, I am aware and authorize the university to remove my
current agent and change it in the student database to my proposed Agent (SI-UK). Based on
my previous Privacy Declaration, (as applicable) all future correspondence will be sent to SI-
UK.

Signature: __________________________ Date: ________________