Change of Agent Form

Students are required to complete this form to officially advise Flinders University of their intent to nominate a
new agent to represent them in their application to study at Flinders University.

Applicant Details
Family Name Gadhiya
First Name Harshid Jayantibhai
Date of Birth 04/12/2001
Flinders University Student Number 2305350
Course Name Master of Information Technology (Network and Cybersecurity Systems):
CRICOS Code 0100837
Email Address harshidgadiya074@gmail.com
Telephone Number +91 9909637172
Name of Current Agent IDP SURAT
Reason for changing Agent

Signature of Current Agent

(required for change of agent
approval to be granted)

I request that the Agent nominated below act for and on my behalf, in relation to all aspects of my application
to study at Flinders University.

New Agent Details

Agency Name TRANS GLOBE
Agency Address

Contact Person
Signature of New Agent

Please note that commission payments will remain with the original agent and will not be transferred to any newly appointed agent. As
per Agency Agreement, Flinders University does not pay split commission or make payments to more than one agent.

Declaration
□✔ I declare that I have appointed …………………………………………………………………..
TRANS GLOBE to act as my
official agent for my application to the course listed above and that the information provided is true and
accurate to the best of my knowledge.
Student’s Signature Date

Parent/Guardian Signature
.
(if student is under 18 years)