Change of Agent Request Form

Change of Agent Request Form

Instruction: This form MUST complete by the student only.
1. Personal Details:
Student ID:
Given Name:
Family Name: *
Gender:

Male Female
Birth date: *

Day Month Year
Mobile Number: *
Email Address: *

4. Declaration:
I confirm that,
- Would like to change my Education Agent with whom I had initially applied to Harward International College.
- From now I would like to go with my above appointed new Education Agent.
- I understand that my decision to change Education Agents is final and that all correspondence will now be through my newly appointed Education Agent.
Signature *
Date *

Day Month Year
Pramukh Group of Companies T/A Harward International College

ABN: 72 135 865 066 I ACN: 135 865 066

Phone: 03 9639 4699 I Fax: 03 8669 4055

Email: info@harward.vic.edu.au I Web: www.harward.vic.edu.au
Should be Empty: