Title (Mr./Mrs./Miss) *

Marital Status *

First Name *

Date of Birth *

Middle Name

Age as on date of filling the form (Months / Years) *

Surname *

Place of Birth *

Sex / Gender *

UK Address (If any)

Country (Application filed from) *

Postcode (UK)

Permanent Home Address (with postcode) *

Visa Expiry Date (If any)

Nationality *

Passport No *

Email *

Passport Place of Issue *

Skype I’d *

Passport Date of Issue *

Mobile Number *

Passport Date of Expiry *

Section 2: UK Immigration History (Leave this section blank if you have never been to the UK before)

Visa type

Visa start date

Visa end date

Course start date

Course end date

Course Name

Level of study

Institution name

Course completed? (If not then explain why)

Section 3: Overseas Qualifications (Please state in chronological descending order)

School/College/University

Awarding Body

Country

Title of Course

Result % / Grade

Dates of Study

Section 4: Work Experience (UK / Overseas)

(Please also add Gap Period after studies and state in chronological descending order)

Organization / Institution

City / Country

Position Served

Mode (Regular / Part Time)

Number of Hours Per week

Dates of Experience (From (mm/yy) To (mm/yy) )

Section 5: References (We will not be able to advise you further if you do not complete all boxes for Reference 1 & 2)

Reference 1

(Academic e.g. Teacher / Course Leader)

Referee 2 (Academic or Employer)

Name

Organisation

Position

Address

Telephone

Relationship

Section 6: University and Course(s) Selection (Please keep the course list priority wise)

University Opted

Courses Selected (Please select from international Full time course)

Duration of Course

Course Fee (Please check the course details on university website)

University and Course(s) suggested (for office use only)

Section 7: Tuition Fees

Please give details of how your tuition fees will be paid (delete as appropriate): Yourself / Parent / Sponsor / Employer / Bank Loan / Scholarship

Section 8: Additional Information

Do you have any Disability/Specific Needs? If yes, please provide brief details

Do you have any criminal convictions?

Have you ever been refused a visa (for any country)?

Section 9: Have you ever attended IELTS / OET / TOEIC (ETS) English test or have been issued with IELTS / OET / TOEIC (ETS) Certificate?

If answered that you have been issued with a IELTS / OET / TOEIC Certificate, Please provide the following information:

Speaking and Writing Tests Registration number is:

Grades / Bands Achieved: /

Test date:

Speaking and Writing Tests Registration number is:

Grades / Bands Achieved: /

Test date:

Section 10: Funds you need to show for your Tier 4 Student visa application

When will your Bank statement (showing the required maintenance fund of GBP 11,500 for 28 days) be ready?

Visit https://www.gov.uk/guidance/immigration-rules/immigration-rules-appendix-p-lists-of-financial-institutions to check Banks whose financial statements are accepted for UK visa applications from your country

Section 11: Declaration

I confirm that the information I have submitted on this application form is accurate and complete and that I have completed this form myself. I also confirm that to the best of my knowledge, the information given in this form is correct and complete, I understand that my application will be withdrawn if found to have been falsified.

I am giving permission to Laurels Education Trading Name of Staff Giant Services Ltd to retain my personal data contained in this form, or other data which may be obtained from me for the purpose of processing my application for any college/university admission. Subsequently, they will be allowed to retain all my personal data and documents including offer letters, visa copies, payment receipt and CAS letter for record keeping.

Signature (Electronic signature accepted):

Date: