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SPM CONSULTANCY SERVICES

16 Vincent Gardens, Dorking, Surrey, No: 1/399, Poriyalar Nagar, 2nd Street, Thirupalai Post,
RH4 3FY, TEL: +44-7889739373 Madurai-14, TEL: 9025062135

DATE: ________________

NAME:

(as mentioned in passport)

ADDRESS:

CONTACT NO:

EMERGENCY CONTACT NUMBER (optional):

EMAIL ID:

GENDER: MALE FEMALE

D.O.B:

NATIONALITY:

PASSPORT NUMBER:

Date of Issue: _______________ Date of Expiry: _______________

AREA OF INTEREST (FIELD OF STUDY):

PREFERRED COUNTRIES:

UK CANADA NEW ZEALAND AUSTRALIA

FINLAND FRANCE USA IRELAND

QUALIFICATION

S.NO CLASS INSTITUTION (START – END) PERCENTAGE


NAME YEAR OF MARKS
1. S.S.L.C
2. H.S.C
3. UG
4. PG
5.
HSC (12th) ENGLISH MARK: ___________ (%) _________

IELTS MARK:

LISTENING WRITING READING SPEAKING OVER ALL


BAND

DUOLINGO MARK: ______________________(OVER ALL)

REFERENCE DETAILS:

ACADEMIC

REFEREE DETAIL 1 REFEREE DETAIL 2


NAME: NAME:

DESIGNATION: DESIGNATION:

REALTION TO YOU: REALTION TO YOU:

CONTACT NUMBER: CONTACT NUMBER:

EMAIL ID: EMAIL ID:

INSTITUTION NAME: INSTITUTION NAME:

PERSONAL - REFERENCE

NAME:

DESIGNATION:

REALTION TO YOU:

CONTACT NUMBER:

EMAIL ID:

INSTITUTION NAME:

Do you have other countries VISA Refusal (Leave blank if not applicable)

Refusal Details
Country Apply date Date of Refusal Reason for refusal
Work/Internship experience (if available)

Job Title:
Name of organization:
Address of organization:
Date
From (MM/YY):
To (MM/YY) :
Duties:

Job Title:
Name of organization:
Address of organization:
Date
From (MM/YY):
To (MM/YY) :
Duties:

Declaration

I hereby declare that the information given in this application is true and correct to the best of my knowledge and belief.
In case any information given in this application proves to be false or incorrect, I shall be responsible for the
consequences.

Date: ___________________ Signature:

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