Agent Application Form - Education Training and Employment Australia

1 Step 1

Agent Application Form

Legal Name

Trading Name

Business Registration Number (country of Origin)

Australian Business Registration Number

Registered Physical Address

0 /

Is Postal Address same as registered address?

YesNo

Registered Postal Address

0 /

Telephone

Website Address

Agent's Principal Executive Officer

Name

Contact Number

Agent's Day to Day Contact

Name

Contact Number

Agent’s nominated recruitment staff involved in ETEA student marketing

Name

Please list the countries where you will market ETEA’s courses.

Nominate ETEA courses and code numbers you are interested in representing in your market and why? (Please attach additional page if insufficient space provided)

0 /

About you:

Number of Students sent to Australia last year and this year until now

Primary Business

Number of student Counselling staff

Services Provided to Students

Member of Associations

Years in education consultation

Have you previously worked in conjunction with another education agent?

YesNo

If Yes, what is the name of that agent?

DECLARATION: I am interested in representing Education Training & Employment Australia as an education agent and I agree to do so in an honest and professional manner.

Name of Authorised Officer

Signature Of Agents Authorised OfficerI agree to the terms and conditions

(Sign Here)

Clear Signature

If you can't draw signature, please upload your signature below.

Signature

Date

Please upload all supporting documents such as Marketing Plan, Agent Profile, MARA Registration, ABN/ACN Registration, Company registration certificate.

Upload