SCIC - Agent Representative Application

AGENT REPRESENTATIVE APPLICTION
COMPANY BACKGROUND
Company Legal Name*
Company Trading Name*
SCIC Account Manager*

FrankRominaAshleyLiviaNot sure
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
ABN
Email*
example@example.com
Website
Number of Years in Business*
Authorised Contact Person*
Student Service Regions*
Are you familiar with the requirements of the Australian ESOS Act and the Australian National Code 2018?*
Have any of your staff completed the PIER (Professional International Education Resources) – QEAC (Qualified Education Agent Counsellors) course?*
MARA License (if applicable)

Browse Files

Cancelof
PIER EATC Counsellor Certificates

Browse Files

Cancelof
REFEREES

Please list the contact details for three current referees
Name of the Institution*
Contact Person*
Contact Numbers
Email Address*
example@example.com
Name of the Institution
Contact Person
Contact Numbers
Email Address
example@example.com
Name of the Institution
Contact Person
Contact Numbers
Email Address
example@example.com
Please sign the declaration below:
- I understand that Sunshine Coast International College is not obliged to accept my application to act as an
  agent to recruit students on its behalf.
- I understand that if my application to act as an agent for Sunshine Coast International College is successful, I
  will be required to enter into a formal agent agreement.
- I confirm that I have the necessary registration, accreditation and permission to act as an agent in all
  territories I have nominated.
- I consent to Sunshine Coast International College’s contacting any of the referees I have nominated.
- By submitting this application to Sunshine Coast International College, I agree to abide by the terms and
  conditions in this declaration.
- I confirm that the information provided in this application is true and correct to the best of my knowledge. I
  have read and understood the information provided by Sunshine Coast International College.
Name*
Position*
Signature*

Clear
Date*

DayMonthYear
THANK YOU FOR TAKING THE TIME TO COMPLETE THIS FORM
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AGENT REPRESENTATIVE APPLICTION

COMPANY BACKGROUND

REFEREES

THANK YOU FOR TAKING THE TIME TO COMPLETE THIS FORM