AGENT APPLICATION FORM-v1.1 Nov.2020

AGENT APPLICATION FORM

Please Note: if Agency have more than one Branch/Locality, please complete one form for every Branch/Locality

A-AGENCY DETAILS
Business Legal Name*
Business/Trading Name (s) *
Website (s) *

Place of Registration*
Australian Business Number (ABN) and/or ACN *
Overseas Business Number (If Not, then write NA)*

Membership of Professional body (e.g ICEF,PIER)*
Year of Establishment*
Business Type (e.g Company, Partnership)*
If Other Type

B- PRINCIPAL AGENT
Title (Mr/Miss/Mrs/Ms/Dr/Prof (e.g)*
First Name*
Family Name*
Date of Birth ( Required For PRISMS Listing)*

DayMonthYear
Date
Principal Agent Email Address*
example@example.com
Principal Agent Business Phone Number*
Principal Agent Mobile Phone*
Principal Agent MARN or Overseas Education Agent ID (if any)*
Principal Agent Membership of any Professional body*
Principal Agent Experience (Years)*
Principal Agent Qualifications*

Principal Agent is also head of office and he is also Agency Director ?*

YesNo
C- AGENCY STATE/LOCALITY DIRECTOR.

(Head of Office, if different from the Principal Agent)
First Name*
Family Name*
Email Address*
example@example.com
Business Phone Number*

D-ADDRESS OF PRINCIPAL PLACE OF BUSINESS
Address Line 1- Office Physical Address*
Address Line 2-Office Physical Address
Suburb/City/Locality*
State*
Country*
Post Code*
Email Address (Office Email ID)*
example@example.com
Phone Number. (Office Phone Number)*

Is postal Address is same as Principal Place of Business*

YesNo
E-POSTAL ADDRESS

(Only if different from the Principal place of business)
Address Line 1*
Address Line 2*
Suburb/City/Locality*
State*
Country*
Post Code*

F- COMPANY DIRECTORS/PROPRIETORS/PARTNERS/AGENCY DIRECTOR

F- COMPANY DIRECTORS/PROPRIETORS/PARTNERS/AGENCY DIRECTOR*

	First Name	Family Name	Phone/Mobile	Email Address	MARN or Overseas Agent ID
1
2
3
4

If the Agency is body Corporate/Company*

YesNo
If the Agency is body Corporate/Company, Is Registered office is the same as Principal Place of Business ?*

YesNo
G-ADDRESS OF THE BODY CORPORATE/COMPANY’s REGISTERED OFFICE.

(If the Agency is body Corporate/Company, then please complete Section G, if not, then go to Section H)
Address Line 1*
Address Line 2*
Suburb/City/Locality*
State*
Country*
Post Code*

H-EMPLOYEE INFORMATIONS.
Please provide the following information about each of the agent’s employee/employees who are involved in facilitating the enrolment. If Employee is registered with the office of Migration Agents Registration Authority, then Migration Agents Registration Number (MARN) is also required. If they have an Overseas Education Agent ID provided by the Department of Home Affairs, please provide the same.

H-EMPLOYEE INFORMATIONS*

	Employee First Name	Employee Family	Phone/Mobile	Email Address	MARN or Overseas Agent ID
Employee 1
Employee 2
Employee 3
Employee 4
Employee 5

I-ACADEMIC REFERENCES
PLEASE ENSURE THAT YOU PROVIDE THE NAMES, CONTACT NUMBERS AND E-MAIL ADDRESSES OF TWO REFEREES FROM INTERNATIONAL OFFICES OF OTHER EDUCATION INSTITUTIONS THAT YOU CURRENTLY REPRESENT THAT WE MAY CONTACT.

Academic Reference-1
Name of Education Provider*
Full Name of Contact Person*
Position*
Phone Number/Mobile*
Email Address*
example@example.com

Academic Reference-2
Name of Education Provider*
Full Name of Contact Person*
Position*
Phone Number/Mobile*
Email Address*
example@example.com

Academic Reference-3
Name of Education Provider
Full Name of Contact Person
Position
Phone Number/Mobile
Email Address
example@example.com

J-STAFF/PERFORMACE
How many staff members are employed in your organisation?*
What languages do your counsellors speak?*

How many of your counsellors have studied in Australia?*
Which other Australian or another country institution do you currently represent?*
When is the most suitable time of year to conduct a marketing trip to your region or a visit to your office to recruit students?*

Please list the total number of students referred to Australian Educational Institution in last two (2) years?*
How do you maintain your staff's professional development?*
How many students do you propose to place with Griffin College in the next 6 months?*

Please describe the characteristics of your potential market (age, income, educational background, University networks, etc). Please use separate sheets, if necessary*
From which geographical area will your potential market come? Please describe any strengths you have in these regions to justify your choice*
What do you believe is the most effective marketing strategy to employ in your region or market?*

K-SERVICES
What services do you provide to students? (Please tick all appropriate responses*

Student counsellingPre-departure briefingsMigrationTravel and accommodationAirport PickupOSHCVisa assistanceOthers (Please specify)
*

L-COMPLIANCE WITH ESOS REQUIREMENTS
Has the company or registered owner ever been declared bankrupt?

YESNo
Has the registered owner or staff of the company even been convicted of a criminal offence?*

YESNo

M-CONFLICTS OF INTEREST
Registered providers must ensure the education agents they engage with act ethically, honestly and in the best interest of overseas students. This means that registered providers must ensure its education agents declare and take all reasonable steps to avoid conflicts of interest with its duties as an education agent of the registered provider. This provision is to ensure transparency in the education agent’s activities. Examples of conflicts of interest include, but are not limited to:
- when the agent charges services fees to both overseas students and registered providers for the same service or
- where an education agent has a financial interest in a private education provider or
- where an employee of an education agent has a personal relationship with an employee of the education provider
Do you have Conflicts of Interest?*

YESNo
If, yes, how you will declare and take all reasonable steps to avoid conflicts of interest with your duties as an education agent of the Griffin College?*
Commission from Griffin College, Student is provided disclosure for the same.

N-PRIVACY STATEMENT
As an appointed education agent of Griffin College, you agree to your personal information being.
- Recorded in PRISMS. This may include your name, business name, email address, phone number, and address, and any other information as required by law.
- Accessed by the Australian Government Department of Education and Training, Department of Home Affairs and other Commonwealth agencies that access PRISMS.
- used to administer or monitor compliance with the Commonwealth legislation e.g. Education Services for Overseas Students Act 2000,
- disclosed by the Australian Government Department of Education and Training to other Australian Government entities (including, but not limited to ASQA and TEQSA), education institutions and publicly. The Australian Government Department of Education and Training will share individual agents’ performance publicly as aggregated data (but will not identify agent – provider relationships). Agent-provider relationships will only be identified when data is shared with education providers and other Australian Government entities.

O-COVID-19 QUARANTINE/ SIMILAR FUTURE SITUATION SUPPORT
Biosecurity measures and travel restrictions are in place to help prevent the spread of COVID-19. Read about what measures are in place when travelling in or out of Australia Australian Government Department of health website www.health.gov.au and Queensland Government official website https://www.covid19.qld.gov.au/. Student must make own arrangements to make sure Students are meeting all the requirements of Australian and state Government at their own cost. Griffin College will help/support Students to meet their obligation at their cost.
Do you provide Students additional support to meet their obligations in COVID-19 like circumstances?*

YESNo

ADDITIONAL INFORMATION
Please provide any other information you consider to be of importance to this application*

P-DECLARATION
- I declare that I am Authorised person to sign this form on the behalf of Agency and obtained required consent from the employee/staff/directors to provide business/ their personal information to Griffin College.
- I declare that I have read and understood the extract from the ESOS Act 2000/ Obligations of Agents
- I confirm and declare that the information provided is true and accurate to the best of my knowledge.
- I authorise Griffin College to approach referees to collect any information/details as Griffin College may request from time to time.
- I do understand Griffin College reserves the right not to proceed with providing an International Education Agreement for reasons it may see fit to apply.
Full Name*
Position*
Date*

DayMonthYear
Date
Signature or Electronic acceptance ( Just type your name with mouse)*

Clear
ABN or Business Registration Documents

Cancelof
ID document of Principal Agent ( To List in PRISMS)

Cancelof
Business Profile (500KB size limit)

Cancelof
Licence/Approval to Run Education or Migration Business (500KB size limit)

Cancelof
Extract of MARA Registration (500KB size limit)

Cancelof
Professional Membership evidance (500KB size limit)

Cancelof
Non-English documents Translated into English. (500KB size limit)

Cancelof
Education Documents of Key staff members (500KB size limit)

Cancelof
Other documents if any (500KB size limit)

Cancelof
Please verify that you are human*
Should be Empty:

AGENT APPLICATION FORM

A-AGENCY DETAILS

B- PRINCIPAL AGENT

C- AGENCY STATE/LOCALITY DIRECTOR.

D-ADDRESS OF PRINCIPAL PLACE OF BUSINESS

E-POSTAL ADDRESS

F- COMPANY DIRECTORS/PROPRIETORS/PARTNERS/AGENCY DIRECTOR

G-ADDRESS OF THE BODY CORPORATE/COMPANY’s REGISTERED OFFICE.

H-EMPLOYEE INFORMATIONS.

I-ACADEMIC REFERENCES

Academic Reference-1

Academic Reference-2

Academic Reference-3

J-STAFF/PERFORMACE

K-SERVICES

L-COMPLIANCE WITH ESOS REQUIREMENTS

M-CONFLICTS OF INTEREST

N-PRIVACY STATEMENT

O-COVID-19 QUARANTINE/ SIMILAR FUTURE SITUATION SUPPORT

ADDITIONAL INFORMATION

P-DECLARATION