Leeds College

Company Details

Agency name:*

Registered business name:*

Is you business registered in Australia?

YesNo

Please enter ABN/ACN*

Upload a copy of your business registration document.*

Accepted format: pdf, doc, docx, xls, xlsx, csv, jpg, jpeg, png, gif

Year established:

Number of offices and locations

Address*

Unit/Level, Street number, Street name

Street Address Line 2

City

State/Territory

Postcode:*

Country:*

Telephone:

Include country/area code

Fax:

Include country/area code

Mobile:*

Include country code if outside Australia

Primary email address:*

example@example.com

Accounts email address:*

example@example.com

Website:

Name of the officer(s) to act as key contact person for Leeds College?*

Company Bank Details for Agent Commission Payment

Does your business have an Australian bank account?*

YesNo

Recipient's full name and street address:*

IBAN or Bank account number:*

SWIFT/BIC code:*

Sort codes or routing code:

Bank name:*

Account name:*

BSB:*

Account number:*

Company Profile

Name of Owner(s) and Director(s)*

Please list the services you provide or intend providing to students.

Education counselingMigration and Visa consultationProfessional yearOverseas student health cover

Do any of the owners/consultants of your agency have the following qualifications? (Please select as many as applicable)*

MARA registrationQEAC CertificatePIER CertificationOther

Upload Certificate

Accepted format: pdf, doc, docx, xls, xlsx, csv, jpg, jpeg, png, gif

Number of qualified student counselors working in the organization.

List top 3 countries you mainly recruit students from.

List top 3 Australian institutes represented by your agency.

Number of offshore students sent to Australia during the last one year?

Number of students enrolled in Australian institutes/RTOs during the last one year?

ELICOS: Number of students
Vocational Course: Number of students
Undergraduate/Postgraduate:Number of students

Do you have a company profile to share?

Yes, please share company profileNo

Please upload a copy of your company profile

Accepted format: pdf, doc, docx, xls, xlsx, csv, jpg, jpeg, png, gif

Reference Details - Referees must be existing institutional clients of the company, preferably with at least one Australian referee

Reference Details - Referees must be existing institutional clients of the company, preferably with at least one Australian referee*

	Reference 1	Reference 2
Organisation name
Position
Full name
Email
Phone number

Applicant's Declaration

I declare that all the information provided in this form is true and correct.
I understand the obligations and requirements of conduct of an education agent specified in relevant legislative instruments.
By signing a contract with LEEDS College, I understand and acknowledge the necessity to abide by all the rules, policies, procedures and requirements included in the agent contract.
Ideclare that I am an authorized person by the agency mentioned in this form to sign a partnership agreement with LEEDS College.
I consent for LEEDS College to contact the references provided in this form.
The key requirement of the ESOS Act is that all providers on the Commonwealth Register of Institutions and Courses for Overseas Students (CRICOS) must maintain a list of all the provider's agents and publish that list on its website. I consent to publishing my below details on LEEDS College's webpage.
Should the application to represent LEEDS College be successful, I agree to preform this role with honesty and professionalism, regularly keep the organization updated with the most recent policies, procedures and requirements of this role, and with the legislative changes by reference to Department of Home Affair' publications.
I declare that I have read the National Code of Practice for Registration Authorities and Providers of Education and Training to
I agree to abide by the relevant Standards, assess all applicants as Genuine Temporary Entrants and a Genuine Student as defined by the Department of Home Affairs. I will endeavor to verify the authenticity and validity of the documents which form part of the relevant application, and will confirm that the applicant has genuine access to the total funds required while in Australia to cover all travel, OSHC, tuition and living costs for themselves and any dependents.
I authorize LEEDS College to seek information from third parties including Australian High Commission post in my relevant/home country regarding my agency.

Agency name:

Branch/Office:*

Name of the signatory:*

Position:*

Date:*

Date

Agent Signature:*