Agent Application Form
Agency Details
Agency Name / Business Name
Company Name / Agency Legal Name
Company / Business Registration No
Date of Registration
-
Day
-
Month
Year
Date
Place of Registration
Please Select
Head office addess
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Website
Countries that you have offices
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Management & staff Details
Directors Details
*
CEO / Principal officer Name
First Name
Last Name
CEO / PO Email
example@example.com
CEO / PO Phone Number
-
Country Code
-
Area Code
Phone Number
Number of student counsellors
Staff information with professional Membership details (eg: QEAC)
*
Day to day contact person and details for each office
*
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Company Background
Number of years in operation as education agent recruiting students to different educational institutions
Less than 1 year
1 to 2 years
2 to 3 years
More than 3 yeas
List the Australian Educational Institutions that you are currently working with
Do you offer immigration advice to students
Yes
No
If yes, are you a Australian registered migration agent (MARA)?
Yes
No
Other services that you provide to students
Have you or any of your staff been convicted of a criminal offence, or have charges pending for criminal offence?
Yes
No
Has your agency or any staff member employed by your agency been convicted or charged with any offence under corporate or regulatory law?
Yes
No
Has your agency previously operated under different trading name and has it been previously pronounced insolvent or bankrupt?
Yes
No
If you answered Yes to any of the last three questions above, please provide further details
Understanding of and complying with ESOS requirements
Do all of the student counselling staff of your company have appropriate knowledge and understanding of the international education system in Australia and the National Code of Practice 2018
Yes
No
Do all of the student counselling staff of your company have appropriate knowledge and understanding of the Australian International Education and Training Agent Code of Ethics
Yes
No
Do you ensure that students coming to Australia on a student visa have a primary purpose of studying and notify them that they must study full time?
Yes
No
Do you understand that you must not make any guarantees about achieving residential status in Australia?
Yes
No
Are you prepared to comply with all requirements of the RTO, with relation to advertising and marketing material, application procedures and providing information to students?
Yes
No
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From which countries will your potential market come? Please describe any strengths you have in these countries to justify your choice?
*
Provide any other other information relevant to the application
Provide at least two referees that you have been associated with (preferably from educational institutions)
*
Application Check List
Completed all sections of this Application Form
Attached business registration certificate for each country proposed (including translations where not in English)
Attached company profile with all services provided by the organisation
Attached evidence of professional certification in an agent training course
Attachments as per the application check list
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of
Declaration and Acknowledgement
I here by declare that
The information provided in the application is true and accurate. I further declare that all information pertaining to this application has been carefully disclosed, irrespective of the information was specifically requested
I declare that I understand all relevant laws and regulation of Australia and the country where the Agency recruits’ students including consumer protection, ESOS Act, National Code and Australian Foreign Relations Bill.
I confirm my obligation to always comply with the laws and regulation, including any amendments from time to time.
I declare that any conflict of interest or perceived conflict of interest will be handled in an appropriate manner and in accordance with the ESOS requirements
I confirm that I have all the necessary registrations, accreditations, and permissions to act as an education agent in all the territories which I have nominated and understand that I must notify the institute in case of any changes in the registration status as soon as possible.
I have read, understood, and agree to abide by the terms and conditions of the Institute’s privacy policy
I consent the Institute to contact any of the referees I have nominated to collect information or details as required
I understand that the institute may conduct a due diligence check and is under no obligation to recruit students until a formal agreement is signed.
I understand that if my application for appointment as a institute approved agent is successful, I will be required to enter and abide by a formal agency agreement.
Signature
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Year
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Please verify that you are human
*
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