LIHE AGENT APPLICATION FORM

AGENT APPLICATION FORM
COMPANY DETAILS
Company Legal Name*
Company Trading Name*
Company Registration Number
Business Registration Number
Australian Business Number
(for Australian based companies only)
Business Address*

Unit Details

Street Address

City / StateState / Province

Postal / Zip CodeCountry
Postal Address*

Unit Details

Street Address

City / StateState / Province

Postal / Zip CodeCountry
Email Validator*
Email*
example@example.com
Phone*
(including country code and area codes)
Fax
Year Established*
Website*
Number of Staff/Counsellors*
Migration Agent Authority Number
Description of Business/ brief summary
Staff Information (Director / CEO / Managers / Counselors)
Name*

PrefixFirst NameLast Name
MaleFemaleOther
Position held*
Email*
example@example.com
Qualifications*
Name

PrefixFirst NameLast Name
MaleFemaleOther
Position held
Email
example@example.com
Qualifications
Name

PrefixFirst NameLast Name
MaleFemaleOther
Position Held
Email
example@example.com
Qualifications
Number of staff
Number of students recruited (Annually)
Target Market (regions/ countries of client base & courses of interest to your clients)
Details of other Institutions/Universities you currently represent in Australia & other countries (please list)
Name of Institution*
Name of Institution*
Name of Institution*
Name of Institution*
Name of Institution*
Performance
The number of students referred to Australian education institutions over the past 2 yrs.
High School & ELICOS Courses:*
Vocational Course:*
Undergraduate Course:*
Post Graduate Course:*
Compliance
Please tick ✓ Yes or No and Complete All Sections
YesNo
YesNo
YesNo
YesNo
YesNo
6. Please list the main responsibilities of Education Agents under the National Code 2018?How do you comply with these obligations?*
YesNo
YesNo
YesNo
Company Name (if marked Yes)
Business Address (if marked Yes)

Unit Details

Street Address

City / StateState / Province

Postal / Zip CodeCountry
Company Business Reg No:
Phone Number:
Fax:
DESCRIPTION OF POTENTIAL MARKETS
What do you believe is the most effective marketing strategy to employ in your region or market?*
From which geographical area will your potential market come? Please describe any strengths you have in these regions to justify your choice.*
Please describe the characteristics of your potential market (age, income, educational background, university networks, etc). Please use separate sheets, if necessary*
What is the most suitable time of the year to conduct a marketing trip to your region or a visit to your office to recruit students?*
STUDENT SERVICES
Please outline the support services you offer to students.*
Do you charge students any service fees? If yes, please provide details.*
ACADEMIC REFERENCES
Please list the names and contact details of three (3) professional referees you represent :
Referee 1
Institute Name*
Contact Name*
Phone Number*
Email*
example@example.com
Referee 2
Institute Name
Contact Name
Phone Number
Email
example@example.com
Referee 3
Institute Name
Contact Name
Phone Number
Email
example@example.com
DECLARATION
I Confirm that the information provided is true and accurate to the best of my knowledge and I authorise LIHE to approach referees to collect any information/details as you may request from time to time.
Signature:

Clear
Name of Contact Person
Date

MonthDayYear
Date
Position
CRITICAL DOCUMENT CHECKLIST REQUIRED ATTACHMENTS

In order to assess your application, the following documents are required:*

Rows	Supplied
Evidence of business registration
Company/Business profile
Photo of premises
Evidence of professional memberships, if any

Upload Documents

Browse Files

Cancelof
Date*

MonthDayYear
V1.0 - April 2025

ABN: 92633029375 | ACN: 633 029 375

TEQSA Provider ID : PRV14389

CRICOS Provider Code: 04342A
Should be Empty:

AGENT APPLICATION FORM

COMPANY DETAILS

Staff Information (Director / CEO / Managers / Counselors)

Details of other Institutions/Universities you currently represent in Australia & other countries (please list)

Performance

Compliance

DESCRIPTION OF POTENTIAL MARKETS

STUDENT SERVICES

ACADEMIC REFERENCES

DECLARATION

CRITICAL DOCUMENT CHECKLIST REQUIRED ATTACHMENTS