Change of Agent Form

Request to Change Agent Form
Student Details
Name

First NameLast Name
Student ID:
Date of Birth:

DayMonthYear
Date
Passport Number:
Course Enrolled:
Intake Start Date:

DayMonthYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal Address
Contact Number:
Please enter a valid phone number.
Email
example@example.com
Change of Agent Details

You can apply for approval for a change of agent if you have any reason to change the agent to act on behalf of yourself to process all the relevant procedures including but not limited to your enrolment.
Request From:
Contact Number:
Please enter a valid phone number.
To:
Contact Number:
Please enter a valid phone number.
Reason: (Please state the reason for this request. It must be specific.)
Signature

Clear
Date

DayMonthYear
Date
Outcome:

ApprovedRejected
Comments:
Decided By:
Date

DayMonthYear
Date
REQUEST TO CHANGE AGENT FORM

Version 22.1
Australian Business Management PTY LTD

ABN: 37 623 414 817, CRICOS Provider: 03826M, RTO: 45578

Address: Ground Floor, 242 Castlereagh Street, Sydney 2000. Phone: 02 9160 4507

Website: www.abm.edu.au Email: info@abm.edu.au
Should be Empty:

Request to Change Agent Form