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Details

Agent Name :

Surname

Given Name

Address in Australia

Suburb

Country

Address (OutsideAustralia)

Suburb

Postcode

Mobile

Telephone (work)

ABN

ACN

Emergency Contact

Address

Telephone

Business History

How long have you been in operation as an education agent? (Please provide a business plan if your company is new).

Does your company deal in areas other than international education?

What is the total number of students that your office recruits each year?

Where (which countries) do you send most of your students?

How many students does your agency brought to Australia to study in the last 12 months?

Do you work with any other education agents as a partnership or an affiliation?

Do you represent any other Australian institutions? (If Yes, please describe the institutions’ names.)

Agency information (Contact person)

Key staff contact (1) Position

Please include the details of two (2) referee we can contact, including one educational institution in Australia.

Referee 1:

Name :

Institution Name :

Title :

Phone :

Fax :

Email :

Referee 2:

Name :

Institution Name :

Title :

Phone :

Fax :

Email :

Declaration

Print Name :

Applicant Signature

Position

Date

Thank you for taking the time to complete this form.

Please return to:

Marketing Manager

ANE Pty. Ltd.

Suite 67 & 68, Level 6, 8-24 Kippax Street

Surry Hills, NSW 2010

Email : marketingmanager@ane.edu.au

Check List

Completed Application form:
Certificate of Business Registration
Business Profile
PIER/MARA Certificate