Representative (Agent) Application Form

Step 1 of 3

Provider Email*
Provider Business Name
This will be used in the Agent agreement
Provider Short Name
Provider Contact Name
Provider Contact Position
Business Contact Details
Company Name*
Business Name*
ABN (if applicable)
Name of contact person*
Director's name/s
Regions
- Australia onshore
- Europe
- East Europe
- Subcontinent
- South East Asia
- China
- South America
- North America
- Other
Australian business address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Overseas business address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mailing address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Telephone
Fax
Mobile*
Email Address*
Website
Other Off-Shore Locations (if applicable)
List any sub-agents (if applicable)
Affiliations with other businesses (if applicable)
Are you a Registered Migration Agent? Please provide MARN:
Please list any memberships or licences
Did you complete the EATC / PIER course?
- Yes
- No
How do you demonstrate knowledge and understanding of the requirements of the ESOS Act 2000 and the National Code 2007?
Did you read and understood Agent Handbook?
- Yes
- No
Agent Handbook
Business Background
How many years your business has been operating?
How many years your business has been in students' recruitment industry?
What is main purpose of your business?
How many students do you recruit each year?
Which Australian and/or overseas institutions do you represent? (please insert extra sheet if required)
Please list country/ies from which you recruit students plus number of students for each country
Country Number of students

Recruitment Details
Hidden
How many students can you recruit for Fluency Hub?
Business IT
Do you charge any service fees? If Yes, please list fee/s name/s and amount/s:
Fee Amount
Does the above fee include Fee for an Australian Student Visa?
- Yes
- No
What services do you provide to students: (Counselling, visa application, placing students to institutions in overseas countries, accommodation arrangement, air tickets, airport transfer, orientation, following up with students during their stay)
How do you promote international education and how will you promote our Institute?
How can we participate on the promotion of Australian education and our Institute?
List the most popular courses requested from your students:
Additional information
Referees
Please indicate a minimum 2 referees from Australian or 3 Australian and overseas institutions you represent.
Referee 1
Company
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Person
Position
Telephone
Mobile
Email
Referee 2
Company
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Person
Position
Telephone
Mobile
Email
Referee 3
Company
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Person
Position
Telephone
Mobile
Email

Country	Number of students

Fee	Amount

Representative (Agent) Application Form

Step 1 of 3

Business Contact Details

Business Background

Recruitment Details

Referees

Referee 1

Referee 2

Referee 3