Canberra Valley Institute

AGENT REGISTRATION FORM

Agency Details

Company Legal Name *

Company Trading Name*

Agency Senior Contact

Position *

Direct No

Direct Email *

Main No

Website

ABN (domestic agents only)

ACN (domestic agents only)

MARA registration number (domestic agents only)

Agency Address*

Mailing Address (if different from above)

Survey Questions :

How many staff does your company employ?

What are the nationalities of students that you recruit?

Is your main business direct overseas student or local internationals?

Do you have offices or sub agents overseas?

If yes, please specify the countries

How many students do you recruit annually?

Please indicate below the percentage of your business to the respective sectors.

Private Higher Education

Universities

Vocational Education and Training

High Schools

English Schools

Other

Name the top 4 providers you represent

How did you hear about Canberra Valley Institute and Axis English College?

Please Provide 2 references (preferably from higher education providers)

Provider 1

Contact Person / Title

Tel No

Provider 2

Contact Person / Title

Tel No

Please provide followings details

Business Registration Certificate

Profile of the company

ABN Letter (for domestic agents)

MARA registration number (for domestic agents)

QEAC certificate (for domestic agents)

Declaration

I confirm that the information given in this application is true and not misleading.

Agency Senior Contact (Please print name)

Signature

Date

Agent Details Of Canberra Valley Institute

AGENT REGISTRATION FORM

Agency Details

Declaration

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