APPLICATIONTOBECOMEANIBTAGENT..docVIP

To assist in assessing your application, please complete all sections. BUSINESS INFORMATION Registered Business Name Local Trading Name Details of Business Ownership Principal Executive Officer Operational/Trading/ Street Address Town/City State/Country Post/Zip Code Website Postal Address (e.g. post office box) Town/City State/Country Post/Zip code CONTACT INFORMATION Title First Name Family Name Position/Job Title Email Address Telephone Fax MAIN CONTACT FOR CORRESPONDENCE (if different from above) Title First Name Family Name Position/Job Title Email Address Telephone Fax  OTHER CONTACT FOR CORRESPONDENCE (if different from above) Title First Name Family Name Position/Job Title Email Address Telephone Fax COMPANY DETAILS How long has the company been involved in the recruitment of international students Is the company registered with any Government Department in the country you recruit from? Where there is a government regulation, do you possess the appropriate license/registration to operate? If yes, please provide details If an Australian registered company please provide ABN Is recruitment of students your main business? If not, what other components are there in your company? Do you have any sub-agents? If so, please advise us of their details (attach a list with contact details) How many students did you send overseas last year? What are your student’s background? (Nationality) To which country do you send most of your students? What type of programs do you send your students to? Language High School University Other Please specify: What other education institutions does your company represent? Please advise of any financial fees that are charged directly to students for applications / counselling / visa processing / administrat