AGENT APPLICATION FORM Step 1 of 3 33% Company DetailsLegal / Entity Name(Required) ABN if Applicable Trading Name(Required) Website Head Office Address(Required) Street Address State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Phone(Required)Email(Required) Company ProfileYear Established(Required) Number of Staffs(Required)— Please Choose —1 to 56 to 1011 to 2021+Number of Students Recruited Each Year(Required)— Please Choose —1 to 1011 to 2021 to 3031+Main Student Nationalities Recruited(Required) Main Australian RTOs Represented(Required) Branch Office Locations (List Cities)(Required) Industry Associations (optional) Which Countries Do You Recruit StudentsList of countries and years recruiting students(Required)countryNumbers of Years recruiting from this country Add RemoveClick the + to add more rows Principal / OwnerName(Required) — Please Choose —Mr.Mrs.Ms.MissDr.Prof. Prefix First Last Job Title(Required) Email(Required) Office Phone(Required)Mobile Phone(Required)Key Contact PersonKey Contact Same as Principal Owner?(Required)— Please Choose —YESNOKey Contact Name(Required) — Please Choose —Mr.Mrs.Ms.MissDr.Prof. Prefix First Last Job Title(Required) Email(Required) Office Phone(Required)Mobile Phone(Required)MarketingWhat strengths do you believe AIC has that will allow you to promote it as a choice of educational institution for overseas students?How many students do you believe you will be able to recruit for AIC in the first year of representation?what do you need from AIC to help you promote it as a choice of educational institution for overseas students?Have you and key agency staff read the National Code of Practice for Registration Authorities and Providers of Overseas Education and Training to Overseas Students 2007?(Required)— Please Choose —YesNoDo you and key agency staff have a sound knowledge of DIPB regulations and Genuine Temporary Entrant criteria?(Required)— Please Choose —YesNoHave you and/or key agency staff done PIER’s Education Agent Training Course (EATC)?(Required)— Please Choose —YesNoAre you and/or key agency staff Qualified Education Agent Counsellors (QEAC)? Yes No(Required)— Please Choose —YesNoAre you and/or key agency staff registered migration agents?(Required)— Please Choose —YesNoPlease specify if you have completed any other industry training RefereesPlease provide two referees including at least one Australian education provider:Referee 11st Referee Name(Required) — Please Choose —Mr.Mrs.Ms.MissDr.Prof. Prefix First Last Job Title(Required) Email(Required) Office Phone(Required)Mobile Phone(Required)Referee 22nd Referee Name(Required) — Please Choose —Mr.Mrs.Ms.MissDr.Prof. Prefix First Last Job Title(Required) Email(Required) Office Phone(Required)Mobile Phone(Required)Supporting Documents SUPPORTING DOCUMENTS Please attach the following documents in support of your application: Business registration certificate (offshore agencies only) Company Profile Evidence of staff training and knowledge (ETAC and ASVP preferred) Registered migration agent certificate/s, if applicable Referee letters if available List of branch offices with contact details, if applicable Supporting documents files upload(Required) Drop files here or Select files Max. file size: 64 MB. DeclarationDECLARATION 1(Required) I/we declare that all information provided in this application are complete and accurate and that all information pertaining to this application has been fully disclosed, irrespective of whether or not such information was specifically requested. I/we authorize Australian International College to collect additional information on my agency if required.(Required)DECLARATION 2(Required) I/We declare that I/we understand all relevant laws and regulations of Australia and of the countries where we recruit students, in particular those laws pertaining to Australian consumer protection, the ESOS Act and the National Code 2007. Also agree to regularly view the DIBP website to monitor policies and any changes to the policies.(Required)DECLARATION 3(Required) I/We confirm my/our obligation to comply with such laws and regulations at all times, including any amendments.(Required)Signature(Required)Name(Required) Position(Required) Date(Required) DD slash MM slash YYYY EmailThis field is for validation purposes and should be left unchanged.
