AGENT RENEWAL FORM

Company Name

Legal Entity Name(Required)

ABN if Applicable

Trading Name(Required)

Website

Head Office Address(Required)

Street Address State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Principal / Owner

Name(Required)

Prefix First Last

Job Title(Required)

Email(Required)

Office Phone(Required)

Mobile Phone(Required)

Declaration

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 authorise Australian International College to collect additional information on my agency if 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. I/We confirm my/our obligation to comply with such laws and regulations at all times, including any amendments.

Signature(Required)

Name(Required)

Position(Required)

Date(Required)