Agent Application Form
Questions marked by * are required.
1.
Agency Name *
2.
Contact Person *
3.
Position in the Company *
4.
Mailing address *
5.
Phone Number (please include any international prefix if applicable) *
6.
Facsimile Number (Phone Number (please include any international prefix if applicable) *
7.
E-mail address *
8.
Website
9.
Year Established *
10.
Number of Students Recruited in 2006
11.
Number of Students Recruited in 2007
12.
Number of Students Recruited in 2008
13.
Australian Contact Person ( if diffrent from contact provided above) *
14.
Preferred Pivot Point Course(s) *
15.
Do You Charge the Student a Processing Fee? *
16.
If Yes, How Much (AUD$)
17.
Are You a Migration Agent? *
18.
If You Are a Migration Agent Please Provide Your Registration Number
19.
Supporting Documents (PDF, DOC)
Supporting Documentation
To establish an Agency Agreement with Pivot Point International Academy Melbourne, supporting documentation needs to be submitted depending on where your headquarters and representatives are based. AGENT A – Headquarters is located outside Australia and do not have representative offices in Australia AGENT B – Headquarters is located outside Australia and have representative offices in Australia AGENT C – Headquarters is located in Australia and have / do not have representative offices in Australia
AGENT A
20.
Company Profile (PDF, DOC)
21.
Copy of current Business Registration / Business Certificate from Overseas (PDF, DOC, JPG)
22.
Statement from your company stating the strategies you will undertake to ensure the student's welfare whilst they are studying in Australia. (PDF, DOC)
23.
Additional Documentation (PDF, DOC, JPG)
AGENT B
24.
Company Profile (PDF, DOC)
25.
Copy of current Business Registration / Business Certificate from Overseas (PDF, DOC, JPG)
26.
Copy of current Australian Business Registration (PDF, DOC, JPG)
27.
Evidence of Australian Citizenship / Permanent Residency(PDF, DOC, JPG)
28.
Additional Documentation (PDF, DOC, JPG)
AGENT C
29.
Company Profile (PDF, DOC)
30.
Copy of current Australian Business Registration (PDF, DOC, JPG)
31.
Evidence of Australian Citizenship / Permanent Residency(PDF, DOC, JPG)
32.
Additional Documentation (PDF, DOC, JPG)
REFEREES
Please provide name and details of TWO referees (preferably from Australian Education Institutions)
REFEREE 1
33.
Institution *
34.
Contact Person Name *
35.
Position *
36.
Address *
37.
Phone Number *
38.
Fax *
39.
E-mail *
REFEREE 2
40.
Institution *
41.
Contact Person Name *
42.
Position *
43.
Address *
44.
Phone Number *
45.
Fax *
46.
E-mail *
Additional Documents
47.
Please Upload Your Official Stamp / Seal (PDF, DOC, JPG)
48.
Please Upload Copy of Your Company Registration Certificate (PDF, DOC, JPG)
