AGENT APPLICATION FORM

Australian NIT College Pty.Ltd.

t/a
Swan Institute Australia

AGENT / AGENCY DETAILS Please write neatly using BLOCK LETTERS.

1. Company name
2. Address
3. Country Post Code:
4. Contact person name
5. Contact person email
6. Company telephone Fax:
7. Company contact email Web:
8. If you have an Australian business/es please quote ABN number/s:

9. How many years have you been in business as an Education Agent?

10. Do you or your company conduct any other type of business? Yes / No
11. If yes, what kind of business is it?
12. Number of students sent to study in Australia last year.
13. Estimated number of students sent to our Institute in next 12 months
14. Which countries do you recruit most students from?
15. How many counsellors do you employ?
16. Contact details of sub-agents that are used.

Notes:

Swan Institute Australia P a g e |1 Created on: 29/8/12

Uncontrolled when printed Reviewed: 16/05/2016
SIAF070 V3
 REFEREES
Please give details of two referees we can contact, preferably Australian institutions that you represent.

Institution 1
Name
Address
Country
Contact Name
Telephone/Mobile
Fax
Email

Institution 2
Name
Address
Country
Contact Name
Telephone/Mobile
Fax
Email

DECLARATION
I confirm the information provided on this questionnaire is correct and up-to-date.

Signature
Name
Position
Date
The information requested on this form will not be passed on to any third party.

Witness by:
Signature
Name
Position
Date

Please send this application form together with your company profile to admissions@sia.wa.edu.au.

Swan Institute Australia P a g e |2 Created on: 29/8/12

Uncontrolled when printed Reviewed: 16/05/2016
SIAF070 V3