Agent Portal

Business Particulars

Business Email *Enter the Business's Email ID

Business NameEnter your Business's name

Contact NameEnter the name of the main Contact in the Business

Address Line 1 *Enter line 1 of the Business's registered address

City *Enter the City the Business is located in

State/Province *Enter the State/Province the Business is located in

Address Line 1 *Enter line 2 of the Business's registered address

Postal CodeEnter the Postal Code for the Business's address

CountryEnter the Country the Business is located in

Primary Phone Number *Enter the Business's Primary Phone Number

Secondary Phone Number *Enter the Business's Secondary Phone Number

Business Website URL *Enter the URL for the Business Website

Business Owner(s)Enter the name of one or more owners of the business. Enter each owner on a separate line.

Current Representations Held

Countries Represented as AgentEnter countries where you are doing business as an education recruitment agent. Enter each country on a separate line.

Educational Institutions Represented as AgentEnter each educational institution and country located in, that you represent as an education recruitment agent. Enter each educational institution, country on a separate line.

Business Potential

Services ProvidedEnter services that your business provides. Enter each service on a separate line.

List of Staff MembersEnter name and designation of your staff members that we will deal with. Enter each staff member's information on a separate line.

Formal Training UndertakenEnter formal training including workshops undertaken by owner(s) and or staff. Enter each training/workshop on a separate line.

Business Particulars

No of Students Per MonthEnter the number of students, on average, that you anticipate sending to CIMT College on a monthly basis

Reference

Name and Address of Reference InstitutionEnter full name and addresses of the institution that is your reference

Reference Contact NameEnter the name of the contact person at the reference institution

Reference Contact EmailEnter the email of the contact person at the reference institution

Reference Contact PhoneEnter the phone number of the contact person at the reference institution

Terms and Conditions

I agree to the above terms and conditionsPlease check the above box to enable the Submit Application button

Name of Agent's RepresentativeEnter the name of the person who is submitting this form on behalf of the agent

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