Agent Questionnaire - Live - Kaplan Australia Kaplan Australia

Step 1 of 6

To help us with your application, please give as much information as possible in the fields below. Your information will not be shared with any third parties and will be kept confidential.
Company Information
Registered Business Name (Trading name)*
Registered Company Name (Legal Name)*
Registered Company Number (If applicable)
Type of Business*
Date Business was established (DD/MM/YYYY)*
DD slash MM slash YYYY
Describe briefly the nature and history of your business*
Address Information
Registered Business Address – Street*
Registered Business Address – Line 2
Registered Business Address – City*
Registered Business Address – State/Province*
Registered Business Address – Postcode*
Registered Business Address – Country/Region*
Is your physical address of head office same as your Registered Business Address?*
Physical Company Address*
Physical Company Address – Street Physical Company Address – City Physical Company Address – State / Province Physical Company Address – Post Code Physical Company Address – Country/Region
Company Contact Details
Company email address*
Do you have a Company Website?
Company Website
Company Phone Number (International format – country code, followed by the mobile number (without the leading "0"'s) – e.g. 61416404571 )*

Personal Contact Information
Position Title*
Full Name (as it appears in the passport)*
Prefix First & Middle Last
Local Name (if applicable)
Nationality*
Country/Region Location*
The place where this Contact currently lives.
Gender*
- Male
- Female
Place of Birth*
The country/region where this Contact was born
Date of Birth*
DD slash MM slash YYYY
Mobile Number (International format – country code, followed by the mobile number (without the leading "0"'s) – e.g. 61416404571 )*
Contact Email Address*
Are you the Director/Owner of the company?*
Director Information
Director/Owner Position Title*
Director/Owner Full Name (as it appears in the passport)*
Prefix First & Middle Last
Director/Owner Local Name (if applicable)
Director/Owner Nationality*
Director/Owner Country or Region Location*
The place where the Director/Owner currently lives.
Director/Owner Gender*
- Male
- Female
Director/Owner Place of Birth*
The country or region where the Director/Owner was born.
Director/Owner Date of Birth (DD/MM/YYYY) – required for regular compliance checks)*
DD slash MM slash YYYY
Director/Owner Mobile Number (International format – country code, followed by the mobile number (without the leading "0"'s) – e.g. 61416404571 )*
Director/Owner Email Address*

Professional References
Please nominate two people from two separate educational institutions abroad to which you have sent students to act as your referee. If you intend to send students to Kaplan International’s university preparation programmes, please give references from a higher education institution. When choosing who to provide as a referee, we recommend you have been working with a partner for a minimum of 12 months. This is so they are able to provide detailed information we require for our background checks. If you have been working with the partner for less than 12 months, have formed a close working partnership within that period and they feel comfortable providing performance related information, this will also suffice. If you are a new agency, we suggest providing a reference from 1) a previous employer, 2) the bank or the lawyer that helped you to set up your business. If you are unsure about who to provide as a referee, please get in touch to check your choices before proceeding with this step.
First Referee
1st Referee – Full Name*
First Last
1st Referee – Name of Institution*
1st Referee – Position*
1st Referee – Phone Number*
1st Referee – Business Email Address*
1st Referee – Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country/Region
1st Referee – Number of years working together*
1st Referee – Background on relationship*
Second Referee
2nd Referee – Full Name*
First Last
2nd Referee – Name of Institution*
2nd Referee – Position*
2nd Referee – Phone Number*
2nd Referee – Business Email Address*
2nd Referee – Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
2nd Referee – Number of years working together*
2nd Referee – Background on relationship*
Other business experience
If you are new to the international education industry and do not have any history of sending students to study abroad, please use the Reference sections above to provide 2 professional references connected to the industry you previously worked in, preferably from international partners. In the box below, please also briefly describe your previous business experience and tell us why you are interested in this new business venture.

Agent Questionnaire – Live

Step 1 of 6

To help us with your application, please give as much information as possible in the fields below. Your information will not be shared with any third parties and will be kept confidential.

Company Information

Address Information

Company Contact Details

Personal Contact Information

Director Information

Company Profile

Marketing

Recruitment and Counselling

Professional References

First Referee

Second Referee

Bank Details