Agent Application Form

Please complete the form below and return it to CCEL at study@ccel.co.nz with your company profile. Once we receive it, your application will be carefully assessed by our management team and you will hear back from us shortly. If your application is approved, you will receive a CCEL Retailer Agreement signed. Please contact us should you have any questions.

Question Title

* Official Name

Question Title

* Type of business:

Sole Trader

Registered Company (Please, send copy of the company incorporation certificate)

Question Title

* If you are a Registered Company, please send a copy of the company incorporation certificate. This document must be in English or translated.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* Trading Name (if different from above)

Question Title

* Company details:

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Company Email Address

Phone Number

Website

Question Title

* Main Contact:

Mr/Mrs/Miss

Family Name

Given Name

Position

Email Address

Question Title

* Alternative Contact:

Mr/Mrs/Miss

Family Name

Given Name

Position

Email Address

Question Title

* Year Established

Question Title

* Please tell us about your company (or attach company profile)

Question Title

* Which types of NZ institution do you already represent? (e.g. High School, Language School etc)

Question Title

* Which countries do you recruit students from?

Question Title

* How many students do you send to NZ per year?

Question Title

* Which services do you offer your clients? (eg travel agency, accommodation placement, visa and immigration advice...)

Question Title

* Have you or your staff ever visited NZ? Please give details.

Question Title

* Do you work with sub- agents? Please give details.

Question Title

* BANK DETAILS:

If you are a registered company, bank details must be under the company name.

Bank Name:

Bank Country

Bank Address

Account Name

Account Number

Swift Code

Currency

IBAN Number

BSB

Question Title

* REFEREE DETAILS:

Please provide contact details of two referees (preferably in New Zealand).

Referee 1

Mr/Mrs/Miss

Name

School

Position

Telephone Number

Email Address

Question Title

* Referee 2

Mr/Mrs/Miss

Name

School

Position

Telephone Number

Email Address

Question Title

* DECLARATION:

The information supplied above is true and correct to the best of my knowledge. I am authorised to sign an agreement on behalf of the retailer named above.

Question Title

* .

Name

Position

Date

Agent Application Form

Question Title

* Official Name

Question Title

* Type of business:

Question Title

* If you are a Registered Company, please send a copy of the company incorporation certificate. This document must be in English or translated.

Question Title

* Trading Name (if different from above)

Question Title

* Company details:

Question Title

* Main Contact:

Question Title

* Alternative Contact:

Question Title

* Year Established

Question Title

* Please tell us about your company (or attach company profile)

Question Title

* Which types of NZ institution do you already represent? (e.g. High School, Language School etc)

Question Title

* Which countries do you recruit students from?

Question Title

* How many students do you send to NZ per year?

Question Title

* Which services do you offer your clients? (eg travel agency, accommodation placement, visa and immigration advice...)

Question Title

* Have you or your staff ever visited NZ? Please give details.

Question Title

* Do you work with sub- agents? Please give details.

Question Title

* BANK DETAILS:If you are a registered company, bank details must be under the company name.

Question Title

* REFEREE DETAILS:Please provide contact details of two referees (preferably in New Zealand).Referee 1

Question Title

* Referee 2

Question Title

* DECLARATION:The information supplied above is true and correct to the best of my knowledge. I am authorised to sign an agreement on behalf of the retailer named above.

Question Title

* .

* BANK DETAILS:

If you are a registered company, bank details must be under the company name.

* REFEREE DETAILS:

Please provide contact details of two referees (preferably in New Zealand).

Referee 1

* DECLARATION:

The information supplied above is true and correct to the best of my knowledge. I am authorised to sign an agreement on behalf of the retailer named above.