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Deakin Cahnge of Agent Form

This document is a Change of Agent Application Form for Deakin University students to nominate a new authorized agent. It requires student details, previous and new agent information, and a student declaration. The completed form must be emailed to Deakin International for processing.

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258 views1 page

Deakin Cahnge of Agent Form

This document is a Change of Agent Application Form for Deakin University students to nominate a new authorized agent. It requires student details, previous and new agent information, and a student declaration. The completed form must be emailed to Deakin International for processing.

Uploaded by

paras81277
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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CHANGE OF AGENT

APPLICATION FORM
Deakin University
Deakin International
Melbourne Burwood Campus
221 Burwood Highway
Burwood, Victoria 3125, Australia
www.deakin.edu.au/international

THIS FORM VERIFIES THAT THE STUDENT BELOW HAS NOMINATED


Agent Name as his/her authorised agent.

STUDENTS DETAILS

Deakin Student ID

Family name Given name(s)

Date of birth / /

Course name Course Code

Course Start Date / /

PREVIOUS AGENT DETAILS


Agent Name

Agent Address

Country Postcode

NEW AGENT DETAILS


Agent Name

Contact Person Position Title

Signature Date / /

STUDENT DECLARATION
I (Student Name) confirm that (New Agent Name ) in

(Agent location) is my new Agent.

Student’s signature: Date: / /


Please email the completed form to [email protected]

DEAKIN INTERNATIONAL USE ONLY

Approved Not approved Commission allocation

IM Signature Date: / /

Name of IM

Comments

Deakin University CRICOS Provider Code 00113B PAGE 1 OF 1

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