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Representative Application Form
Company details
Company or business Name
*
Country or Countries you will recruit students from
Registered address of company/business
*
Correspondence Address (
if different to above
)
Full name and address of the company in the local language:
Contact details
Primary Telephone (incl. country & area code)
*
Primary Facsimile (incl. country & area code)
Primary Email
*
Company Website
*
http://
Primary Contact Person
*
Direct Phone Number
*
Email
*
Contact details for use by THUAS (if applicable)
Marketing Director
Direct Phone Number
Email
Educational Advisor
Direct Phone Number
Email
Primary Email
Secondary Email
Fees charged by the company for the services to prospective students
*
Does your company have more than one office/branch? Please supply contact details for all other offices.
Registered address of company/business
Correspondence Address (
if different to above
)
Primary Telephone (incl. country & area code)
Secondary Telephone
Primary Facsimile (incl. country & area code)
Secondary Facsimile
Provide the following information in support of this application
Names and contact details of referees – preferably those of Dutch organizations
*
A list of institutions currently represented by my company
*
An explanation of my understanding of an agent’s responsibilities under the Code of Conduct
*
Certified copies of registration papers/licences, if applicable
*
I have read and agree with
the code of conduct
*
=
Input is required