COMPANY NAME
COMPANY OWNER NAME
COMPANY REGISTRATION NUMBER
DATE OF ESTABLISHMENT
COMPANY ADDRESS
CITY
STATE/PROVINCE
POSTAL CODE
COUNTRY
WEBSITE
OFFICIAL EMAIL ADDRESS
CONTACT PERSON NAME
CONTACT PERSON PHONE NUMBER
CONTACT PERSON EMAIL
TYPE OF AGENCY (SELECT ALL THAT APPLY)
Student RecruitmentImmigration ConsultancyCareer CounsellingOther
IF 'OTHER', PLEASE SPECIFY
NUMBER OF EMPLOYEES
COUNTRIES REPRESENTED
NUMBER OF STUDENTS RECRUITED ANNUALLY
SELECT CERTIFICATIONS
ICEFBritish CouncilPIEROthers
IF 'OTHERS', PLEASE SPECIFY CERTIFICATIONS
BANK ACCOUNT NAME
BANK ACCOUNT NUMBER
BANK BRANCH ADDRESS
IFSC/SWIFT CODE
I confirm that the information provided above is accurate and true to the best of my knowledge.
SIGNATURE & AGENCY STAMP
DATE
I CONFIRM that all information provided is accurate and true
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