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APPLICATION FORM FOR REPRESENTATIONSHIP
Ukrainian International Education Council
2016 / 2017

COMPANY DETAILS

Name of Organization

Registered Company Name (if different)

Company Director / Principal

Business Addresses (registered and physical)

Bank Account

Contact Person

Position

Phone №

E-mail

Web-site

Skype

Twitter/Facebook/ LinkedIn

BUSINESS INFORMATION

Year founded

Number of staff

1-3 4-6 7-10 11+

Number of students enrolled in education institutes each year

1-15 16-50 51-100 100+

Please list out the location of your offices

Do you have partnerships / affiliations with other agencies in your territory?

No Yes

If yes, please provide details

How long has your business been in operation as an education recruitment Agent?

Do you, or your company, conduct business activities other than student recruitment?

No Yes

If yes, please provide details

For which countries do you currently recruit students (Please mention for how long you have been recruiting for these countries)?

Have you ever recruited students for Ukrainian Institutions?

No Yes

If Yes, please provide details

What territory do you cover?

Passport or ID copy of Director (MD)

Company Registration Document 1

Company Registration Document 2

Company Registration Document 3

DECLARATION

I am interested in representing you as an educational representative and I agree to do so in an honest and professional manner. I agree to: Regularly monitor UIEC policies and regulations and changes to these policies and regulations if any. I have read the UIEC Guidelines and agree to adhere to the relevant criterions.