MKT002

Please complete this form and include a (i) company profile and (ii) marketing plan
for our evaluation and review. We look forward to welcoming you as part of our
esteemed recruitment representative network worldwide.

AGENT APPLICATION FORM

1 Registered Business Name:
2 Nature of Business:
3 Business Address & Contract:

Postcode:
State:
Tel:
Fax:
4. Website (if any): www.
5 Person(s) in charge: Name:
Designation:
Contact Number:
Email:

Name:
Designation:
Contact Number:
Email:
6 Number of years in business:
7 Number of staff: -
8 Recruitment areas / offices / 1.
branches: 2.
3.
9 Which are the colleges / 1.
institutions / universities that you 2.
represent in Malaysia? (Please 3.
state name)
10 Which are the colleges / 1.
institutions / universities that you 2.
 represent outside of Malaysia? 3.
(Please state name)

11 Past performance: please indicate 1.

number of students recruited for the 2.
above colleges / institutions / 3.
universities that you represent during
the previous year(s).
12 Please tell us which are the key 1.
programmes offered at SEGi that you 2.
think may appeal very much to your 3.
target market.
13 Please tell us what were the main 1.
reason(s) that you have selected SEGi 2.
to be partners with? 3.
14 Remarks (if any):

Please provide us with other information that you may find relevant and useful for our
assessment. Thank you.

For and on behalf of …………………………….. (Company name)

……………………………………
Name:
Designation:
Date:

For office use only

Date:
Status: Approve Reject
Remarks:

Received & Evaluated by:

Signature:
Name:
Designation: