APPOINTMENT OF AGENT FORM
Do not use this form if you already have an agent.
EMAIL TO: [email protected]
STUDENT DETAILS
University of Sydney ID number (SID):
Family name:
First names:
Date of birth:
Course name:
Email address:
NEW AGENT DETAILS
Agency Name:
Agent (TPXXXXX) Code :
Address: ..........................................................................................................................................
...........................................................................................................................................................
Contact person:
Phone no:
Email address:
STUDENT DECLARATION
I, ................................................................................... (print name), declare that I have appointed
............................................................................................................................ to act as my agent
for my application for the course listed above. I lodged the application (please tick below):
 myself, direct to The University of Sydney; or
 via UAC (Universities Admissions
Centre)
 via another agent
Student signature:
(as per signature on passport/application form)
ABN 15 211 513 464
CRICOS 00026A
Date signed: