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Step 1
Agent Reference Check Form
Name
Agent Applicant
Referee Organization
Name of Contact at Organization
In what capacity do you deal with the applicant?
Contact Number
Email
a valid email
email
Nature of Relationship to Agent Applicant
Is the Agent an authorised representative for your institute?
Select
Yes
No
How long has your institution been dealing with this Agent?
Select Duration
0-3 years
3-5 Years
More Than 5 years
Have you found the applicant to be ethical with reference to:
Poor
Average
Good
Business dealings
Business relationships
Rights of consumers
Responsibilities to consumers
Financial dealings
Expert within their field of operation
Professional within their field of operation
Is honest and ethical
What is this organizations greatest strengths?
0
/
Is there something you believe this organization can/should do better?
0
/
Additional Comments
more details
0
/
Thank you very much for your assistance and for taking the time to complete this form. Your response is very important to us and we care about privacy. These responses are confidential therefore we will not share this with anyone.
Submit Form
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