Agent Application

Midream Certificate of Representation

To be Midream's certified agent, please fill out the form below in full.





Conpany Information

Company name

Country

Your name

Phone number

Website

Email

Skype ID

Postal Address

Business History

Q1. How long have you been in operation as an education agent?

Q2. Does your company deal in areas other than international education?

Q3. What is the total number of enrollments that your office processes each year?

Q4. Which countries do you send most of your students?

Q5. Do you work with any other education agents as a partnership or an affiliation?

Q6. Do you promote any other Japanese institutions? If yes, provide the names.

Q7. Have you or any of your counselors ever visited Japan? If yes, state the purpose.

Q8. Please describe your reason for wanting to promote the Provider as a recommended school.

Bank Details

Bank name

Branch name

Bank address

Branch phone number

Account holder’s name

Account number

Swift

Referees

Please include the details of two referees we can contact, including one education institution.

Referee 1

Referee’s Name

Title

Organization

Organization address

Phone

Email

Website

Referee 2

Referee’s Name

Title

Organization

Organization address

Phone

Email

Website

Please upload the following documents.

1. A short profile of the agency

2.A copy of Business Registration Certificate

3.Identification document of Director/owner [Passport, Drivers license etc..]