SAC-Register Form

Company Details

Address *
Does the company / provider plan to gain registration *
The Provider promises that it, and its partners, staff and consultants, do not have and are not aware of any actual or potential conflicts of interest which may arise between IEG Campus and the Company/ Provider unless indicated below. *

Main Contact for all correspondence

Additional Contact Details

Bank and Finance Details

Bank Details

Financial Details

Are there any significant events, matters or circumstances which have arisen since the end of the last financial year which may affect the operations of the Company / Provider? *
Are there any mergers or acquisitions that can be notified, either within the past 12 months or which are imminent? *
Are there any court proceedings of any kind, actual or threatened against the Provider, its parent or associated entities or any director of the Company/Provider, its parent or associated entities within the past 5 years? *
Are there any insolvency or bankruptcy actions against the Company / Provider, a director of the Company / Provider or its parent or associated entities within the past 5 years? *
Are there actions of insolvency proceedings, actual or threatened (including Voluntary Administration, Application to Wind Up, or other) against the Company / Provider its parent or associated entities within the past 5 years? *
Are there any breaches of or defaults under any agreement, contract, order or award binding on the Company / Provider, or its parent or associated entities? *
Are there any other factors which could impact on the financial ability to successfully perform the contract? *
Is the Company / Provider “trading solvent and able to meet its debts as and when they fall due in the normal course of business”? *
IEG Campus may use an independent credit rating agency or other organisation to conduct financial assessments and reports. For this assessment to be completed, a representative from one of these organisations may contact you concerning the financial information that you provide. The financial assessment report is specifically for use by IEG Campus the purpose of assessing Providers and will be treated as strictly confidential. You agree to assist in the assessment process. The Provider agrees that it will co-operate with an independent credit rating agency or other organisation during the conduct of financial assessments and reports. *

Company Overview

Into which Division of IEG will you be enrolling most students? *
Is your business licensed by the government of your country? *
What type of academic programs are your customers interested in? *
Which are the most common sources of finance of your students? *
I am interested in receiving product information on the following destinations *

Company Operations

How do you advertise your services? *


Second Referee

Expertise and Experience

Key Staff:

Briefly introduce key academic and operational staff (please attach a resume copy for each listed).


IEG Campus Study Abroad Centre Student Support Office and Learning Room.

If more than one file, kindly please zip and upload.

Education Services for Overseas Students (ESOS) Compliance or Similar in your country of operation:

Following any Re-registration or external ESOS audits held at your organisation’s teaching/training locations were there any major non-compliant issues raised in your reports?  Definition of major non-compliant issue: Issue that could result in your organisation losing Service Provider Registration or equivalent in your country of operation. *

Attached Relevent Documents

If more than one file, kindly please zip and upload.


The Company / Provider warrants that all information contained in this Due Diligence form is accurate and complete. The Company / Provider warrants that it has not provided any inaccurate or misleading information to IEG Campus or representatives of IEG Campus. The person executing this form on behalf of the Company / Provider warrants that he or she is authorised by the Company / Provider to so execute. *