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Get Deakin University Agents

S THAT THE STUDENT BELOW HAS NOMINATED Agent Name as his/her authorised agent. STUDENTS DETAILS Deakin Student ID Family name Given name(s) Date of birth / / Course name Course Code Course Start Date / / PREVIOUS AGENT DETAILS Agent Name Agent Address Country Postcode NEW AGENT DETAILS Agent Name Contact Person Position Title Signature Date / / STUDENT DECLARATION I (Student Name) confirm that (New Agent Name (Agent location) is my new Agent. Student s signature: ) i.

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