7/29/2019 CertIV MB Enrol

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International Institute of Technology Registered Training Organisation 21421

ABN 86 104 815 750

FNS40811Certificate IV in Finance & Mortgage Broking

Student Enrolment Form

1. Personal Details

You may complete this form "onscreen" by entering your information into the formfields. The form may be submitted education@iit.edu.au

You can save data entered into this form to your computer.Alternatively you may print the form and fax it to 03 8677 6911

Contact Details.

Title *First Name: Middle Name: *Last Name:

Pref Name: *Date of Birth: *Gender:

*Address:

*Suburb: *State:

*Postcode:

Country:

Course material is dispatched by courier to a street address during business hours.Please provide a street address as someone must be available to sign for the delivery. The Courier is unable to deliver to Post Office Boxes.If a PO Box delivery is required a surcharge of $15 for Australia Post express postal charge will be added to your enrolment fees.

Home Address Postal AddressPlease send course materials to my:Postal Address:

Address:

Suburb: State:

Postcode:

Country:

*Phone: *Email:

Additional Information:

Language and Cultural Diversity:

Country of Birth: Aboriginal or Torres Straight Islander? I Speak English:

Education:

Highest School Level: I completed School in: I have received previous qualifications

Place a tick in all boxes that apply:Bachelor Degree orHigher

Advanced Diploma or AssociateDegree

Diploma (or AssociateDiploma

Certificate IV (or Advanced Cert/ Technician)

Certificate III or TradeCertificate

Certificate II Certificate I Certificates other than the above

Employment Information:

Please select your Employment Status:

Occupation: Company Name:

Financial Services Industry Experience (over last 8 years):

Special Needs:

Do you have any special needs that need to be taken into consideration to support your learning (eg language, physical disability,

literacy, impairment)? Yes No

If so, please provide details:

Please note: Fields marked with * are required fields and must be completed

eg 1988

5 Years Plus

7/29/2019 CertIV MB Enrol

2/2

International Institute of Technology Registered Training Organisation 21421

ABN 86 104 815 750

FNS40811Certificate IV in Finance & Mortgage Broking

Student Enrolment Form

2. Course enrolment details (Please Select):

3. Payment Details (Please Select):

Payment Method: Card Number: Visa/Mastercard Only:

Expiry Date: Cardholder's Name:

If Paying by Bank Transfer please ensure you attach a Payment Transfer Confirmation to your completed Enrolment Form.

Transfer should be made to Account Name "International Institute of Technology" BSB 313-140 Account Number: 2313 7699

From Bank: Reference ID: Transfer Date:

Same day dispatch of course materials is possible if fully completed form/s and payment (as agreed) are received

PRIOR to 2pm. When forms and/or funds are received after 2pm next business day dispatch occurs. You will receive

an email confirming your enrolment within three business days.

4. Student Declaration

I have read, understood and agreed to all the information in the Student Information Guide, the privacy policy and all other terms and conditions as set out byIIT, including those contained in this enrolment form. I declare that all the information I have provided to IIT is accurate and true. I understand and agree thatIIT reserves the right to refuse an enrolment, I understand IIT may take action if part or all of the information provided is false or misleading, Information maybe shared with third parties in accordance with IIT's Privacy Policy and the AQTF compliance requirements. I also grant the right for IIT to email meinformation in relation to products/services it offers and to use my student testimonial in any of its marketing materials, including websites, brochures, flyersand the like.

*Full Name: *Date:

I understand by typing my name into the above text box that I agree to, and am bound by, the above student declaration.

Refer to www.iit.edu.au or call 1300 88 33 46 for pricing information.

RPL: Eligible for RPL/Credit Transer: *I plan to complete my course via:

Workshop Day 1:

Workshop Day 2:

Total Course Fee $In most cases course material is delivered by courier at no additional charge.

You may choose to upgrade to Express Post (next day) delivery on payment of $15 surchargeInternational postage and handling incurs a surcharge of $100

Total including additional postage if requested $

For completed forms please email to education@iit.edu.au or Fax to 03 8677 6911

I would like to pay byinstalments (please enterpreferred paymentdetails on the right)

Preferred Workshop Attendance Dates: (Not Applicable to Distance Education or E-Learning Sutdents)

No Thanks

mm/yyyy

Surname, Initial

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