Request For Duplicate Or Replacement Diploma Form

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OFFICE OF THE REGISTRAR
Request for Duplicate or
Waterloo, Ontario, Canada N2L 3G1
519-888-4567, ext. 35378 | fax 519-746-2882 | uwaterloo.ca/registrar
Replacement Diploma
GRADUATE STUDIES
Waterloo, Ontario, Canada N2L 3G1
519-888-4567, ext.35411 | fax 519-746-3051 | uwaterloo.ca/graduate-studies
Print clearly and complete all areas below.
Important notices:
 Complete this form if you are a graduate wishing to obtain a duplicate copy of your diploma or wishing to replace a lost, damaged, or destroyed diploma.
 Send requests for undergraduate diplomas to the Office of the Registrar and requests for graduate diplomas to the Graduate Studies Office; both are in Needles Hall.
 Enclose the appropriate processing fee. The cost per duplicate or replacement diploma is $20.00 plus any additional mailing costs. See the section “What should
we do with your order?”
 Normal processing time is 7 days.
Waterloo student identification number ____________________________________
Complete the section below to order a duplicate or replacement diploma.
Duplicate diploma – The word DUPLICATE will be printed on the diploma. Select diploma type:  Undergraduate
 Master’s
PhD
The number of Duplicate diplomas requested equals ________.
 Replacement diploma – Select diploma type:
 Undergraduate
 Master’s
 PhD
One replacement diploma will be issued.
Select which option is applicable:
Original diploma was lost or damaged or destroyed. A Statutory Declaration form must be completed for a replacement
diploma if the original diploma is not attached. This form is on page 2.
 Yes
 No
Indicate if the original diploma is enclosed.
Official name change (A copy of an official document must be submitted with this request. Acceptable documents include a
copy of a passport or marriage certificate or birth certificate or court document.)
The total number of Duplicate and Replacement diplomas requested equals ________.
What should we do with your order? Select one.
Hold for pick up (Identification is required for release.)
Mail to the following address (A $10.00 mailing charge applies to Master’s and PhD diplomas.)
Send by courier. Additional mailing charges are:
$10 if in Ontario
$20 if in other Canadian provinces
$25 anywhere in the United States
$35 international (outside Canada and the United States)
Mailing address: Street ____________________________________________________________________ City ____________________________
Province or State ______________________________ Country ____________________________ Postal or zip code ___________________
Record identification data:
Print your full name below in upper- and lower-case letters as it appeared on your original diploma.
Last name _______________________________________________________________________________________________________________
First name __________________________________________________ Middle name(s) _______________________________________________
Last name at last attendance ________________________________________________________________________________________________
Degree or Diploma ________________________________________________________________________________________________________
Birth date (day) _________ (month) _________ (year) _________
Confer date (day) _________ (month) _________ (year) ___________
I hereby certify that all of the above statements are correct and complete.
Signature _______________________________________________________________________ Date ____________________________________
Email _________________________________________________ Phone number (area code) ________ (number) ___________________________
Payment information:
Total amount $ __________________________________________
Office use only
Cash
Cheque
Name on credit card ______________________________________
Amount ________________________
Debit
Credit card number _______________________________________
Credit Card
Received by _____________________
WatCard
Credit card expiry date (month) __________ (year) ___________
Date received ___________________
Card holder’s signature ___________________________________
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