Authorization Form For Collection Of Academic Documents (Not Applicable To Graduation Certificate)
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1Authorization Form for
Collection of Academic Documents (not applicable to Graduation Certificate)
If you wish to authorize a representative to collect the academic document(s) (e.g. transcript, certifying
letter, etc) on your behalf, please complete this form.
(
The personal data of the student/graduate or the representative will be used for collection of the academic document(s) and
record purpose only. This Instruction and copy of the student’s/graduate’s/representative’s ID document will be kept in the
Graduate School. For correction of or access to the personal data after submission of this form, please contact the Graduate
)
School at 852-3943 8976, or email to gradschool@cuhk.edu.hk.
Personal data of the student/graduate
Name (in English):
Name (in Chinese):
HKID Card/
Other Identity No.:
Student ID:
Degree:
Programme:
Contact Phone No. (in HK):
E-mail Address:
---------------------------------------------------------------------------------------------------------------------------
(ATTENTION: The representative should bring along this form together with the copy of the
identity document of the student/graduate mentioned above. Original document will not be
accepted for verification.)
I hereby authorize the following representative to collect my document(s)* on my behalf:
Certifying Letter
Transcript
Report on Curriculum Details
Others, please specify:
*Please tick as appropriate.
Personal data of my representative
Name (in English):
Name (in Chinese):
Passport / Identity Card
Type of ID Document#:
ID Document No.:
Signature of Student/Graduate:
Date:
#Please delete as appropriate.
Acknowledgement of receipt of the above academic document(s)
Signature of
Date:
Representative:
---------------------------------------------------------------------------------------------------------------------------
For Graduate School Office use only
Handled by:
Date:
(Version: June 2012)
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