Uts Documents Proxy Collection Form printable pdf download

UTS DOCUMENTS PROXY COLLECTION FORM

Please note this form should only be completed if you are unable to collect your testamur and graduation documents or other personal UTS

documents in person or at your graduation ceremony. In completing this form you are authorising a friend or relative (who shall be known as your

Proxy in this form) to collect your personal UTS documents from UTS on your behalf.

DECLARATION

I, the undersigned student, understand and agree that in the case of testamur collection

Rule 13.9

of the UTS Student Rules states:



A testamur is an official University certification document that confirms a qualification has been awarded to an individual.



A testamur is a legal document issued under the seal of the University and is issued in original form only once for each specific award conferred.



A certificate of replacement for a testamur may be requested by a graduate and issued under the authority of the Director, Student

Administration Unit in the form and on such conditions as determined by the Vice-Chancellor from time to time.

UTS STUDENT DETAILS

UTS Student ID:

Family name:

Given names:

Address:

UTS email (enrolled students):

Telephone:

Personal email (former students or graduates):

Full title of degree/diploma/certificate:

Proof of Student Identity

As the student, please attach a certified copy of one of the following documents:

current Australian driver’s licence or Proof of Age card, or

Note: to protect privacy, this consent will not

be accepted without proof of your identity

current Passport, or

other proof of signature and current address details

PROXY DETAILS

Family name:

Given names:

Address:

Telephone:

Email:

Proxy’s signature:

Date:

STUDENT AUTHORISATION OF PROXY

I, ________________________________________________, authorise (proxy name) ________________________________________________

to collect my (tick one only - ):

Testamur and Graduation documents

Academic Transcript

Statement of Course Completion

Statement of Enrolment

Other (please specify) ___________________________________.

Student’s signature:

Date:

This form must be signed by the enrolled student, former student or graduate and proxy. Documents will not be released to a proxy without this

signed authorisation. The proxy must present official photo ID, such as UTS Student ID, driver’s license or passport, for identification purposes when

collecting documents.

TESTAMUR COLLECTION ADDRESS (other documents can be collected from your specified Student Centre)

Student Centre: Building 10, Level 2, City campus, Jones St, Ultimo. Telephone: 1300 275 887 (or International + 61 2 9514 1222)

OFFICE USE ONLY (complete at time of collection)

Collection date:

Collection time:

Proxy ID details:

Sighted by (Student Centre Officer name):

Student Centre Officer signature:

Proxy signature:

Date:

UTS Documents proxy collection form, Student Records, March 2015

Uts Documents Proxy Collection Form

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