Replacement Card Request Form
Lost
Stolen
Damaged
Other
Surname:
First Name:
ID Number:
Course:
Contact Number:
Address:
Replacement Card Charges
To be paid prior to the printing of the Unique card
Lost or damaged cards:
£10
*Stolen cards:
Free
*ONLY with a VALID Police crime sheet, submitted at the time of application, otherwise a fee of £10 will
apply ‘PROPERTY LOST IN THE STREET’ sheets are not accepted
For full details of the UWL ID card card and any benefits included, please visit
http://uwl.ac.uk/idcard
Office Use
Date:
NEW Talis:
Ealing
Paragon
Name:
Signature:
UWL Card Card Centre, University of West London, Room C128, St. Mary's Rd, Ealing, W5 5RF
UNQ/UWL-07/05-2.1.E (01/06)