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:
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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 spec ific 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:
Date of Birth (DOB):
Family name:
Given name(s):
Address:
UTS email (enrolled students):
Personal email (former students or graduates):
Telephone:
Course Completion OR Last Enrolment Date
Semester:
Year:
Title of Degree/Course:
Proof of Student Identity
As the student, please attach a certified copy of one of the following documents:
Note: to protect privacy, this consent will not
be accepted without proof of your identity
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current Australian driver’s licence or Proof of Age card, or
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 (only valid for 30 days from the date of student signature)
I, ________________________________________________, authorise (proxy name) ________________________________________________
to collect my (tick one only - ):
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Testamur and Graduation documents
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Academic Transcript
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Statement of Course Completion
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Statement of Enrolment
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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:
Sighted by (Student Centre Officer name):
Proxy signature:
UTS Documents proxy collection form, Student Records, April 2015
Proxy ID type/ number (attach a copy):
Student Centre Officer signature:
Date: