Collaborative Programmes Student Records Administration Handbook
Collaborative Programmes Student Records Administration Handbook
Collaborative Programmes Student Records Administration Handbook
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<strong>Collaborative</strong> <strong>Programmes</strong><br />
<strong>Student</strong> <strong>Records</strong> <strong>Administration</strong> <strong>Handbook</strong><br />
<strong>Collaborative</strong> <strong>Programmes</strong><br />
Quality Management Division<br />
Academic Registry<br />
September 2010
Document title<br />
<strong>Collaborative</strong> <strong>Programmes</strong> <strong>Student</strong> <strong>Records</strong> <strong>Administration</strong> <strong>Handbook</strong><br />
Document author and department<br />
Responsible person and department<br />
Clare Privett<br />
Quality Management Division<br />
Academic Registry<br />
EITHER<br />
For public access online (internet)?<br />
(tick as appropriate)<br />
Rebecca Broome<br />
Quality Management Division<br />
Academic Registry<br />
OR<br />
For staff access only (intranet)?<br />
(tick as appropriate)<br />
Yes<br />
<br />
Yes<br />
For public access on request copy to be<br />
mailed<br />
(tick as appropriate)<br />
Password protected<br />
(tick as appropriate)<br />
Yes <br />
No Yes No<br />
<br />
Edition no. 1
Contents<br />
Introduction ............................................................................................................................... 5<br />
1. Programme Funding Type ...................................................................................................... 5<br />
2. Admissions Process ................................................................................................................ 6<br />
3. Registration Paperwork ......................................................................................................... 6<br />
3.1 Registration Coversheet and Registration List ..................................................................... 7<br />
3.2. Progression Coversheet and Progression List ..................................................................... 7<br />
4. Registration of Applicants ...................................................................................................... 7<br />
5. Class List ................................................................................................................................. 8<br />
6. Confirmation of Registration Email ........................................................................................ 8<br />
7. Letter of Registration ............................................................................................................. 8<br />
8. Amendments .......................................................................................................................... 9<br />
9. Study Break ............................................................................................................................ 9<br />
10. Transfer ................................................................................................................................ 9<br />
11. Withdrawal......................................................................................................................... 10<br />
12. Unit Registration ................................................................................................................ 10<br />
13. Unit Assessment Board ...................................................................................................... 10<br />
14. Board of Examiners ............................................................................................................ 10<br />
15. Conferment List (UP6)........................................................................................................ 10<br />
16. Inputting of Assessment Results ........................................................................................ 11<br />
17. Name Checking Report ...................................................................................................... 11<br />
18. Parchment .......................................................................................................................... 11<br />
19. Transcript ........................................................................................................................... 12<br />
20. <strong>Collaborative</strong> Text on Parchment/Transcript .................................................................... 12<br />
21. Notarisation and or Legalisation of a Parchment and or Transcript ................................. 13<br />
22. Contact Details ................................................................................................................... 13<br />
Annex A Registration Coversheet 15<br />
Annex B Registration List 17<br />
Annex C Registration List Guidance Notes 19<br />
Annex D Progression Coversheet 23<br />
Annex E Progression List 25<br />
Annex F Withdrawal/Study Break/Transfer/Amendment Form (WSTA Form) 27<br />
Annex G Class List 29<br />
Annex H Confirmation of Registration Email 31<br />
Annex I <strong>Collaborative</strong> <strong>Programmes</strong> <strong>Student</strong> Card Application Form 33<br />
Annex J Letter of Registration 35<br />
Annex K University Computer Account and <strong>Student</strong> Card Information Paper 37<br />
Annex L Conferment List (UP6) 39<br />
Annex M Name Checking Report 41<br />
Annex N UP12 Form 43
Introduction<br />
The purpose of this <strong>Handbook</strong> is to inform University of Portsmouth (University) and Partner<br />
institution staff of the <strong>Student</strong> <strong>Records</strong> administration processes for Registered‐only (Rcoded)<br />
collaborative programmes, from initial registration on our <strong>Student</strong> <strong>Records</strong> System<br />
right through to completion and printing of the student’s parchment. This <strong>Handbook</strong> does<br />
not apply to the administration processes for C‐coded collaborative programmes, which<br />
follow the University’s administrative processes for home programmes.<br />
1. Programme Funding Type<br />
It is helpful to start with an explanation of the University’s programme code system. All<br />
University programmes have a unique code which has a prefix of either C or R followed by<br />
xxxx numbers. All programmes delivered on campus at Portsmouth start with a C i.e. C0123.<br />
<strong>Collaborative</strong> programmes can start with either a C or an R depending on the funding<br />
arrangement of the programme. This is detailed in the table below:<br />
Funding Type Explanation C or R Programme Code<br />
HEFCE Indirectly Funded This is where the University<br />
receives HEFCE funding for<br />
the programme. The<br />
University allocates each<br />
year a percentage of the<br />
funding to the partner<br />
institution. This means the<br />
partner is indirectly funded<br />
through HEFCE to deliver the<br />
programme. This can only<br />
apply to programmes being<br />
delivered through a partner<br />
located in the UK.<br />
<strong>Collaborative</strong> programmes<br />
with this type of funding<br />
have a programme code<br />
starting with a C i.e. C0123.<br />
HEFCE Directly Funded<br />
This is where the UK‐based<br />
Partner Institution receives<br />
HEFCE funding for the<br />
programme directly. The<br />
University does not receive<br />
any HEFCE funding and<br />
therefore, the University<br />
supports the collaborative<br />
programme on a Full Cost<br />
financial business case.<br />
<strong>Collaborative</strong> programmes<br />
with this type of funding<br />
have a programme code<br />
starting with an R i.e. R0345.<br />
Page 5 of 44
Full Cost<br />
This is where neither the<br />
University nor the Partner<br />
receives any HEFCE funding<br />
for the programme. The<br />
University supports the<br />
collaborative programme on<br />
a Full Cost financial business<br />
case. This applies to some<br />
UK‐based partnerships and<br />
ALL overseas partnerships.<br />
<strong>Collaborative</strong> programmes<br />
with this type of funding<br />
have a programme code<br />
starting with an R i.e. R0345.<br />
For a current list of R‐coded and C‐coded collaborative programmes please contact the<br />
<strong>Collaborative</strong> <strong>Programmes</strong> Office (CPO) either via email cpo@port.ac.uk or telephone<br />
+44 (0) 23 9284 3502.<br />
2. Admissions Process<br />
The purpose of the admissions process is to ensure that all applicants who wish to study on<br />
a collaborative programme satisfy the minimum entry requirements.<br />
Authority to grant admission decisions is determined through the formal collaborative<br />
programme approval process. Some Partner institutions may be given delegated authority<br />
to grant admission against standard entry criteria.<br />
Partner institutions that have no delegated authority must submit each applicant’s entry<br />
qualifications to the University before the programme commences, exactly when this<br />
happens will be established with the Partner institution after the programme has been<br />
approved. The specific admissions arrangement, including any delegated authority, will be<br />
detailed in the <strong>Collaborative</strong> Operational <strong>Handbook</strong>.<br />
3. Registration Paperwork<br />
The registration paperwork is the means by which the Partner institution can list and submit<br />
to CPO those applicants who have been approved entry through the admissions process.<br />
The paperwork will be sent electronically by CPO to the Partner Institution where possible<br />
one month prior to the commencement of the intake. Once the completed paperwork has<br />
been received by CPO applicants will be registered onto the University’s <strong>Student</strong> <strong>Records</strong><br />
System.<br />
The registration paperwork comprises of:<br />
• Registration Coversheet (Annex A)<br />
• Registration List (Annex B)<br />
• Registration List Guidance Notes (Annex C)<br />
• Progression Coversheet, if applicable (Annex D)<br />
• Progression List, if applicable (Annex E)<br />
• Withdrawal/Study Break/Transfer/Amendment Form (Annex F)<br />
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3.1 Registration Coversheet and Registration List<br />
The Registration Coversheet (Annex A) is the means by which the Partner institution<br />
confirms to CPO that they have made applicants aware of, and agree to abide by, the<br />
declaration statements set out within it. It is a form that the Partner institution is required<br />
to sign and return along with the completed Registration List.<br />
The Registration List (Annex B) is the means by which the Partner institution can list and<br />
submit to CPO those applicants who have been approved entry through the admissions<br />
process. It is a spreadsheet that the Partner institution must complete and return along<br />
with the signed Registration Coversheet.<br />
The Registration Coversheet and Registration List are sent electronically by CPO to the<br />
Partner institution one month prior to the commencement of the intake.<br />
Failure to return the Registration Coversheet and Registration List by the return date stated<br />
on the Coversheet could result in applicants not being registered onto the University’s<br />
<strong>Student</strong> <strong>Records</strong> System.<br />
3.2. Progression Coversheet and Progression List<br />
The Progression Coversheet (Annex D) and Progression List (Annex E) are the means by<br />
which the Partner institution confirms and notifies CPO of the progression status of each<br />
student once the student has been presented to a Board of Examiners (BoE).<br />
The Progression Coversheet is a form that the Partner institution is required to sign and<br />
return along with the completed Progression List. Once signed it is confirmation that the<br />
Partner institution has supplied accurate and complete information on the Progression List<br />
for each student.<br />
The Progression List is a spreadsheet that the Partner institution must complete and return<br />
along with the signed Progression Coversheet.<br />
The Progression Coversheet and Progression List are sent electronically by CPO to the<br />
Partner institution one month prior to the commencement of the intake.<br />
Failure to return the Progression Coversheet and Progression List by the return date stated<br />
on the Coversheet could result in students’ records not being updated and their access to<br />
University services being affected.<br />
For some Level 3, Top‐up programmes CPO has delegated responsibility for carrying out the<br />
progression process to the relevant University Department. For a list of programmes this<br />
applies to, contact CPO.<br />
4. Registration of Applicants<br />
Within two weeks of CPO receiving the completed Registration Paperwork from the Partner<br />
institution, applicants will be newly registered or progressed to the next Level on the<br />
University’s <strong>Student</strong> <strong>Records</strong> System. Once registered it is at this point that applicants<br />
become University students. The University does not retrospectively register students.<br />
Page 7 of 44
5. Class List<br />
Once students have been registered and or progressed, CPO will produce a Class List (Annex<br />
G) identifying all students registered on the programme for the current year.<br />
The Class List will be sent to the:<br />
• Partner institution<br />
• University Academic Contact<br />
• University Administrative Contact<br />
• Faculty Registrar<br />
6. Confirmation of Registration Email<br />
Once registered, CPO will send students an email (Annex H) which will confirm their<br />
registration with the University and:<br />
• <strong>Student</strong> Registration Number<br />
• Programme Code<br />
• Name<br />
• Programme Start Date<br />
• Expected to Complete Date<br />
• Mode of Study<br />
• Instructions on how a student can obtain a computer account username and<br />
password<br />
• Instructions on how to obtain a University <strong>Student</strong> Card (the <strong>Collaborative</strong><br />
<strong>Programmes</strong> <strong>Student</strong> Card Application Form (Annex I) will be attached to the email)<br />
• Information on online services and resources at the University<br />
• Instructions on how to obtain a formal Letter of Registration (Annex J)<br />
7. Letter of Registration<br />
Some Partner institutions may request to have a formal Letter of Registration (Annex J)<br />
printed for students rather than the Confirmation of Registration email sent. <strong>Student</strong>s can<br />
also request to have a formal Letter of Registration printed as detailed in the Confirmation<br />
of Registration email.<br />
The letter will confirm that the student is registered with the University and:<br />
• <strong>Student</strong> Registration Number<br />
• Programme Code<br />
• Name<br />
• Programme Start Date<br />
• Expected to Complete Date<br />
• Mode of Study<br />
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Accompanying the letter will be a Paper (Annex K) that has:<br />
• Instructions on how a student can obtain a computer account username and<br />
password<br />
• Instructions on how to obtain a University <strong>Student</strong> Card (the <strong>Collaborative</strong><br />
<strong>Programmes</strong> <strong>Student</strong> Card Application Form (Annex I) will accompany the letter)<br />
• Information on online services and resources at the University<br />
8. Amendments<br />
If amendments are required to a student’s personal details such as their name, address or<br />
email etc. then a Withdrawal/Study Break/Transfer/Amendment Form (WSTA Form) (Annex<br />
F) must be completed by the Partner institution and returned to CPO, within seven working<br />
days of the student notifying the Partner institution.<br />
Once CPO has taken receipt of the WSTA Form the student’s record will be updated<br />
accordingly.<br />
9. Study Break<br />
If a student wishes to apply for a study break then a WSTA Form (Annex F) must be<br />
completed by the Partner institution and returned to CPO, prior to the student going on the<br />
study break.<br />
Once CPO has taken receipt of the completed WSTA Form, approval will be sought from the<br />
relevant University Academic Contact. If the study break is approved CPO will update the<br />
student’s record accordingly and inform the Partner institution. The Partner institution<br />
should then inform the student that the study break has been approved.<br />
If the study break is not approved the University Academic Contact will notify the Partner<br />
institution accordingly.<br />
CPO will automatically reinstate a student once their expected to return date has been<br />
reached. If, however, a student wishes to extend their study break then the Partner<br />
institution must complete another WSTA Form and submit it to CPO for approval. Likewise,<br />
if a student returns early then a WSTA Form must be completed and returned to CPO so the<br />
student’s record can be updated accordingly.<br />
10. Transfer<br />
If a student wishes to transfer to another collaborative programme then a WSTA Form<br />
(Annex F) must be completed by the Partner institution and returned to CPO, within seven<br />
working days of the student notifying the Partner institution.<br />
Once CPO has taken receipt of the completed WSTA Form, approval will be sought from the<br />
relevant University Academic Contact. If the transfer is approved CPO will update the<br />
student’s record accordingly and inform the Partner institution. The Partner institution<br />
should then inform the student that the transfer has been approved. If the transfer is not<br />
approved the University Academic Contact will notify the Partner institution accordingly.<br />
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11. Withdrawal<br />
If a student wishes to withdraw from a programme then a WSTA Form (Annex F) must be<br />
completed by the Partner institution and returned to CPO, within seven working days of the<br />
student notifying the Partner institution.<br />
Once CPO has taken receipt of the completed WSTA Form the student will be withdrawn<br />
from the University’s <strong>Student</strong> <strong>Records</strong> System and notification sent to the relevant<br />
University Administrative Contact.<br />
12. Unit Registration<br />
Registration of students on specific units is conducted and managed directly through the<br />
relevant University Academic Department and the Partner institution.<br />
13. Unit Assessment Board<br />
A Unit Assessment Board (UAB) is the “first tier” in a “two tier” assessment board system<br />
adopted by the University. The “second tier” is a Board of Examiners (BoE).<br />
A UAB confirms the marks awarded to each individual student attempting assessment in<br />
that unit during the previous semester or year (as appropriate). It is the responsibility of the<br />
relevant University Academic Department to arrange a UAB and record the marks.<br />
For further information on a UAB please refer to the University’s Exam and Assessment<br />
Regulations document.<br />
14. Board of Examiners<br />
The primary purpose of a Board of Examiners (BoE) is to decide on matters of student<br />
progression and the recommendation of awards (i.e. degrees, diplomas, certificates etc).<br />
It is the responsibility of the relevant University Academic Department to arrange the BoE<br />
and record the decisions.<br />
For further information on a BoE please refer to the University’s Exam and Assessment<br />
Regulations document.<br />
15. Conferment List (UP6)<br />
It is the responsibility of the relevant University Academic Department to produce the<br />
Conferment List (UP6) (Annex L) and take it to the BoE for decisions to be made. Decisions<br />
from the BoE are marked on the UP6 accordingly. A photocopy of the completed UP6 is<br />
kept by the University Academic Department for their own records while the original UP6 is<br />
sent to CPO within one week of the BoE being held, unless otherwise previously agreed.<br />
Once CPO has taken receipt of the completed UP6 the data will be checked against the<br />
Parchment Print Report for accuracy. If errors are found then the Faculty Advisor for<br />
<strong>Collaborative</strong> <strong>Programmes</strong> will liaise with the relevant University Academic Department.<br />
Page 10 of 44
If a decision is made after the BoE has convened a Chair’s Action Memo is produced by the<br />
relevant University Academic Department. A photocopy of the completed Chair’s Action<br />
Memo is kept by the Department for their own records while the original Chair’s Action<br />
Memo is sent to CPO.<br />
For further information on a UP6 please refer to the University’s Exam and Assessment<br />
Regulations document.<br />
16. Inputting of Assessment Results<br />
It is the responsibility of the relevant University Academic Department to input the<br />
assessment results against each student’s record in the University’s <strong>Student</strong> <strong>Records</strong><br />
System. This must be done within one week of the BoE convening, unless otherwise<br />
previously agreed.<br />
17. Name Checking Report<br />
Upon receipt of a UP6 a Name Checking Report (Annex M) will be produced by CPO and sent<br />
to the Partner institution to check the accuracy of the names of the students for whom a<br />
parchment will be printed. If, once the Name Checking Report has been returned, there are<br />
errors then these will be amended on the University’s <strong>Student</strong> <strong>Records</strong> System by CPO<br />
before parchments and transcripts are printed.<br />
Not all Partner institutions will receive a Name Checking Report it will depend on what was<br />
previously agreed between the Partner institution and CPO. For a list of which Partner<br />
institutions receive a Name Checking Report please contact CPO.<br />
18. Parchment<br />
Parchments are produced within eight weeks of CPO taking receipt of a correctly input UP6<br />
(Annex L) or Chair’s Action Memo from the University Academic Department, and after<br />
receiving the Name Checking Report (Annex M) from the Partner institution, if applicable.<br />
Once parchments have been printed they are sent to either the relevant University<br />
Academic Department, Partner institution or directly to the student depending on what has<br />
been agreed between the Partner institution and CPO.<br />
Parchments that are sent to the Partner institution are accompanied by a Delivery Receipt.<br />
The Partner institution must sign, date and return the Delivery Receipt to CPO to confirm<br />
that all parchments were received and are correct. It is then the responsibility of the<br />
Partner institution to make sure each student receives their parchment.<br />
The request for a replacement or duplicate parchment is made through CPO. A UP12 Form<br />
(Annex N) must be completed and returned to CPO by the graduate. Once CPO has taken<br />
receipt of the completed UP12 Form the replacement or duplicate parchment will be<br />
produced as soon as possible.<br />
There will be a fee for producing a replacement or duplicate parchment. For information on<br />
what the fee is please contact CPO.<br />
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19. Transcript<br />
A transcript is an official document that is produced by the relevant University Academic<br />
Department and details all the credit that has been awarded to a student. The production<br />
of transcripts must not be delegated to the Partner institution, unless this has been officially<br />
approved and stated in the contractual Agreement.<br />
The request for a replacement or duplicate transcript is made through the relevant<br />
University Academic Department and could incur a fee. For information on what the fee is<br />
please contact the relevant University Academic Department.<br />
20. <strong>Collaborative</strong> Text on Parchment/Transcript<br />
In 2004 the QAA reviewed their Code of Practice and published revised guidance notes.<br />
Section 2 of the notes relates to all collaborative agreements and it specifies that<br />
collaborative text stating the name and location of the Partner institution should appear on<br />
either the parchment or transcript for example<br />
Parchment text:<br />
A transcript of studies has been issued to accompany this parchment.<br />
Then<br />
Transcript text:<br />
delivered under a collaborative arrangement with ,.<br />
OR<br />
Parchment text:<br />
delivered under a collaborative arrangement with ,.<br />
Here, collaborative transcript text is not required and does not need to be printed on the<br />
transcript.<br />
CPO wrote to all Partner institutions to ask them to choose their preference which was then<br />
acted upon accordingly.<br />
In 2007 the Senior Registrar, Quality Management Division decided that all new<br />
collaborative arrangements approved from 2007 onwards would, by default, have the<br />
collaborative text printed on the parchment for example<br />
Parchment text:<br />
delivered under a collaborative arrangement with ,.<br />
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To find out which Partner institutions automatically have the collaborative text printed on<br />
the parchment, University Academic Departments can run the following Discoverer report<br />
'Parchment and Transcript Text (1194)' found within 'REP_SR.STUD <strong>Collaborative</strong> Text'.<br />
Partner institutions can contact CPO to establish where the collaborative text will be<br />
printed.<br />
21. Notarisation and or Legalisation of a Parchment and or Transcript<br />
Some graduates may require their parchment and or transcript (documents) to be notarised<br />
and legalised.<br />
Notarisation is carried out by a Notary Public (Solicitor) who verifies the documents are<br />
authentic and the award of the University of Portsmouth.<br />
Legalisation is carried out by the Legalisation Office of the Foreign and Commonwealth<br />
Office. It is the official confirmation that a signature, seal or stamp on a UK document is<br />
genuine. Legalisation is usually required by foreign authorities before they will allow a UK<br />
document to be used for official purposes in their country.<br />
There are costs involved when requesting documents to be notarised and or legalised.<br />
These costs are set by the Notary Public and the Foreign and Commonwealth Office and are<br />
liable to change annually. Graduates should contact CPO in the first instance if they wish to<br />
have their documents notarised and or legalised for information on what the costs are.<br />
To have documents notarised and legalised can take several weeks to be processed by the<br />
relevant offices.<br />
22. Contact Details<br />
If you would like further information about <strong>Collaborative</strong> <strong>Student</strong> <strong>Records</strong> administration<br />
processes, please contact CPO either via email cpo@port.ac.uk or telephone<br />
+44 (0) 23 9284 3502.<br />
Page 13 of 44
Page 14 of 44
Annex A<br />
<strong>Collaborative</strong> <strong>Programmes</strong><br />
Registration Coversheet<br />
This form MUST be completed by the authorised Partner institution Administrative Contact<br />
Registration Coversheet and List to be returned by:<br />
Partner Institution<br />
Programme<br />
Level Start Date End Date<br />
Declaration<br />
• I confirm that all the applicants listed on the Registration List are qualified to study on the above programme/level.<br />
• I confirm that all details given for each applicant are accurate and complete.<br />
• I confirm that all applicants have been made aware that the data given on the Registration List will be retained by<br />
the University of Portsmouth and used for the purpose of registration and may be used for reporting purposes,<br />
both internally and externally in accordance with the provisions of the Data Protection Act 1998.<br />
• I confirm that all applicants have been made aware of the Data Protection Act 1998.<br />
• I confirm that all applicants have been made aware of and agree to abide by the regulations determined by the<br />
University of Portsmouth.<br />
• I understand that failure to return the Registration Coversheet and List by the return date stated above could result<br />
in applicants not being registered and I understand that the University of Portsmouth does not retrospectively<br />
register applicants.<br />
• I confirm that any future amendments to students’ personal details will be reported to the University of<br />
Portsmouth’s <strong>Collaborative</strong> <strong>Programmes</strong> Administrator (Registrations and Invoicing) by completion of a WSTA<br />
Form, within 7 working days of the student notifying us of the amendment.<br />
• I confirm that any amendments required to incorrect student personal details could be subject to an administration<br />
fee as laid out in the signed Fee Schedule.<br />
Signature:<br />
Date:<br />
Printed Name:<br />
Please return the Registration Form and Registration List to:<br />
Administrator (Registrations and Invoicing), <strong>Collaborative</strong> <strong>Programmes</strong>, Quality Management Division, Academic Registry,<br />
University of Portsmouth, University House, Winston Churchill Avenue, Portsmouth, Hampshire PO1 2UP<br />
Email: Tel: Fax:<br />
Page 15 of 44
Page 16 of 44
Annex B<br />
<strong>Collaborative</strong> <strong>Programmes</strong><br />
Registration List<br />
The Partner institution will receive the Registration List in a spreadsheet format. All columns on the<br />
spreadsheet must be completed and returned together with the Registration Coversheet to the<br />
<strong>Collaborative</strong> <strong>Programmes</strong> Office. Failure to do so could result in applicants not being registered.<br />
The information required on the Registration List is:<br />
• Programme<br />
• Mode of Study<br />
• Partner Institution <strong>Student</strong> Registration Number<br />
• Title<br />
• Surname/Family Name<br />
• Forename(s)<br />
• Preferred Name<br />
• Parchment/Certificate Name<br />
• Gender<br />
• Date of Birth<br />
• Home/Permanent Address<br />
• Correspondence Address<br />
• Telephone Number<br />
• Mobile Number<br />
• Email Address<br />
• Nationality<br />
• Country of Birth<br />
• Area of Permanent Residence<br />
• Ethnic Origin<br />
• Disability/Special Needs<br />
• Entry Qualifications<br />
• Admissions Information<br />
• Where were the Qualifications obtained<br />
• IELTS Score Information<br />
• TOEFL Score Information<br />
• Cambridge Test Information<br />
• Other English Language Qualification<br />
• If an applicant is planning on taking an English language test please give details of what test is to be<br />
taken and the date<br />
• Has the applicant been educated in English Yes or No (if Yes please state number of years)<br />
• Criminal Convictions<br />
• Passport Number<br />
• Does the applicant require a Visa for entry to the UK<br />
Page 17 of 44
Page 18 of 44
<strong>Collaborative</strong> <strong>Programmes</strong><br />
Registration List Guidance Notes<br />
Annex C<br />
Programme<br />
The title of the programme the student is studying i.e. BSc (Hons) Computing.<br />
Mode of Study<br />
Full‐time or part‐time.<br />
Partner Institution <strong>Student</strong> Registration Number<br />
If your institution assigns a registration number to a student you can type it here and it will be shown on the<br />
Class List that is printed once registration has occurred. You might find this helpful in identifying the student<br />
on your own records.<br />
Name<br />
Please enter the student’s surname/family name and forename(s) exactly as they appear on official<br />
documents such as examination certificates, passport or driving licence. It is essential that you inform the<br />
University of Portsmouth’s Administrator (Registrations and Invoicing) <strong>Collaborative</strong> <strong>Programmes</strong> should a<br />
student’s name change by completing a WSTA Form within 7 days of the student notifying you of the change.<br />
Any amendments made to incorrect student personal details after completion of the registration process<br />
could be subject to an administration fee.<br />
Preferred Name<br />
If a student has a different name they would rather be known by, please enter it here. For example, if a<br />
student is called Andrew they might want to be known as Andy.<br />
Parchment/Certificate Name<br />
Please enter the student’s full name as they wish it to appear on their University of Portsmouth<br />
Parchment/Certificate. If the parchment/certificate is printed and the name is incorrect then the partner<br />
institution could be subject to an administration fee and a reprint parchment fee.<br />
Address<br />
A student’s home/permanent address is the address where the student usually lives. If a student prefers<br />
correspondence to be sent to a different address, please complete the ‘Correspondence Address’ column. It<br />
is essential that you inform the University of Portsmouth’s Administrator (Registrations and Invoicing),<br />
<strong>Collaborative</strong> <strong>Programmes</strong> if the student’s Home/Permanent Address or Correspondence Address changes by<br />
completing a WSTA Form within 7 days of the student notifying you of the change.<br />
Nationality<br />
Please enter the student’s nationality as stated in their passport. If a student has dual nationality, please<br />
enter both.<br />
Page 19 of 44
Area of Permanent Residence<br />
If the student’s permanent home is in the UK please enter the metropolitan area, borough or county. If the<br />
student lives outside the UK please enter the country.<br />
Ethnic Origin<br />
The University is required to release this information to the Higher Statistics Agency to whom all UK<br />
universities are legally obliged to report data:<br />
10 White<br />
21 Black or Black British – Caribbean<br />
22 Black or Black British – African<br />
29 Other Black background<br />
31 Asian or Asian British – India<br />
32 Asian or Asian British – Pakistani<br />
33 Asian or Asian British – Bangladeshi<br />
34 Chinese<br />
39 Other Asian background<br />
41 Mixed – White and Black Caribbean<br />
42 Mixed – White and Black African<br />
43 Mixed – White and Asian<br />
49 Other Mixed background<br />
80 Other Ethnic background<br />
98 Information refused<br />
Disability/Special Needs<br />
If a student has a disability, special needs (including dyslexia or another specific learning difficulty) or a<br />
medical condition, please select the most appropriate code from the list below:<br />
A<br />
B<br />
C<br />
D<br />
E<br />
F<br />
G<br />
H<br />
I<br />
J<br />
<strong>Student</strong> has no disability<br />
<strong>Student</strong> has social/communication impairment such as Asperger’s syndrome/other autistic spectrum<br />
disorder.<br />
<strong>Student</strong> is blind or has a serious visual impairment uncorrected by glasses.<br />
<strong>Student</strong> is deaf or has a serious hearing impairment.<br />
<strong>Student</strong> has a long standing illness or health condition such as cancer, HIV, diabetes, chronic heart<br />
disease, or epilepsy.<br />
<strong>Student</strong> has a mental health condition, such as depression, schizophrenia or anxiety disorder.<br />
<strong>Student</strong> has a specific learning difficulty such as dyslexia, dyspraxia or AD(H)D.<br />
<strong>Student</strong> has a physical impairment or mobility issues, such as difficulty using their arms or using a<br />
wheelchair or crutches.<br />
<strong>Student</strong> has a disability, impairment or medical condition that is not listed above.<br />
<strong>Student</strong> has two or more impairments and/or disabling medical conditions.<br />
Admissions Information<br />
Choose a code from the following list:<br />
01 Standard admission qualification<br />
02 Non‐standard admission qualification<br />
03 Progression from a formal Articulation arrangement<br />
English Language Proficiency<br />
If English is not the applicant’s first language, please tell us about any English language qualifications the<br />
applicant holds.<br />
Page 20 of 44
Criminal Convictions<br />
To help us ensure that the interests and safety of all members of the University community are safeguarded,<br />
we must know about any relevant criminal convictions that an applicant may have. If an applicant has a<br />
relevant criminal conviction, please put ‘Yes’. The information that you provide will not affect the academic<br />
assessment of the applicant’s application. However, the University may want to consider the application<br />
further or ask for more information before making a decision.<br />
Relevant criminal convictions are only those convictions for offences against the person, whether of a violent<br />
or sexual nature, and convictions for offences involving unlawfully supplying controlled drugs of substances<br />
where the conviction concerns commercial drug dealing or trafficking. Convictions that are spent (as defined<br />
by the Rehabilitation of Offenders Act 1974) are not considered to be relevant and need not be disclosed<br />
except in the circumstances set out below.<br />
You must put ‘Yes’ if any of the following statements applies to an applicant:<br />
• An applicant has a relevant criminal conviction that is not spent.<br />
• An applicant is serving a prison sentence for a relevant criminal conviction.<br />
You should make applicants aware that for courses in teaching, health, social work or courses involving work<br />
with children or vulnerable adults, any criminal convictions, cautions (including verbal cautions), reprimands,<br />
final warnings and bind‐over orders are exempt from the Rehabilitation of Offenders Act 1974. If an applicant<br />
is applying for these courses, the University will ask the applicant to agree to have a criminal record check.<br />
The applicant may also need an ‘enhanced disclosure document’ from the Criminal <strong>Records</strong> Bureau or the<br />
Scottish Criminal Record Office Disclosure Service. This means that if the criminal record check identifies that<br />
an applicant has had a conviction, caution, reprimand, final warning or bind‐over this information will be<br />
made available to the University. The University will send the applicant the appropriate documents to<br />
complete.<br />
If an applicant is convicted of a relevant criminal offence after they have been registered, you must tell us. Do<br />
not send details of the offence simply tell us that the student has a relevant criminal conviction. The<br />
University will then ask the applicant for more details.<br />
Page 21 of 44
Page 22 of 44
Annex D<br />
<strong>Collaborative</strong> <strong>Programmes</strong><br />
Progression Coversheet<br />
This form MUST be completed by the authorised Partner institution Administrative Contact<br />
Progression Coversheet and List to be returned by:<br />
Partner Institution<br />
Programme<br />
Level Start Date End Date<br />
Declaration<br />
• I confirm that all the students listed on the Progression List have been presented to the relevant Board and are<br />
eligible to progress to the next level of study.<br />
• I understand that failure to return the Progression Coversheet and List by the return date stated above could result<br />
in students not having their records maintained correctly, which in turn could affect a student’s ability to access<br />
their University of Portsmouth computer account, library and other online resources.<br />
• I confirm that all students have been made aware that the data given on the Progression List will be retained by the<br />
University of Portsmouth and may be used for reporting purposes, both internally and externally in accordance<br />
with the provisions of the Data Protection Act 1998.<br />
• I confirm that all students have been made aware of the Data Protection Act 1998.<br />
• I confirm that all students have been made aware of and agree to abide by the regulations determined by the<br />
University of Portsmouth.<br />
• I confirm that any future amendments to students’ personal details will be reported to the University of<br />
Portsmouth’s <strong>Collaborative</strong> <strong>Programmes</strong> Administrator (Registrations and Invoicing) by completion of a WSTA<br />
Form, within 7 working days of the student notifying us of the amendment.<br />
• I confirm that any amendments required to incorrect student personal details could be subject to an administration<br />
fee as laid out in the signed Fee Schedule.<br />
Signature:<br />
Date:<br />
Printed Name:<br />
Please return the Progression Coversheet and List to:<br />
Administrator (Registrations and Invoicing), <strong>Collaborative</strong> <strong>Programmes</strong> Office, Quality Management Division, Academic<br />
Registry, University of Portsmouth, University House, Winston Churchill Avenue, Portsmouth, Hampshire PO1 2UP<br />
Email: Tel: Fax:<br />
Page 23 of 44
Page 24 of 44
Annex E<br />
<strong>Collaborative</strong> <strong>Programmes</strong> Progression Class List: R0000F – 09SEPPN3<br />
Partner Institution<br />
BSc (Hons) Example Programme<br />
September 2009 Intake / Full‐time / Year 3<br />
Total Number of <strong>Student</strong>s: 7<br />
Withdrawn Study<br />
Break<br />
Repeat<br />
Unit(s)<br />
Repeat<br />
Year 2<br />
UoP ID Surname, Forenames Gender DoB Home Address Progress to<br />
Year 3<br />
X<br />
111111 DOE, Jon M 03‐Feb‐71 University House<br />
Winston Churchill Avenue<br />
Portsmouth<br />
PO1 2UP<br />
X<br />
Comments<br />
111112 SMITH, Sam M 11‐Jun‐79 University House<br />
Winston Churchill Avenue<br />
Portsmouth<br />
PO1 2UP<br />
111113 BLACK, Katie F 06‐Nov‐79 University House<br />
Winston Churchill Avenue<br />
Portsmouth<br />
PO1 2UP<br />
X<br />
X<br />
111114 BROWN, Derek M 21‐Jan‐63 University House<br />
Winston Churchill Avenue<br />
Portsmouth<br />
PO1 2UP<br />
Repeat<br />
Unit TTT3<br />
X X<br />
111115 BAT, Paul M 20‐Mar‐72 University House<br />
Winston Churchill Avenue<br />
Portsmouth<br />
PO1 2UP<br />
111116 TOWN, Mary F 18‐Sep‐77 University House<br />
Winston Churchill Avenue<br />
Portsmouth<br />
PO1 2UP<br />
X<br />
X<br />
111117 PILLOW, Troy M 08‐Apr‐70 University House<br />
Winston Churchill Avenue<br />
Portsmouth<br />
PO1 2UP<br />
Page 25 of 44
Page 26 of 44
Annex F<br />
<strong>Collaborative</strong> <strong>Programmes</strong><br />
WSTA Form<br />
This form MUST be completed by the authorised partner institution administrative contact<br />
UoP <strong>Student</strong> Registration Number<br />
<strong>Student</strong> Name<br />
Programme<br />
Please complete relevant box:<br />
Withdrawal<br />
Date of withdrawal:<br />
Reason for withdrawing:<br />
Study Break<br />
Last date of attendance:<br />
Expected to return date:<br />
Reason for study break:<br />
Transfer<br />
Transfer date:<br />
Transferring to:<br />
Amendment (please state nature of amendment here)<br />
Signature:<br />
Date:<br />
For UoP use only<br />
Date of Input:<br />
Input By:<br />
Page 27 of 44
Page 28 of 44
Annex G<br />
<strong>Collaborative</strong> <strong>Programmes</strong> Class List: R0000F – 09SEPPN3<br />
Partner Institution<br />
BSc (Hons) Example Programme<br />
September 2009 Intake / Full‐time / Year 3<br />
Total Number of <strong>Student</strong>s: 7<br />
Status Cat Home Address Email Address Partner ID<br />
UoP ID Surname, Forenames Gender DoB Start Date Expected<br />
End Date<br />
cpo@port.ac.uk DOE01<br />
111111 DOE, Jon M 03‐Feb‐71 01/09/2009 30/06/2010 R University House<br />
Winston Churchill Avenue<br />
Portsmouth<br />
PO1 2UP<br />
cpo@port.ac.uk SMI02<br />
111112 SMITH, Sam M 11‐Jun‐79 01/09/2009 31/06/2010 R University House<br />
Winston Churchill Avenue<br />
Portsmouth<br />
PO1 2UP<br />
cpo@port.ac.uk BLA03<br />
111113 BLACK, Katie F 06‐Nov‐79 01/09/2009 31/06/2010 R University House<br />
Winston Churchill Avenue<br />
Portsmouth<br />
PO1 2UP<br />
cpo@port.ac.uk BRO04<br />
111114 BROWN, Derek M 21‐Jan‐63 01/09/2009 31/06/2010 R University House<br />
Winston Churchill Avenue<br />
Portsmouth<br />
PO1 2UP<br />
cpo@port.ac.uk BAT05<br />
111115 BAT, Paul M 20‐Mar‐72 01/09/2009 31/06/2010 R University House<br />
Winston Churchill Avenue<br />
Portsmouth<br />
PO1 2UP<br />
cpo@port.ac.uk TOW06<br />
111116 TOWN, Mary F 18‐Sep‐77 01/09/2009 31/06/2010 R University House<br />
Winston Churchill Avenue<br />
Portsmouth<br />
PO1 2UP<br />
cpo@port.ac.uk PIL07<br />
111117 PILLOW, Troy M 08‐Apr‐70 01/09/2009 31/06/2010 R University House<br />
Winston Churchill Avenue<br />
Portsmouth<br />
PO1 2UP<br />
Page 29 of 44
Page 30 of 44
Annex H<br />
<strong>Collaborative</strong> <strong>Programmes</strong><br />
Confirmation of Registration Email<br />
The following text will be sent to each student via their personal email address to confirm their<br />
registration with the University of Portsmouth. This email will be sent from the <strong>Collaborative</strong><br />
<strong>Programmes</strong> Administrator (Registrations and Invoicing):<br />
Dear [insert student’s name]<br />
1. WELCOME<br />
I should like to welcome you as a new student of the University of Portsmouth (University).<br />
You have been registered on the [insert month/year] intake of the [insert programme]. This is a [insert<br />
mode of study] programme delivered under a collaborative arrangement with [insert partner<br />
institution’s name]. You are expected to complete the programme in [insert month/year].<br />
2. UNIVERSITY STUDENT REGISTRATION NUMBER AND PROGRAMME CODE<br />
Your unique University student registration number is [insert number]. This number must be quoted on<br />
all correspondence you have with the University – this number is very important please keep safely.<br />
Your University programme code is [insert code].<br />
3. UNIVERSITY COMPUTER ACCOUNT<br />
As a collaborative student you are entitled to access the University network, and for this you will need a<br />
computer account username and password. To obtain your username and password please visit<br />
www.port.ac.uk/studentaccount and follow the instructions. This will give you access to our online<br />
services and resources including Google Mail, and <strong>Student</strong>s’ Union, for further information on these and<br />
the other services and resources you are entitled to please view the services and resources leaflet.<br />
4. UNIVERSITY STUDENT CARD<br />
You are also entitled to a University student card. The student card provides you with another means to<br />
demonstrate to others that you are a student of the University. If you wish to apply for a student card<br />
please complete the attached <strong>Collaborative</strong> <strong>Programmes</strong> <strong>Student</strong> Card Application form and return it<br />
together with a passport sized photograph to your programme representative at the institution where<br />
you are studying. Once the representative has verified your application form it will be submitted to the<br />
University’s Campus Card Office for action. Once your student card has been produced it will be posted<br />
to the representative at the institution where you are studying.<br />
Page 31 of 44 Page 1 of 2
5. LETTER OF REGISTRATION<br />
If required, a formal letter of registration from the University can be printed and posted to you. To request<br />
a letter please contact me.<br />
Finally, I should like to take this opportunity to wish you good luck with your studies.<br />
Kind regards<br />
Administrator (Registrations and Invoicing)<br />
<strong>Collaborative</strong> <strong>Programmes</strong><br />
Quality Management Division<br />
Academic Registry<br />
University of Portsmouth<br />
University House<br />
Winston Churchill Avenue<br />
Portsmouth<br />
Hampshire<br />
PO1 2UP<br />
T: +44 (0) 23 9284 3285<br />
F: +44 (0) 23 9284 3197<br />
W: www.port.ac.uk<br />
Page 32 of 44
Annex I<br />
<strong>Collaborative</strong> <strong>Programmes</strong><br />
<strong>Student</strong> Card Application Form<br />
Please use BLOCK CAPITALS when completing this form. Once completed you MUST return it<br />
together with a passport sized photograph to your programme representative at the institution<br />
where you are studying. The institution will verify the application and will submit it to the University<br />
of Portsmouth’s Campus Card Office for action.<br />
1. Your University of Portsmouth <strong>Student</strong> Registration Number<br />
2. Your University of Portsmouth Course Code<br />
Please stick a good<br />
quality passport<br />
photograph here.<br />
No pins, staples,<br />
sellotape or paper<br />
clips please<br />
Write your name on<br />
the back of the<br />
photograph<br />
3. Your First Name(s)/Forename(s)<br />
4. Your Surname(s)/Family Name(s)<br />
5. Agreement<br />
I certify that the information given is correct. I understand the card is not transferable and that it remains the property of the<br />
University of Portsmouth. This Form is subject to regulation by the Data Protection Act 1998. I give my permission for the<br />
data provided on this Form to be used for the purposes of administering my <strong>Student</strong> Card.<br />
Signed: ……………………………………………………………………………………………….. Dated: …………………………………….<br />
This section is to be complete by the authorised partner institution administrative contact<br />
I verify that the photograph accompanying this Form is that of the student applying for a <strong>Student</strong> Card<br />
Signed: ……………………………………………………………………………………………….. Dated: …………………………………….<br />
Printed Name: …………………………………………....................................<br />
Partner Institution’s<br />
Official Stamp<br />
Page 33 of 44
Page 34 of 44
Annex J<br />
Academic<br />
Registry<br />
Academic Registry<br />
University of Portsmouth<br />
Winston Churchill Avenue<br />
Portsmouth PO1 2UP<br />
Our ref: [Programme Code] / [<strong>Student</strong> Registration No.]<br />
[Date]<br />
LETTER OF REGISTRATION<br />
<strong>Student</strong> Registration Number:<br />
Programme Code:<br />
Name:<br />
Programme Start Date:<br />
Expected to Complete Date:<br />
Mode of Study:<br />
This is to certify that the above student has been registered on a programme of study<br />
leading to the award of [programme] delivered under a collaborative arrangement with<br />
[partner institution].<br />
Senior Registrar<br />
Quality Management Division<br />
Page 35 of 44
Page 36 of 44
Annex K<br />
<strong>Collaborative</strong> <strong>Programmes</strong><br />
University Computer Account and<br />
<strong>Student</strong> Card Information<br />
UNIVERSITY COMPUTER ACCOUNT<br />
As a collaborative student you are entitled to access the University network, and for this you will need a<br />
computer account username and password. To obtain your username and password please visit<br />
www.port.ac.uk/studentaccount and follow the instructions. This will give you access to our online<br />
services and resources including Google Mail, Victory and the <strong>Student</strong>s’ Union, for further information<br />
on these and the other services and resources you are entitled to please visit<br />
www.port.ac.uk/accesstoinformation/policies/collaborativeprovision/filetodownload,106841,en.pdf<br />
UNIVERSITY STUDENT CARD<br />
You are also entitled to a University student card. The student card provides you with another means to<br />
demonstrate to others that you are a student of the University. If you wish to apply for a student card<br />
please complete the attached application form and return it together with a passport sized photograph<br />
to your programme representative at the institution where you are studying. Once the representative<br />
has verified the application form it will be submitted to the University’s Campus Card Office for action.<br />
Once your student card has been produced it will be posted to the representative at the institution<br />
where you are studying.<br />
Page 37 of 44
Page 38 of 44
Annex L<br />
Dept: CPO<br />
Faculty: CPO<br />
UNIVERSITY of PORTSMOUTH<br />
Form UP6 ‐ Conferment list<br />
R0000F BSC (HONS) EXAMPLE PROGRAMME (PARTNER INSTITUTION) 09SEPPN3<br />
Date Printed: 06‐JUL‐2010 Time: 11:05<br />
Date of Meeting: 06 July 2010<br />
External Examiner<br />
Fred Blogs<br />
______________________________<br />
______________________________<br />
COMPULSORY: Signature or Letter<br />
Reference: Examination and Assessment Regulations 14.4<br />
______________________________<br />
______________________________<br />
______________________________<br />
I certify that I attended the above Board of Examiners’ meeting and that the<br />
following number of students has been manually added to this Conferment List<br />
I certify that the Board of Examiners has fulfilled its responsibilities in accordance with the<br />
current version of the Examinations and Assessment Regulations and makes the following<br />
recommendations to Academic Council:<br />
Signed: ______________________________ Chair, Board of Examiners.<br />
Print Name:<br />
______________________________<br />
For Academic Registry Use Only<br />
I certify that the recommendations contained herein in respect of ______ students are<br />
accepted by Academic Council and the awards recommended are conferred.<br />
Signed: ______________________________ Academic Registrar.<br />
Results must be input and original form sent to Academic Registry within 24 hours of the<br />
meeting.<br />
Page 39 of 44
R0000F<br />
BSC (HONS) EXAMPLE PROGRAMME<br />
(PARTNER INSTITUTION)<br />
09SEPPN3 <strong>Student</strong>s: 7<br />
To be completed in ink and correction fluid must not be used.<br />
Date Printed: 06‐JUL‐2010 Time: 11:05<br />
DEBT<br />
No Id Surname,Forename Result Lib Fin Comments Grade Named<br />
Award<br />
Hold<br />
Parchment<br />
1 111111 Jon Doe 2:2 R0000<br />
2<br />
111112 Sam Smith 1 R0000<br />
3<br />
111113 Katie Black O<br />
Eligible for<br />
O Def<br />
R0000<br />
U<br />
4 111114 Derek Brown Repeat X R0000<br />
5<br />
111115 Paul Bat 3 R0000<br />
6 111116 Mary Town Exclude X R0000<br />
7 111117 Troy Pillow O<br />
Eligible for<br />
O Ref/Def<br />
R0000<br />
U<br />
I have input these results and the data has been checked and confirmed.<br />
Signature: ______________________________ Date: ____________________<br />
Print Name:<br />
______________________________<br />
Page 40 of 44
Annex M<br />
Partner Institution<br />
BoE date Instance <strong>Student</strong> ID Name in students record Certificate name Grade Revised decision since BoE?<br />
R0000F BSc (Hons) Example Programme<br />
06/07/2010 07JULPN3 111111 Jon Doe John Doe Pass BSc (Hons) Example<br />
Programme<br />
06/07/2010 07JULPN3 111112 Sam Smith Sam Smith Pass BSc (Hons) Example<br />
Programme<br />
06/07/2010 07JULPN3 111115 Paul Bat Paul Mack Bat Pass BSc (Hons) Example<br />
Programme<br />
Page 41 of 44
Page 42 of 44
Annex N<br />
Form UP12<br />
Please return to:<br />
<strong>Collaborative</strong> <strong>Programmes</strong> Office<br />
University of Portsmouth<br />
Academic Registry<br />
University House<br />
Winston Churchill Avenue<br />
Portsmouth<br />
PO1 2UP<br />
Fax: +44 (0) 23 9284 3197<br />
APPLICATION FOR THE ISSUE OF A DUPLICATE AWARD PARCHMENT<br />
A duplicate / replacement award parchment costs £35.00 sterling. Any additional parchments ordered at<br />
the same time will be charged at £10.00 each.<br />
Please use one form per Named Award.<br />
I request a duplicate certificate and<br />
additional copies.<br />
Signature…………………………………………………………<br />
Date…………………………………………...<br />
DETAILS OF AWARD:<br />
Full Name (on original award)………………………………………………………………………….…………...<br />
Title of Course…………………………………………………………………………………………….…………..<br />
Date of Award…………………………………………………………………………………………………………<br />
Classification………………………………………………………………………………………………………….<br />
YOUR DETAILS:<br />
Full Name……………………………………………………………………………………………………………..<br />
Full Postal Address…………………………………………………………………………………………………..<br />
………………………………………………………………………………………………………………………….<br />
……….……………………………………………………Post Code……………………………………………….<br />
Telephone No.………………………………………..<br />
Page 43 of 44
PAYMENT DETAILS:<br />
Please return this form with:<br />
i) A cheque made payable to “University of Portsmouth” for:<br />
Duplicate certificate £35 £<br />
Additional Copies £10 each £<br />
Contribution to <strong>Student</strong> Hardship Fund Voluntary £<br />
Total Payable £<br />
OR<br />
ii)<br />
Please debit my VISA/MASTERCARD/ACCESS/DELTA/SWITCH card as follows:<br />
Duplicate certificate £35 £<br />
Additional Copies £10 each £<br />
Contribution to <strong>Student</strong> Hardship Fund Voluntary £<br />
Total Payable £<br />
Card Number<br />
Card Issue Number<br />
(For Switch cards this is an 18 digit number)<br />
(Switch Only)<br />
Expiry Date Start Date Security Code*<br />
Cardholder’s Signature<br />
(Last 3 numbers on<br />
Cardholders signature<br />
strip)<br />
Date_______________________<br />
Card holders name & address, if different from overleaf<br />
___________________________________<br />
___________________________________<br />
___________________________________<br />
___________________________________ * Post Code __________<br />
*Please ensure that security code and postcode are completed. Payment will not be processed<br />
without this information<br />
Page 44 of 44