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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 />

Page 6 of 44


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 />

Page 8 of 44


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 />

Page 9 of 44


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 />

Page 11 of 44


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 />

Page 12 of 44


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

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