AUTHORISATION FORM - University of Wollongong

ARD: CLIENT SERVICEAUTHORISATION FORMUse this form to nominate/authorise another person to collect items from Student Central on your behalf. Youcan change the arrangement any time by contacting Student Central.1. MY DETAILSSurname:Student Number:Phone:First Name:Date of Birth:Email:Address:2. AUTHORISED PERSON DETAILSSurname:Date of Birth:Address:First Name:Phone:Email:Student number (if applicable):3. ITEMS TO BE COLLECTED BY AUTHORISED PERSONNumber of items:Name of items (eg. Fee Statement, Transcript, Graduation Certificates):4. DETAILS OF ARRANGEMENTI want this arrangement to last:Until I advise you OR From ____/____/____ to ____/____/____5. MY AUTHORISATIONI authorise the person named on this form to collect the items listed above from Student Central.By signing this authorisation, I acknowledge that: the information I have provided is correct; the authorised person must provide photo ID to Student Central at the time of collection to enableverification of their identity (for example: student card*, passport, driver’s licence). Student Central will not release items unless it is satisfied with the identity of the authorised personnamed on this form; the University of Wollongong accepts no responsibility for items once they have been collected bymy authorised person; I understand that I should only allow someone I trust to collect items on my behalf; and the information I provide on this form will allow the authorised person to collect items on my behalfduring the period I specify.Signature____________________________________ Date: ____/____/____*Student card must be a current University of Wollongong student card or if another student card is used, it must havephoto identification and sufficient information to verify the identity of the personARD-CS-FRM-035 ARD-CS-FRM-035 Authorisation Form 2012 July 31 Page 1 of 2Hardcopies of this document are considered uncontrolled. Please refer to UOW intranet for latest version.https://intranet.uow.edu.au/ard/clientservice/index.html

6. DOCUMENT COLLECTIONTo be completed on collection of the items listed above:Signature of Authorised Person___________________________ Date of Collection: ____/____/____Item/s collected:__________________________________________________________________Details of identification sighted:______________________________________________________Staff Name:______________________________Staff Signature________________________________ARD-CS-FRM-035 ARD-CS-FRM-035 Authorisation Form 2012 July 31 Page 2 of 2Hardcopies of this document are considered uncontrolled. Please refer to UOW intranet for latest version.https://intranet.uow.edu.au/ard/clientservice/index.html