APPLICATION FORM RE-ISSUANCE OF CERTIFICATE

Please select*

Reprint of Original Certificate or Record of Achievement $50Copy of Original emailed only $0

1. PERSONAL DETAILS (Please print clearly in BLOCK LETTERS)

Family Name*

Given Names*

Home phone number

Mobile phone number*

Date of Birth*

Date

Email address*

What is your postal address?

Unit / Flat / Suite / Apartment details

Building / property name

Street or lot number (e.g 205 or Lot 118)

Street name

Postal delivery information (e.g. PO Box 254)

Suburb / Locality / Town

State / Territory

Postcode

Name of Qualification completed

Year completed

Reason for requesting a replacement certificate?*

LostDamagedStolen

TERMS OF CONDITION OF THIS APPLICATION

1. A fee of $50 is charged for each lost, damaged or stolen Certificate, Statement of Attainment or Record of Achievement where a reprint is required

2. Once your application is received and all information can be deemed correct you will receive an invoice to pay for the replacement costs of the certificate(s).

3. Upon payment your certificate will be re-issued and sent to your nominated postal address supplied within this application form.

4. You will receive your certificate within 14 days of our organisation receiving payment.

5. Copies of any Certificate, Statement of Attainment or Record of Achievement are accessible within 12 months from date of issuance. After this date the $30 administration fee will apply where a copy of the original is required.

DECLARATION*

By selecting this box and completing and submitting this online application you are declaring all information you have entered to be correct and agree to all of the terms and conditions of this application.

Signature

please sign the box above using either your mouse, stylus or finger depending on the device you are using to complete this form Clear

If you cannot sign the document in the above box you can upload an electronic image of your signature below

Qualification completion confirmed?

YesNo

Replacement fee to be charged ($)

Invoice Date

Date

Invoice #

Invoice sent via & date

EmailMail

Invoice paid date

Date

Despatch date of certificate

Date

Event log entered into student record system

Yes