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Certificate Request Form

This document is a certificate request form for University College Birmingham, allowing individuals to request replacement certificates or certified copies of original documents. It outlines the necessary information required, payment options, and the process for submitting the request. The university aims to respond within ten working days of receiving payment and ensures compliance with data protection legislation.

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iqanahmedup01
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5 views2 pages

Certificate Request Form

This document is a certificate request form for University College Birmingham, allowing individuals to request replacement certificates or certified copies of original documents. It outlines the necessary information required, payment options, and the process for submitting the request. The university aims to respond within ten working days of receiving payment and ensures compliance with data protection legislation.

Uploaded by

iqanahmedup01
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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University College Birmingham

CERTIFICATE REQUEST FORM


Your Information

Forename: __________________________________________

Surname: ___________________________________________
Date of Birth:_____/_____/_____

Address to which we should send your certificate/copies


____________________________________________________
____________________________________________________
____________________________________________________

Postcode: ____________

Request (tick the appropriate box):


Replacement Certificate (£25)
To request a replacement certificate, complete this part of the form and send this together with a cheque
(payable to UCB) for £25 to the address below. Alternatively, you may pay over the phone using a
debit/credit card to the UCB Cash Office on (0121) 232 4017. Electronic payments can be made through the
Online Payments page on the UCB website: https://portal.ucb.ac.uk/#/online-payments.

Course: ______________________________________________

Year of Study:_________________________________________

Certified Copies of Original Documents (£2 per copy)


To request a number of certified copies complete this part of the form and send BOTH the original
certificate AND the required number of copies AND a cheque for the necessary amount (payable to UCB) to
the address below. Electronic payments can be made through the Online Payments page on the UCB
website: https://portal.ucb.ac.uk/#/online-payments.

Certified Copy of Certificate (£2 per copy):


Checklist:
Number of copies enclosed
Original included:

When sending original documents you should use a Courier or Recorded Delivery.
PLEASE NOTE THAT THE UNIVERSITY CANNOT BE RESPONSIBLE FOR THE LOSS IN
TRANSIT OF ANY DOCUMENTS POSTED TO IT.

Signed: _______________________________________________ Date: ________________


Reason for request: (please tick appropriate box)

Lost original

Duplicate for employment purposes

Duplicate for education purposes

Other:________________________________________________

Please return this fully completed form together with appropriate payment to:

Registry
University College Birmingham
Birmingham
B3 1JB
United Kingdom

The form can be emailed to [email protected] and payment made to the UCB Cash Office on (0121) 232
4017.

We aim to respond to your request within ten working days of receipt of payment.

Thank you,

Registry
The details given on this form will be kept in accordance with Data Protection Legislation. The information given will be used for the sole purpose of
processing replacement UCB certificate applications. The data will be stored on a secure database and the form will be kept secure and destroyed
after a period of 3 months. No personal information will be shared with any third party without your permission. UCB’s privacy notices and Data
Protection policy can be found at http://www.ucb.ac.uk/about-us/data-protection-resources.aspx

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