ࡱ> <>; bjbjSS .$11          $D 0`Lwyyyyyy$( O"OO  -'''O"  w'Ow'''p@Ŕq:'c0'' '<h'TIuOOOO : Ҵý 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:  HYPERLINK "https://portal.ucb.ac.uk/" \l "/online-payments" 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:  HYPERLINK "https://portal.ucb.ac.uk/" \l "/online-payments" 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 Ҵý Birmingham B3 1JB United Kingdom The form can be emailed to  HYPERLINK "mailto:registry@ucb.ac.uk" registry@ucb.ac.uk 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. 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[ @VerdanaA$BCambria Math"1hsegsegܳ  nnx24 3QHX?WL2!xx 8Birmingham College of Food, Tourism and Creative StudiesStaffStephanie GallowayOh+'0  4 @ L Xdlt|<Birmingham College of Food, Tourism and Creative StudiesStaffNormalStephanie Galloway2Microsoft Office Word@@IՁ@;@; ՜.+,D՜.+,h$ hp  BCFTCS  9Birmingham College of Food, Tourism and Creative Studies Titlet 8@ _PID_HLINKSA,GL =http://www.ucb.ac.uk/about-us/data-protection-resources.aspxmmailto:registry@ucb.ac.ukhttps://portal.ucb.ac.uk//online-paymentshttps://portal.ucb.ac.uk//online-payments  !"#$%&'()*456789:=@Root Entry FQlCY?Data 1TableWordDocument.$SummaryInformation(DocumentSummaryInformation83CompObjr   F Microsoft Word 97-2003 Document MSWordDocWord.Document.89qOh+'0dH    (08@NormalStephanie Galloway2Microsoft Office Word@@IՁ@;@; Stephanie GreganCertificate request form