Request for copying of unpublished thesis

UNDER SECTION 51 OF THE COPYRIGHT AMENDMENT ACT 1980

Please complete the declaration regarding use of the item
(either A or B to be completed).
Thesis details
Author:
Title:
Degree:
Date conferred:
 

A To be completed where the copy is requested for retention by an individual person

Please provide me with a copy of the above unpublished thesis, which is held in your library.

I declare that I will only use the copy provided for the purpose of private study and research.

Name:
Email:
Postal address:
State:
Postcode:
Country:
Date:
Signed:

B  To be completed by an authorised officer, where the copy is requested for retention by a university or research institution, (eg for their library).

Please provide the institution below with a copy of the above unpublished thesis which is held in your library.

I declare that the copy provided will only be used for the purpose of private study and research.

Acceptance of quote for

Full name:
Official title:
Purchase order:
Institution:
Postal address:
State
Postcode
Country
Date:
Signed:

Upon receipt of the form we will copy the thesis and send it to you with an invoice.

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