Re-Issuance of Certificate Application Form

Student ID *

Date *

First Name *

Last Name *

Contact Number *

Email *

USI Number *

Certificate of Qualification Required *

Reason for requesting a replacement certificate? *

Lost / Stolen

Damaged

Evidence of Supporting documentation * Maximum file size: 2MB per file

Request For *

Certificate

Statement of Attainment

Letter of Completion

Terms and Conditions of this Application

A fee of $100 will be charged for each lost, damaged, or stolen Certificate, Statement of Attainment, or Record of Achievement for which an electronic duplicate is available.
Upon receipt of your application and verification of the information provided, an invoice will be issued for the replacement certificate(s).
Your replacement certificate will be issued within 14 days of receipt of payment.

Declaration

By selecting this box and submitting this online application, you confirm that all information provided is accurate and complete to the best of your knowledge and that you agree to the terms and conditions of this application.

Student Signature *

Date *

Re-Issuance of Certificate Application Form