Re-Issuance of Certificate Application Form | North Coast Community College

Please Select*

Reprint of Original Certificate or Record of Achievement
Copy of Original only

PERSONAL DETAILS (Please print clearly in BLOCK LETTERS)

Name*

First Last

If Applicable, Please Provide any Previous Names (e.g Maiden Name)

First Last

Phone Number*

Date of Birth*

Email Address*

What is your postal address?*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Qualification completed*

Year completed*

Reason for requesting a replacement certificate?*

Lost
Damaged
Stolen

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*