COPYRIGHT DECLARATION             Date of declaration

Please fill in all sections, print (or scan) the form and sign the declaration.
Fill in a separate form for each thesis copy

Email as an attachment to: thesissupply@library.uq.edu.au
or
Post to: Digitisation Team
Scholarly Publishing and Digitisation Service
The University of Queensland Library
Level 3, Duhig Tower
The University of Queensland.
St Lucia Campus.
Qld. 4072 Australia

Please supply me with a copy of the following thesis in accordance with S51 (2) of the Copyright Act 1968.

Author

Title

 

 

Thesis No.

Degree

Date conferred

I declare that:

I require the copy for the purpose of research or study and will not use it for any other purpose. I have not previously been supplied with a copy of this thesis by an authorised officer of the library.
 
I wish to order the above thesis that will be sent via a secure delivery service via the Internet. Once sent, I will have 4 (four) days to download the thesis. If the thesis is not downloaded in this time, a new request will have to be made for the thesis.

Email address for thesis and tax receipt

Contact telephone

 
Signed     __________________________________________

COST
 
A$65.00 per thesis / per volume for theses that require digitisation (if supply is within Australia, add A$6.50 GST).
A$16.50 per thesis if already digitised (for each digitised thesis regardless of the number of files).
Note : Goods and Services Tax not payable on overseas requests.
Total cost:   

Method of payment       Please check one box
    Visa
    Mastercard
    American Express

Cardholder Name

Cardholder Number

Expiry date

    Tax Invoice Transaction Receipt Required. (Please indicate the name required on the receipt.)

Explore UQ Library