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.)

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