Third-party Authorisation
ABN 63 942 912 684
Please read Notes below before completing this form. Fill out sections required, print and sign the form.
Date
Title (Mr,Mrs,Ms,Dr,etc.)
Last Name
First Name and other initials
Student or staff number (UQ students or staff to complete)
Library number (other clients to complete)
Name of Authorised person
Amount to pay
 
Signature _____________________________________________________________

Notes:

1. This form should be completed by the Library client. They must authorise a third-party to pay their charges for them.

2. This form must be completed and returned to the Loans Desk at any branch library. It may also be faxed to: 07 3365 6888 or sent as an email attachment to circ@library.uq.edu.au.