Registrar’s Office

RO.1044/04C

COLLECTION OF DEGREE /DIPLOMA SCROLL AND COMPLIMENTARY TRANSCRIPT
Please select, by ticking [], and complete either Option A or B below and return the completed form to Registrar’s Office, National University of Singapore, University Hall, Lee Kong Chian Wing, #UHL04-01, 21 Lower Kent Ridge Road, Singapore 119077 (Fax No. : 65-67786371) with a photocopy of the graduate’s identity card/passport. Graduate’s Name in full: (Please use BLOCK LETTERS) Identity Card / Passport No.:

Degree:

Year of Graduation:

Graduate’s Signature

Date (DD/MM/YYYY)

OPTION A: COLLECTION BY PROXY I authorize the following person to collect my degree/diploma scroll and a complimentary transcript on my behalf. *Authorized Person’s Name in full:
(Please use BLOCK LETTERS)

Identity Card / Passport No.:

* This person must produce his/her identity card or passport, for identification purposes, when collecting the scroll and complimentary transcript.

OPTION B: SEND BY MAIL / COURIER SERVICE I request that the University send my degree/diploma scroll and complimentary transcript to me with the understanding that the University would not be able to replace the scroll should it be lost or irreversibly damaged in the mail. Please complete the following mailing and payment details: Name of Graduate: (Please use BLOCK LETTERS)

Email address:

#

Contact No.:

(# required by courier service)

Address:

Attached is a bank draft/money order for S$ “National University of Singapore”.
** Administrative Charges: - for Singapore address - for Overseas address The degree scroll will be sent by  SingPost LUM Service (for Singapore address)  Federal Express (for Overseas address) (Amount to be credited into A/c C-003-000-003-001/732101 S$ 10.00 60.00

**, made payable to
For Office Use Only:

Tax Code : IZ)
Updated 01 Sep 09

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