Letter of Authorization_Letter

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If you wish to authorize a representative to collect the academic document(s)(e.g.transcript, certifying letter, etc)on your behalf, please complete this form.(The personal data of the student/graduate or the representative will be used for collection of the academic document(s)and

record purpose only.This Instruction and copy of the student’s/graduate’s/representative’s ID document will be kept in the Graduate School.For correction of or acce to the personal data after submiion of this form, please contact the Graduate School at 852-3943 8976, or email to gradschool@cuhk.edu.hk.)

Name(in English):HKID Card/ Other Identity No.: Degree:

Name(in Chinese):

Student ID:

Programme:

Contact Phone No.(in HK):E-mail Addre:

------------------------------(ATTENTION: The representative should bring along this form together with of the identity document of the student/graduate mentioned above.Original document will be accepted for verification.)

I hereby authorize the following representative to collect my document(s)* on my behalf:

 Certifying Letter Report on Curriculum Details

*Please tick as appropriate.Name(in English): Type of ID Document#:

Signature of Student/Graduate:

#Please delete as appropriate. Transcript

Name(in Chinese):ID Document No.:

Date:

Paport / Identity Card

Acknowledgement of receipt of the above academic document(s)

Signature of

Date: Representative:

------------------------------Handled by:

Date:

(Version: June 2012)

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