Institutional Request to Copy an Unpublished Thesis for Research & Study

Please complete all sections of the form. A separate form is required for each thesis copy request.


To: Document Delivery, The University of Sydney Library


Please supply a copy of the following thesis in accordance with the By-laws of the University of Sydney, Higher Degree Theses and the Copyright Act 1968

Date
Order Number

Library Details

Name
Address
Contact Number
Email Address

Thesis Information

Author
Title
Degree
Date conferred



Copyright Declaration

Please sign the option which applies to your circumstances

   SECTION 200AB: I declare that I require a copy of the above stated unpublished thesis for inclusion into the above stated Library's collection. It shall be used inline with the provisions of the Copyright Act 1968 (Cth)



Signed ______________________________________________________           Date _________________

   PART VB STATUTORY LICENSE DECLARATION: I declare that I require a copy of the above stated unpublished thesis for use at the above stated institution for educational purposes under Part VB statutory licence of which my institution is a signatory. I declare that I am aware of the notice, acknowledging and registration requirements of using material under this provision.



Signed ______________________________________________________           Date _________________
This information is required for copyright administration and ordering purposes and as such all fields are compulsory. Supplied information will be held secure and will not be disclosed for any other purpose than the above stated.

Method of Payment

Please check one box
   Mastercard    Visa

Cardholder Name

Cardholder Number
Expiry date

   Cheque

   AUD$ Bank Draft/ Money Order

Payable to: The University of Sydney Library

   Invoice


Price:   AUD $165.00 (incl. GST) within Australia ; AUD $150.00 for others


Please check that all sections are completed, print the form and send to:
Fax: +61  2   9351 4593 

or

Email: library.supply@sydney.edu.au

or

Mail:
Document Delivery (Theses)
Fisher Library, FO3
University of Sydney
NSW 2006
Australia