AS-39d

The Graduation Office

The University of Auckland
Private Bag 92019
Auckland Mail Centre 1142, NZ
Email: graduation@auckland.ac.nz
Phone: +64 9 373 7599

Request for courier delivery of certificate

Personal details (Please print clearly)
PLEASE NOTE: This is not an application to graduate. You must return to the online Application to Graduate form and
submit it.

Family name ID number

First name/s Contact phone

Email address

Courier charge (All charges are in NZ$ and include NZ GST of 15%)

Within New Zealand $10.00

To Australia $30.00
Rest of the world $60.00

Payment details

Amount payable (all in NZ$) Account Number: 630 8406

For administration use only: Cashiers Stamp

Courier/postage fee:
Within New Zealand ........ $10.00
To Australia ................... $30.00
Rest of the world ............ $60.00
Total (NZ$) Amount: ................................................
Receipt No: ................................................
Date: ................................................

Cheques: Please make cheques out to: The University of Auckland

Credit card details: (If paying by credit card ensure the cardholder signs this section)

Credit card type: MasterCard VISA AMEX Name on card:

Card No: Cardholders signature:

Expiry date: M M Y Y

Sign and date form before sending to Graduation Office

dd / mm / yyyy
Signature: Date:

OFFICE USE ONLY

Payment processed Certificate label checked

SSO details entered Certificate couriered

Page 1 of 1 Last updated: 15 January 2016