Application for Replacement Parchment

UniSA provides replacement parchments to graduates whose original parchment has been irretrievably
lost, stolen, destroyed or damaged.
A Statutory Declaration stating what has occurred to the original parchment must accompany an
application for lost, destroyed or stolen parchments or will not be processed; see notes page 2.
Damaged parchments must be surrendered with this application.
Fee for replacement parchment is $50.00 and includes domestic or international postage, if requested.
This form must be lodged with original supporting documents. Lodgement and payment details are
located on page 2.
Replacement parchments take one week to produce.
Please read the further information regarding replacement parchments on page 2.
Further enquiries please contact Campus Central 8:30am to 6:00pm (ACST) on 1300 301 703 (within
Australia), for calls from overseas, please call +61 8 8302 0150 or email graduations@unisa.edu.au.

Part A: Personal details - Please print clearly

Student ID (if known):

Title: First name(s):

Family name: Previous name:

Date of birth: Contact No: Email:

Reason for replacement parchment:
My parchment is irretrievably lost or destroyed or stolen and I have attached a Statutory Declaration explain this.
My parchment has be significantly damaged and I have attached and surrender the document to you.

Student Signature*: Date:

*The signature cannot be electronic. It needs to be physically signed.

Part B: Program details:

Institution where you studied (see Notes for Part B):

Name of program/award:

Date award was conferred: Years of study:

Part C: Collection/Postage details

I will collect from Level 1, 101 Currie St, Adelaide.

I authorise _______________________________________________________________ to collect my parchment.

Post to the following address (please note: courier will not deliver to PO Boxes).

Name:

Address:

Suburb:

State/ Postcode/ Country

Province: ZIP Code: (if not Australia):

OFFICE USE ONLY: Campus Central

Receipt no: Amount: Initials: Date:

Damaged Parchment sighted and securely destroyed Accompanied by original signed Stat Dec

Application for Replacement Parchment Page 1 of 2

Current: June 2017
CRICOS Provider No. 00121B
 Application for Replacement Parchment
Part D: Payment

Cash/Cheque/Credit Card in person at Campus Central (see below for address details, Mount Gambier EFTPOS only)

Cheque/Money Order/Credit Card via mail (see below for address details)

Credit card type (please tick): Visa MasterCard

Card holder name:

Card number:

Card expiry date: Amount AUD$ 50.00

Authorisation signature: Date:

Cheques should be made payable to The University of South Australia.

Notes

For parchments lost, stolen or destroyed a statutory declaration must be submitted with your form. Original documentation must
be received; emailed statutory declarations will not be accepted. Statutory declarations are available here or from Australia Post.
For applications from outside Australia please have the statutory declaration signed by a person legally authorised to witness
signatures in your country such as lawyer or notary.
A replacement parchment is not identical to the original. Pre-1991 parchments will not be issued in the name of the original
awarding institution.
The replacement parchment states it is a replacement and includes the replacement date.

Notes for Part B Parchments for courses studies at institutions other than UniSA

Please do NOT complete this form for studies completed at the following institutions:
Adelaide Teachers College, Adelaide College of Advanced Education and South Australian College of Advanced Education
(City/Kintore Ave Campus) Contact the University of Adelaide Student Centre on +61 8 8313 0899
Bedford Park Teachers College, Sturt College of Advanced Education or South Australian College of Advanced Education (Sturt
Campus) Contact the Flinders University Graduation Office on +61 8 8201 3950

LODGING YOUR APPLICATION WITH CAMPUS CENTRAL

In person By post
City East City West Magill University of South Australia
Campus Central Campus Central Campus Central Campus Central (insert name of
Level 3 Level 2 Level 1 campus)
Playford Building Jeffrey Smart Building B Block GPO Box 2471
Adelaide SA 5000
Australia

Whyalla
Mawson Lakes Mount Gambier
Campus Central
Campus Central Regional Centre Office
Ground Floor- Main Bldg
Ground Floor Wireless Road
111 Nicolson Avenue
C Building Mount Gambier SA 5290
Whyalla Norrie SA 5608

Application for Replacement Parchment Page 2 of 2

Current: June 2017
CRICOS Provider No. 00121B