Certificate Re-issue and Record of Achievement Application Form
Please complete all relevant sections on this application form in conjunction with the attached guidance notes
YOUR DETAILS
LIBF number _____________________________________________________
Title (eg Mr / Mrs / Ms etc) __________________________________________
First name(s) / Given name(s) ________________________________________
Last name / Family name ____________________________________________
Date of birth
_____________________________________________________
Telephone no.
_____________________________________________________ Gender Male
n
Female
n
Email address __________________________________________________________________________________________________________________________________
Certificate delivery address ___________________________________________________________________________________________________________________
Postcode
_____________________________________________________ Country _____________________________________________________
SECTION 1 YOUR DETAILS
YOUR DETAILS
The cost of re-issuing a qualification certificate is £48 per certificate if the request is made more than 60 days from date of issue.
All units of a qualification are included in one certificate.
Please complete name of each qualification you wish to have a certificate for eg, Certificate in Mortgage Advice and Practice, Certificate
for Financial Advisers
Name of qualification ______________________________________________________________________________________________________________________________
Name of qualification ______________________________________________________________________________________________________________________________
The cost of issuing an individual unit/module certificate is £48.
Individual unit/module certificates only include an individual unit/module completed under a qualification.
If you are requesting a certificate for UK Financial Regulation, Financial Services Regulation and Ethics or Pension Transfers,
the cost is £30.
Please complete the name of each qualification and unit/module you wish to have an individual unit/module certificate for eg UK
Financial Regulation, Investments and Risks etc.
Name of qualification ______________________________________________________________________________________________________________________________
Name of unit/module ______________________________________________________________________________________________________________________________
Name of qualification ______________________________________________________________________________________________________________________________
Name of unit/module ______________________________________________________________________________________________________________________________
SECTION 2 CERTIFICATE
The London Institute of Banking & Finance is a registered charity, incorporated by Royal Charter.
YOUR DETAILS
Record of Achievements cost £48 and list all the units you have passed, the date taken and grade achieved, in one letter.
Name of qualification ______________________________________________________________________________________________________________________________
Name of qualification ______________________________________________________________________________________________________________________________
SECTION 3 RECORD OF ACHIEVEMENT
YOUR DETAILS
If you have the original certificate you must return it with the application.
If you need a replacement certificate because of a change of name you will also need to include a certified copy of your marriage
certificate or change of name deed.
Please give details of why you need a new certificate
_______________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________________________
SECTION 4 REASON FOR REQUEST
Y
OUR DETAILS
n
N
umber of certificates requested
£48 each
£
____________
n
Record of Achievement requested
£48 each
£ ____________
n
Number of certificates requested
£30 each
£ ____________
n
Courier fee (optional) - UK £10
£ ____________
n
C
ourier fee (optional) - Overseas £30
£
____________
TOTAL
£ ____________
Payment options
n
I enclose a cheque for the total payable, made payable to
The London Institute of Banking & Finance
n
I authorise The London Institute of Banking & Finance to
debit my Visa / MasterCard / Switch Card for total payable
Card number
nnnn nnnn nnnn nnnn
Expiry date
nn
/
nn
Valid from
nn
/
nn
I
ssue number
nnn
(if applicable)
Security number*
nnn
*T
his is the last 3 digits found on the signature strip on the reverse of your card
.
Signature ___________________________________________________________
Date ___________________________________________________________
S
E
C
T
IO
N
5
PA
Y
ME
N
T
D
E
TA
IL
S
YOUR DETAILS
We will process your data in accordance with the principles of the UK Data Protection Act (1998). By supplying your address, telephone
number and email details you are giving your consent for us to contact you in any of these ways in connection with this request.
I confirm that by completing and submitting this form I give consent to the processing of this data.
I confirm that to the best of my knowledge all the information that I have given is correct.
Signature
_____________________________________________________ Date
_____________________________________________________
Please note that all unsigned forms will be returned and will result in a delay in the processing of your enquiry
SECTION 6 DECLARATION
YOUR DETAILS
Date form received by LIBF
___________________________________________
Checked by
___________________________________________
Acknowledgment sent
___________________________________________
Form Passed to FE Operations on Date
_____________________________
Correct payment of £
nnn
.
nn
Received and processed? Yes
n
No
n
Request checked against policy Yes
n
Request rejected by
___________________________________________
Date
___________________________________________
Because
___________________________________________
Request approved By
___________________________________________
Date
___________________________________________
Record of Achievement Number
____________________________________
Issue number
___________________________________________
Issued on
___________________________________________
Certificate number
___________________________________________
Issued on
___________________________________________
Record of Achievement/certificate sent to student by
______________
OFFICE USE ONLY
n
I will pay by bank transfer (ensuring all bank charges are
covered)
Bank transfer information (please provide your details with the transfer so we can trace your payment):
Account Name: The London Institute of Banking & Finance Account Number: 10514632 Sort Code: 20-18-00
International Bank Account Number (IBAN): GB83 BARC 2018 0010 5146 32
SWIFTBIC (Bank Identifier Code): BARCGB22
We will use and protect your personal data in accordance with
current data protection legislation to evaluate your claim. Further
details, including your rights, the disclosure of data to third
parties, storage, retention and how to amend your personal
data, can be found within our Privacy Notice
(www.libf.ac.uk/privacy).
YOUR PERSONAL DATA
n
I declare that the information contained in this form is true
and accurate, consent to the processing and use of personal
data as outlined in the Privacy Notice and accept our
terms and conditions.
Signed __________________________________________________
Date __________________________________________________
Please note that all unsigned forms will be returned and will result in a
delay in the processing of your enquiry
DECLARATION
click to sign
signature
click to edit
click to sign
signature
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Guidance notes for completion of Certificate Re-issue and Record of Achievement
Application Form
Please read these notes carefully in conjunction with the Terms and Conditions for The London Institute of Banking & Finance's Regulated
Advice and Specialist Qualifications or contact our Student and Customer Services team on +44 (0)1227 818609 or email
customerservices@libf.ac.uk
Section 1 Contact Details
LIBF number
This can be found on the confirmation email / letter that you will have
received when you initially registered with us. Members of the Institute can
find their membership number on their membership card.
Date of birth
Your date of birth must be included on the form so that we are able to
confirm your identity when processing your request.
Telephone no.
In order for us to deal effectively with your request, a contact telephone
number is required. If we do not have this information a delay may occur in
us being able to process your application.
Section 2 Certificate
If you are requesting a certificate you should complete this section and then
Section 4.
Re-issue of qualification certificate – Please tell us which qualification
certificate(s) you need to have re-issued. Please refer to the Terms and
Conditions for the circumstances that are acceptable for re-issue of
qualification certificates. You must now complete Section 4.
Re-issue of unit / module or unit certificate Please tell us which unit /
module or unit certificate(s) you need to have re-issued. Please refer to the
Terms and Conditions for the circumstances that are acceptable for re-issue
of unit / module or unit certificates. You must now complete Section 4. We
do not routinely issue certificates for modules or unit that contribute to an
award. However, should you require a certificate at unit / module or unit
level we can supply one. A fee will be payable
Section 3 Record of Achievement
If you are requesting a Record of Achievement you should complete this
section and then Section 4.
Please tell us the qualification for which you require the Record of
Achievement and the date of award or the last module/unit of the
qualification you have taken.
Section 4 Reason for request
Reason for request
This section only needs to be completed if you are asking us to re-issue a
Record of Achievement or certificate.
Certificate lost / stolen
Please give us as much information as you can about the circumstances that
have resulted in your application if not one of the specific situations
described. A fee is required for the replacement.
Certificate not received
Students are required to keep us informed of any change of address. If you
did not tell us about your move before your certificate was issued a fee will
be applicable.
Changes advised but not recorded by us
If you told us about a change in your details that was not recorded, we will
issue another certificate without payment. Payment is required if you did
not inform us of the change before the issue of the certificate or in good
time to allow us to make the changes. Please make sure that you return the
original certificate with the application, as we will not issue the new one
until it is received.
Certificate damaged
If your certificate was damaged in transit, please return it with the form for
a free replacement. If your certificate has become damaged after receipt,
please return it with the form and replacement fee. If there is another
reason for your request please describe it here. Please check that the
request meets the criteria in the Terms and Conditions.
Section 5 Payment details
You may pay by cheque, bank transfer, credit or debit card. If you use a
debit card please make sure that you quote the card number (not your
account number) together with the issue number.
Signature of cardholder – If the card you use is not your own, please
ensure that the card owner signs Section 5.
Section 6 Declaration
A declaration is included at the end of the form to confirm that the
information that has been given is correct and true.
Signature – You must sign the application form. Forms that are not signed
will be rejected and returned.
Please submit your completed application form to:
Student and Customer Services
The London Institute of Banking & Finance
4 – 9 Burgate Lane
Canterbury
Kent CT1 2XJ
United Kingdom
MS07/18
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