400 UMSU University Centre
Winnipeg MB R3T 2N2
Canada
Fax: 204-269-1065 Phone:
204
-474-6018
REQUEST FOR REPLACEMENT PARCHMENT
Bachelor of Laws to Juris Doctor
The Replacement Parchment looks similar to the original, and the wording certifies that you graduated, but IT IS NOT a duplicate
of your original parchment. The fee for a Replacement Parchment is $75.00 (subject to annual review). Cheques/money orders
should be made payable to the University of Manitoba. You may also pay by credit card (if ordering by mail or fax, please fill out
credit card information below). If ordering in person you may also pay by debit. Please submit a complete Request for Change of
Name should you wish to have this parchment issued under your current legal name. Note that you must relinquish your current
LL.B. parchment and submit it with this request.
Allow approximately five to six weeks from our receipt of this request for processing.
Name: ___________________________________________________________________ Student Number:
Last Name(s) Given Names
Date of birth: _ Daytime telephone number:
I hereby request that my University of Manitoba academic records be changed to reflect that I have completed the requirements for
and now hold a Juris Doctor degree rather than the Bachelor of Laws as originally awarded. I understand that I may not make a later
request to revert my records to the original Bachelor of Laws degree.
I have
included my original Bachelor of Laws parchment with this request.
Signature: Date:
Shipping address (mail or courier only):
Name:
Address:
City/Province: Postal Code:
FOR PICK UP: MAIL OUT: PLEASE COURIER:
Additional Courier fees: (n.b. cannot courier to a box number)
*$20.00 Anywhere in Winnipeg
*$50.00 Anywhere in Canada or the U.S.A
*$100.00 International/Overseas
For Office Use Only: Date Ordered _ Date Shipped _
Card holder signature:
Proceed to back of this page for further information
Payment: Cheque/Money Order: MasterCard:* Visa:* *No other cards accepted.
Card #: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __ Expiry Date: __ __ / __ __
(Month) (Year)
I hereby authorize payment of $____________ using the above noted credit card and number.
Total amount
Notice Regarding Collection, Use, and Disclosure of Personal Information by the University
Your personal information is being collected under the authority of The University of Manitoba Act. The information you provide will be used by the University
for the purpose of updating your records to reflect your full legal name and to replace your parchment(s). Your personal information will not be used or
disclosed for other purposes, unless permitted by The Freedom of Information and Protection of Privacy Act (FIPPA). If you have any questions about the
collection of your personal information, contact the Access & Privacy Office (tel. 204-474-9462), 233 Elizabeth Dafoe Library, University of Manitoba, Winnipeg,
MB, R3T 2N2.
The replacement parchment will be printed on the same paper as current original parchments are printed,
including the University of Manitoba seal, using the same font as current original parchments use, in landscape
format. The format of a replacement parchment is shown below.
The University of Manitoba
hereby certifies that on the [Date of your graduation]
Your Name
was awarded the degree of
Juris Doctor
with all the rights and privileges thereto appertaining.
In testimony whereof the University of Manitoba has caused its seal to be affixed hereto attested by the
signatures of its proper officers in that behalf this [Date of printing of replacement parchment]
Signature University Seal Signature
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