Third Party Authorisation
Received Student
Business Centre
IMPORTANT INFORMATION
Complete and return this form via email (from your student email) to sbc@bond.edu.au or in person at the
Student Business Centre.
Use this form to:
Authorise release of personal information to a third party (eg parent/guardian, relative, insurance,
financial and legal organisations on request)*
Enable someone to collect student information on your behalf when requested
Bond University is subject to the Information Privacy Act 2009 and is committed to protecting the privacy of
personal information. Information collected on this form will be used to process your request for third party
authorisation to access information relating to your studies. The information will not be disclosed further, unless
required by law. For further details see our Privacy page
.
*For Power of Attorney you must provide a certified copy of Power of Attorney document.
STUDENT DETAILS
Student Number
Family Name
Given Names
Date of Birth
Email address (if not current student)
Contact Phone number
DETAILS OF THIRD PARTY
Relationship to student
Family Name
Given Names
Telephone Number
Email address
Organisation (if applicable)
Date of Birth
INFORMATION TO BE RELEASED
Student Account and Financial Information, including provision of statements of account
Application, enrolment and academic information
By signing this form, I authorise the above as indicated.
Student’s signature ............................................................................. Date ........./........./.......
Bond
Office Use
Only
ID of student verified
Emailed student ........./........./.......
TPA received via student
email
S1 Comment Code “THRD PARTYadded
Added 3
rd
party email in Contact Details, email details,
email type: Invoices and billing
TPA processed by
click to sign
signature
click to edit
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