Monitor FAULTY CARD REPLACEMENT application form

PART 1 - Your details

Do you have a FAULTY staff photocopying card in your possession, and are you authorised to request its replacement?

No, I am NOT authorised to request the replacement of the FAULTY staff photocopying card in my possession Yes, I AM authorised to request replacement of the FAULTY staff photocopying card which is in my possession

What is your UniSA email address?

What is the delivery address within UniSA to which the REPLACEMENT CARD should be sent?

        Name of recipient:    

Building / room number:   

                    Campus:        Please choose campus City East City West Magill Mawson Lakes Underdale Whyalla

PART 2 - FAULTY staff photocopying card details

What is the CARD NUMBER of the FAULTY card? (as printed on the front of the card)

What is the REGISTERED NAME of this card? (refer to sticker on the reverse of card)

Please note:

• at least one and preferably both of the above fields must be entered so that the FAULTY card can be properly identified.
• any unused photocopying credit will be transferred to a replacement card
• the replacement card will be issued and sent via internal mail to the address specified, usually within 1 working day of receipt of these details at Document Services.
• upon the receipt of the replacement card, the original FAULTY card should be destroyed.

Is this a CORRECTION to a FAULTY CARD application form submitted earlier today?

NO        YES