APPLICATION FOR THE ISSUE OF A REPLACEMENT DIPLOMA SUPPLEMENT
Guidance for Applicants:
1.
The Diploma Supplement issued by Leeds Beckett University is a unique and valuable document.
Replacement Diploma Supplements have precisely the same standing as the original, are produced in the
format currently in use and may not be an exact copy of the original.
2.
Diploma Supplements are only issued to award holders who received an award since 2005.
3.
The University can only issue documents in the name in which you were awarded.
4.
A replacement will only be issued at the discretion of the University, which reserves the right to refuse an
application without specifying a reason for its decision.
5.
Applicants requesting a replacement Diploma Supplement MUST provide:
a) This application form fully completed, signed and with proof of ID*- either posted to the address at
the bottom of page 2, or scanned and emailed to awardsandexams@leedsbeckett.ac.uk
b) A cheque for £30 made payable to LEEDS BECKETT UNIVERSITY or pay over the phone by calling our
Cashier’s Office on 0113 8123832. Please insert receipt number in Section B below (Fees are subject
to change without prior notification).
__________________________________________________________________________________________________________
SECTION A (to be completed by ALL applicants in BLOCK CAPITALS)
Full Name of Applicant:
___
Date of Birth: _______
Student ID if Known: _____________ _____
Year of Award: ______ ____
Award and Title of Course:
_________________
Contact Telephone No: _________________
Signature:
____
Email Address: _______________________________
Date:
____
* N.B. Valid forms of ID include a photocopied or scanned copy of e.g. driving license, passport, student ID
card or other official photo ID. Please do not send original documents.
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SECTION B – Declaration to be completed by ALL applicants - please indicate reason below
I (CURRENT FULL NAME)
___________________
FULL NAME at time of award (if different to above)
confirm that (please state reason for requesting a replacement here)
I enclose a cheque for £30
/ Receipt number (for payments made by telephone) _______________
Applicant’s Signature:
SECTION C - Postage/ Collection Details:
Please post to this address
I wish to collect my Diploma Supplement: Y/N - delete as appropriate
If someone else is to collect your Diploma Supplement on your behalf, please provide their name below. They
must provide proof of ID when collecting it. Please note that the Diploma Supplement will not be released to any
other person.
Name of person collecting on your behalf: ___________________________________________________
FOR UNIVERSITY USE ONLY
Student ID:
Amount of Fee:
Date Received:
Date Sent:
Please return to:
Awards and Examinations
Governance Planning and Registry,
Room 205, Leighton Hall,
Leeds Beckett University,
Headingley Campus,
Leeds, LS6 3QS
Email: awardsandexams@leedsbeckett.ac.uk
Tel: 0113 812 5463
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Mode of Study:
Authorised By: