For attention the UJ Certification Office: 

Since I will not be attending the forthcoming graduation ceremony, I hereby undertake to collect the certificate in person from the relevant faculty office within one week after the graduation. I also take note that the certificate will not be posted to me.

____________________________________________________________________________

Student number:<StudNumber>
____________________________________________________________________________

Title, initials and surname:<StudTitleInitSurn>
____________________________________________________________________________    

Degree or Diploma:
<QualDesc>
____________________________________________________________________________

Signature:                      			Date:
____________________________________________________________________________

                         OR

I have given proxy to:

____________________________________________________________________________
ID number:
____________________________________________________________________________
to collect my certificate on my behalf

Signature:				Date:

This form must be handed in at the faculty concerned.