REFERENCE NO REQUEST FORM (STUDENT) INTERLIBRARY LOAN AND

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Please check PolyU library catalogue before submitting requests

Reference No.:

Request Form (Student)

Interlibrary Loan and Document Delivery Services

Pao Yue-kong Library

The Hong Kong Polytechnic University

IMPORTANT

Please note that once an interlibrary loan/ document delivery request is submitted to us, we will deduct one unit from your available interlibrary loan and document delivery quota regardless of the outcome of the transaction. Hence, before you submit your request to us:

Document delivery request : Please search the PolyU Library catalogue to check if the journal title is available at PolyU Library.

Loan request : Please search the Hong Kong Academic Library Link (HKALL, http://hkall.hku.hk) to check if item is

available at other UGC libraries for DIRECT PATRON REQUEST.

REFERENCE NO REQUEST FORM (STUDENT) INTERLIBRARY LOAN AND

Student Name: Lecturer’s Name:

PolyU ID No.: Dept.: Dept.: Ext.:

Contact Phone No.: Course Code: Lecturer’s Signature:

To speed up processing, please provide title of the database if you retrieved the reference from an electronic source:

REFERENCE NO REQUEST FORM (STUDENT) INTERLIBRARY LOAN AND

Journal Book Proceedings Thesis Patent Others

TITLE:

BOOK AUTHOR/ EDITOR:

YEAR: ED.: VOL.: PART/NO.: PAGES FROM P. to P.

PLACE OF PUBLICATION: PUBLISHER:

ARTICLE TITLE:

ARTICLE AUTHOR:

_________________________________________________________________________________________________________________________________________

The Library reserves the right to suspend interlibrary privilege or impose fines resulting from late return, damage or loss of the loaned item.

========================================================================================================================

COPYRIGHT DECLARATION

1. I declare that if a copy is supplied to me in compliance with the request made above, I will use it for the purpose of my research or private study only and not

for circulation or further reproduction or any other purpose.

2. To the best of my knowledge, no other person with whom I work or study has made or intends to make, at or about the same time as this request, a request for substantially the same material for substantially the same purpose.

3. I declare that, in the case of articles in periodicals, I have not been previously supplied with a copy of the said article or with copies of more than one article contained in the same issue of the periodical, and in the case of parts of published works, a copy of the same material or with a copy of more than a reasonable proportion of the work.

4. I understand that if I make a false declaration and I am supplied with a copy which would have been an infringing copy if made by me:

a) I am liable for infringement of copyright as if I had made the copy myself;

b) The copy will be treated as an infringing copy.

5. I undertake to accept the full responsibility of this photocopying and indemnify this Library and the University any liability incurred in relation to this photocopying should a dispute concerning copyright infringement arise.

6. For loan request, I undertake to conform to the Hong Kong copyright laws.

The information you provide in this form will be used for the purpose of providing general library services or a directly-related purpose in PolyU. The Library may give specified information to authorized PolyU offices and legal authorities, where applicable, for purposes relating to the collection of such information.

Requester's Signature _____________________________________________ Date ______________________________________

16 PTR1QUICKGUIDE QUICK REFERENCE GUIDE CONTRIBUTED
CHARITY TRUSTEE REFERENCE FORM NAME OF APPLICANT
CONSULTANCY TERMS OF REFERENCE UNRWA IS A

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