University of the Witwatersrand, Johannesburg
Office of Alumni Relations
Alumni House, Wits Club Complex, West Campus ∙ Private Bag 3, Wits 2050, South Africa ∙ Fax: (011) 403-4493 ∙ Telephone: (011) 717-1090 Email: alumni@alumni.wits.ac.za ∙ Website: www.gradnet.wits.ac.za
Requests for detailed reports, lists, personalised letters/invitations, computer files and address labels: 1. I hereby request the following information from your database (Please be specific about Degree information, graduation date, country/district required, etc.).
2. I would like the information to be sorted as follows (Tick the applicable):
Alphabetically by Surname and Initials. By Postal Code (Post Office gives discount only if >40 000). Other (Please state):_______________________________________________________________. 3. I would like the information to be produced in the following format (Tick the applicable): Detailed Report (All Addresses, Contact Numbers and All Degrees) Short List (Names & Contact Numbers) Address Labels Personalised Invitations/Letters Computer File (File format________________________). 4. I would like to receive the data by: Fax E-mail CD 5. The data is required for the following purpose: _______________________________________________. I, as Dean/Head of Department in the Faculty of___________________________ give the assurance that the information provided by the Alumni Office will be treated as confidential. The information will only be used for bona fide academic purposes. If it is being used for research purposes, the research will be written up in a way that will prevent third parties from being able to identify individuals. The information will not be used for any commercial purposes whatsoever. Nor will it be made available to unauthorised parties. On completion of the research, I will ensure that the information is either destroyed or returned to the Office of Alumni Relations. I accept the following charges: R 0.25c R 1.50 R 1.50 R 20.00
Per Page - Reports Per Page – Labels Per Page – Fax CD (Each) Payment Methods: 1. Internal requisition: Account Code: 001-157-4512101-8114102. Please send the Internal Requisition. 2. Cheques: Made payable to: Office of Alumni Affairs. Information about the individual who will be responsible for the data appears below Staff Number:
Name Position Department/Faculty Walker Account Code Telephone Number/s Fax #: Hand Delivery Address Signature Date: Please help us to help you: Send us feedback on the data we provide you with. Notify us of corrections, address updates or missing persons. Phone Ms Purvi Purohit at 717-1093, or Fax 403-4493.
Solomon Motsoane
Page 1 of 1
13/08/2008