TERTIARY INSTITUTIONS SERVICE CENTRE
(Incorporated in Western Australia)
Level 1, 100 Royal Street, East Perth
Western Australia 6004
Telephone (08) 9318 8000
Facsimile (08) 9225 7050
http://www.tisc.edu.au/
APPLICATION FOR RECORD OF RESULTS
CUSTOMER SERVICE STATEMENT
Our goal is to provide records of results within four (4) working days of receiving a completed application
form. TISC takes every effort to protect confidentiality of examination results.
INCLUDE THE FOLLOWING WITH YOUR APPLICATION
1. Proof of Identity eg copy of current drivers licence, current photo card, current passport, WA proof of age
card or birth certificate. If you have no proof of identity, complete the Proof of Identity section on page 3.
2. Change of name documentation (if applicable) eg copy of marriage certificate, deed poll certificate.
3. Payment of $37 (incl. GST) per certificate see next page for payment by credit card.
NOTE: If paying by credit card this completed form and copy of ID can be scanned and emailed to past-results-request@tisc.edu.au.
APPLICANT DETAILS
FAMILY NAME:
GIVEN NAMES:
FULL NAME AS IT
WILL APPEAR ON
ORIGINAL RECORD:
Please leave blank if same as above. If different, also provide proof of name change.
DATE OF BIRTH:
GENDER (M/F):
POSTAL ADDRESS:
POSTCODE:
TELEPHONE:
EMAIL:
SIGNATURE:
DATE:
DOCUMENT(S) REQUIRED
Tick item(s)
required
$37.00 per copy
Year(s)
of examination
TAE - Joint Admissions Advice Letter (1975 - 1985)
TEE Universities Admission Advice Letter (1986 - 2008)
WACE - Universities Admission Advice Letter (2009 onwards)
ATAA - Alternative Test for Adult Admission (1980 - 1991)
STAT - Special Tertiary Admissions Test (1992 onwards)
WAUFP Western Australian Universities Foundation Program
Results Letter (1996 2010; 2013 onwards)
WAUPP Western Australian Universities Preparatory Program
Results Letter (2011 - 2012)
See page 2
Curtin University Edith Cowan University Murdoch University The University of Western Australia
IDENTIFYING DOCUMENT/S SUBMITTED (please tick)
Current Photographic ID eg Passport, Drivers Licence, Photo card or WA Proof of Age card
Official Birth Certificate (extract not acceptable)
Witness Statement - using Authorised Witness as described under the Western Australian
Oaths, Affidavits and Statutory Declarations Act 2005 (see page 3)
IF APPLICABLE - Proof of name change eg Marriage Certificate
DOCUMENT(S) COLLECTION/DELIVERY (tick one)
Please post to the address I have provided on this form
I will collect from TISC office on or after ____________________
Proof of identification will be required when collecting the document(s).
If another person is to collect the document(s) on your behalf. Please complete:
I authorise
(Name)
(Date of birth)
to collect the document on my behalf.
(Your signature)
METHOD OF PAYMENT
Payment is only accepted in Australian dollars. Forms received without payment will be returned unprocessed.
Cash/Eftpos (only available when lodging in person at our office)
Cheque/Money Order (payable to TISC)
Credit Card (see below)
Please charge my
Mastercard
Visacard
CARDHOLDER NAME (please print):
CARD NUMBER:__ __ __ __ / __ __ __ __ / __ __ __ __ / __ __ __ __ EXPIRY DATE: __ __ / __ __
with the amount of $ __________________ being for _____________ result/s @ $37 per copy.
SIGNATURE OF CARDHOLDER:
DATE:
NOTE: Should credit card payment be declined your form will be returned unprocessed. Also should you be using a non-Australian
credit card, confirm with your bank that overseas transactions are acceptable before submission. If not acceptable, a bank draft in
Australian Dollars would be required.
Office use only
Checked ID
CheckedManual
Photocopied
Posted/Collected
Page 2 of 3
NO PROOF OF IDENTITY WITNESS STATEMENT
If you have no proof of identity, please have the following section completed by someone who is described as
an authorised witness under the Oaths, Affidavits and Statutory Declarations Act 2005 and who is NOT related
to you by birth or marriage. Refer to http://www.courts.dotag.wa.gov.au/W/witnessing_documents.aspx.
WITNESS STATEMENT
I certify that
is known to me and that he/she has signed this form in my presence.
WITNESS SIGNATURE:
OCCUPATION:
DATE:
REGISTRATION No:
NAME (please print):
STREET
ADDRESS:
SUBURB:
POSTCODE:
DAYTIME TELEPHONE:
Professions as of January 2012 that can witness statutory declarations are:
Academic {post-secondary institution}
o Member of academic staff at the Universities
or State Training Providers
Accountant member of:
o Association Of Taxation and Management
Accountants
o CPA Australia
o The Institute of Chartered Accountants in
Australia
o Institute of Public Accountants
o National Tax and Accountants Association
Ltd
Architect
Registered under the Architects Act 2004
Australian Consular Officer
Australian Diplomatic Officer
Bailiff
Bank Manager
Chartered secretary
o Member of Chartered Secretaries Australia
Ltd
Chemist
Chiropractor
Company auditor or liquidator
Court officer {Judge, magistrate, registrar or clerk}
Defence Force officer
o An officer within the meaning of the Defence
Force Discipline Act 1982
o A non-commissioned officer within the Act
with 5 or more years of continuous service
o A warrant officer within the meaning of the
Act
Dentist
Doctor
Electorate Officer {State WA only}
Engineer
A member of the Institution of Engineers
Australia other than at the grade of student
Industrial organisation secretary
Insurance broker
o Member of the National Insurance Brokers
Association of Australia
Justice of the Peace {any State}
Lawyer
Local government CEO or deputy CEO
Local government councillor
Loss adjuster
o Member of the Australasian Institute of
Chartered Loss Adjusters
Marriage Celebrant
Member of Parliament {State or Commonwealth}
Minister of religion
Nurse
Optometrist
Patent Attorney
Physiotherapist
Podiatrist
Police officer
Post Officer manager
Psychologist
Public Notary
Public Servant {State or Commonwealth}
Real Estate agent
o Holder of a licence under the Real Estate
and Business Agents Act 1978
Settlement agent
o Holder of a licence under the Settlement
Agents Act 1981
Sheriff or deputy Sheriff
Surveyor
Under Licensed Surveyors Act 1909
Teacher
Tribunal officer
Veterinary surgeon
Page 3 of 3
