Form AS2

APPLICATION FOR REPLACEMENT OF POLYU STUDENT IDENTITY CARD

(Not applicable to Research programmes and PolyU award programmes administered by SPEED)

Please read the notes overleaf before completing this form.

I.PARTICULARS OF STUDENT

Student No.

Name

ProgrammeStream

Programme Title / _
*Hong Kong Identity Card/Passport No./Mainland ID No. / ( )
Day-time Contact Number

II.Reason for replacement (Please tick as appropriate)

Defective smart card(can’t gain accessto library
and other facilities) / Loss of card / Damage of card
Others (e.g. Amendment of name/Change of programme mode) Please specify ______

III.PAYMENT(If applicable, please tick as appropriate. Please note that fee paid are not refundable)

By cash/octopus (Payment receipt no. ______)
By on-line credit card (Visa/Master/UnionPay) (invoice no. ______) at https://www40.polyu.edu.hk/foccp/ccp_payment_menu.jsp

IV.DECLARATION

I declare that the information provided above is true and correct. I fully understand that making a false declaration is a criminal offence and may result in the University’s reporting the case to the police.

Signature of Student Date ______


*delete as appropriate

FOR OFFICE USE

V.Academic Secretariat

HKID Card/Passport/Mainland ID is checked by on

Student Status: SID Expiry Date: Replacement no.

Payment receipt no./invoice no. ______.

Replacement SID distribute by on

VI.ACKNOWLEDGEMENT (to be completed by student upon collection of the replacement student identity card)

I acknowledge receipt of the replacement student identity card and undertake to return my original card to the Academic Secretariat for cancellation should it be found subsequently. I understand that it is an offence to possess more than one student identity card for the same programme at the same time and that I shall be subject to disciplinary action if found committing such offence.

Signature of Student Date ______

(18 Jun2015)

Form AS2

NOTES TO STUDENTS

If your PolyU student identity card is defective/damaged/lost and you wish to apply for a replacement card, please follow the procedures specified below:-

  1. Complete Sections I, II, III and IV of this form.
  1. A fee of HK$110.00 will be charged for a replacement card if the original card is lost/damaged, or if there is any change regarding the student name and programme mode/level. Fees paid are not refundable.
  1. For payment, settlement can be made via the following means:

- by cash/octopus (Please collect the debit note slip at the Academic Secretariat Service Centre and settle the feeat the counter of the Finance Office [Location: Room VA205, Shaw Amenities Building; Office Hours: Mon – Fri : 9:00 am – 5:00 pm; Sat : 9:00 am – 12 :00 noon]). Please keep the payment receipt for future reference.

- by on-line credit card (Visa/Master/UnionPay) at

https://www40.polyu.edu.hk/foccp/ccp_payment_menu.jsp

  1. The completed form should be sent to the Academic Secretariat for processing via one of the following means:

-in person or by mail to the following address:

Academic Secretariat Service Centre

Room M101, Li Ka Shing Tower

The Hong Kong Polytechnic University

Hung Hom, Hong Kong.

- by email to ‘’ or by fax to 2334 6671 (for payment by credit card only).

Presentation of your Hong Kong Identity Card/Passport or Mainland ID (applicable to non-local students) is required for submission in person. For application via mailing/email/fax, a copy of your Hong Kong Identity Card/Passport or Mainland ID is required to be attached.

Please note that this form is not applicable to Research programmes and PolyU award programmes administered by SPEED. Please visit the website of Research Office (http://www.polyu.edu.hk/ro/) or SPEED (http://www.speed-polyu.edu.hk/) for details of the application procedures

  1. Your HKID/Passport/Mainland ID copy will be destroyed after the processing of this application.
  1. For replacement/renewal of student identity card, you are required to return your original student identitycard to the Academic Secretariat for cancellation. Before your return, please clear all the money value stored in the e-purse of the student identity card. The University shall not be liable for any subsequent claims for unspent balance after the card has been cancelled.
  1. Normally it takes 3 working days from the date of receiving the application to process the replacement card. For applications made via post/e-mail/fax, you will be informed via email when the card is ready for collection.
  1. In case you could not come in person, you may authorize in writing a representative to collect it on your behalf. Your representative should bring along a copy of your Hong Kong Identity Card (or Passport/Mainland ID as appropriate) for verification purpose. Such copy will be returned to your representative afterwards.
  1. The information given in this form will only be used for processing this application.
  1. Your original student identity card will be invalidated once the replacement card is issued. You should immediately return the original student identity card to the Academic Secretariat for cancellation should it be found subsequently. It is an offence to possess more than one student identity card for the same programme at the same time and you shall be subject to disciplinary action if found committing such offence.

(18 Jun2015)