Chapter:	528B	Title:	COPYRIGHT (LIBRARIES) REGULATIONS	Gazette Number:
Schedule:	3	Heading:		Version Date:	30/06/1997

[regulation 6]

The Librarian of

the Library

(Address)

1. I [ ] of [ ] hereby request you to make and supply to me *[a copy of (particulars of article)] *[a copy of (particulars of work of which a part is required to be supplied and particulars of that part)], which I require for the purposes of research or private study.

2. I have not previously been supplied with a copy of *[the said article] *[the said part of the said work] by any librarian.

3. I undertake that if a copy is supplied to me in compliance with the request made above, I will not use it except for the purposes of research or private study.

[Note: This must be the personal signature of the person making the request. A stamped or typewritten signature or the signature of an agent is NOT sufficient.]