Copyright Declaration Form

To the Librarian, .............................................................................................. Library

I hereby request you to supply me with a copy of the specified document.

  1. I have not previously been supplied with a copy of the same material by you or by any other library.
  2. I will use the copy only for non-commercial research or private study and will not supply a copy of it to any other person.
  3. To the best of my knowledge, no other person with whom I work or study has made or intends to make at about the same time as this request, a request for substantially the same material for substantially the same purpose.
  4. I understand that if this declaration is false in a material particular the copy supplied to me by you will be an infringing copy and that I shall be liable for infringement of copyright as if I had made the copy myself.

Document requested:

Title: ..............................................................................................................
Author(s): ..............................................................................................................
Journal reference: ..............................................................................................................

Signed: ................................................................................... Date: ......................................


This form should be printed out and signed by the requester when collecting the document from the requesting library.

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