WIA Student Authority to Act Form

STUDENT AUTHORITY TO ACT FORM
An Authority to Act is an official permission given by a person to another person and/or entity to act on certain matters, or granted to a person or entity to act on behalf of another person through an existing legal instrument for a certain period of time. An Authority to Act can be given in relation to all business transactions with the institute or extended in relation to certain matters only. Students must complete all sections, including provision of appropriate certified identity documents. Incomplete forms cannot be processed.
Student Information
Student name *

First Name Middle Name Last Name
Student email *
Authorised Representative to Act on Student’s Behalf
Full name *

First Name Middle Name Last Name
Organisation *
Email *
ABN/ACN *
Please tick below.

This Authorisation is :
This Authorisation is :

To be ongoing until I complete my business with the institute during my enrolment period To be limited to the following period:
From *

Month Day Year
Date
To *

Month Day Year
Date
Authorisation and Proof of Student Identity
I confirm the information provided in this form is true and correct and I give authority to the Authorised Representative named above to act on my behalf during the time specified above.
Signature of student

Clear
Date:

Month Day Year
Date
Should be Empty:

STUDENT AUTHORITY TO ACT FORM