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Record Request Form V5 December 2019 Page 1 of 2
Records Request Form TR498
This form can be used by any current or previous CIM students, members or third parties, who wish to verify qualification(s) and/or membership.
Please note: As per our privacy policy qualification information, including assessment results, will be retained for 25 years. Membership information will be retained for a period of ten years from the last renewal date.
Replacement certificate – for individual modules and/or completed qualifications. A hard copy of the certificate will be
sent via post. An EMCQ certificate may also be provided; please indicate this in section 1.3.
Qualification transcript – to show a record of all individual modules and/or qualifications completed with CIM/CAM. A
WES specific qualification transcript may also be provided, for which a completed WES Academic Records Request Form
must be submitted along with this form.
Verification letter – to confirm a person’s membership status and/or completion of CIM/CAM qualifications. This can be
requested by the candidate or a verification company.
Please select the appropriate option below to indicate who is requesting the record:
Candidate (myself) – please complete section 1.1 - 1.5
A company on behalf of a candidate – please complete section 1.1 – 1.4 and 1.6
1.1 Candidate details
1.2 Service required
Please indicate which service you require. Our Customer Experience Team will contact you for payment on receipt of your
application. Please note fees are applicable for each service that is requested.
* Not applicable for company requests** Via Special Delivery to UK addresses or International Signed to non-UK addresses
*** Upgraded Postage available please see 1.4
Title Mr Mrs Ms Miss
Other (please specify)
CIM membership
number
First name Last name
Any previous
names
Date of birth
(DD/MM/YY)
Email address Telephone
number
Address
Replacement
certificate *
Qualification
transcript *
Verification
letter
Standard
service
£40
Dispatched within ten working days of payment. ***
Express
service
£75
Dispatched within one working day of payment **
Please note that this service may not be available
during peak periods. This is not applicable for EMCQ
requests.
Additional
copies
£5
Please indicate the number of additional copies
required: . Not
applicable
Record Request Form V5 December 2019 Page 2 of 2
1.3 Qualification/membership details
Title of module(s)/
qualification(s) and
year(s) achieved
Membership level
and date joined
(Verification
requests only)
Please provide any specific requirements for your document(s) below and we will endeavour to include this:
1.4 Delivery details
I do not require a hard copy of the qualification transcript/verification letter to be posted. Please email me a soft copy
only.
Upgraded postage - UK Royal Mail signed for - £3
International tracked/signed postage (dependent on Country) - £8.65
Please indicate below if the document(s) should be posted to an alternative address to section 1.1.
1.5 Candidate declaration
I confirm that I authorise CIM to distribute this request to the delivery details provided. If requesting a replacement
certificate, I understand that it will be marked ‘replacement’ as required by regulatory authorities and requests will be
processed according to CIM’s current format. I understand that it will not be possible to amend or cancel this request once
payment is made.
Signature Date
1.6 Company declaration
If this is a company request, CIM can verify a person’s CIM membership status and/or CIM/CAM qualification(s). A signed
consent from the candidate must accompany this form.
I confirm that this request has been authorised by the candidate and this form has been submitted with the candidate’s
signed consent.
This form should be emailed to: [email protected]
Alternatively, post to: Customer Experience, CIM, Moor Hall, Cookham, Berkshire, SL6 9QH, UK
You can view our Privacy Policy here: cim.co.uk/privacy
Contact/organisation name
Postal address
Email address
Company name Requester name
Email address Telephone number
Company address
Signature Date