Certified Copy Request Form

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{company_phone}}

Email: {{company_email}}

Website: {{company_website}}

Date of Request

Date: {{request_date}}

Employee Information

Employee Name: {{employee_name}}

Employee ID: {{employee_id}}

Department: {{department}}

Contact Number: {{employee_phone}}

Employee Email: {{employee_email}}

Document(s) Requested

Please specify the document(s) for which certified copies are required:

1. {{document_name_1}}

2. {{document_name_2}}

3. {{document_name_3}}

(Add more lines if needed)

Reason for Request: {{reason_for_request}}

Certification Requirement

Please indicate the level of certification required:

- {{certification_type_internal}} (Internal Company Certification)

- {{certification_type_notary}} (Notarized Certification - additional fees may apply)

Purpose of Certification: {{purpose_of_certification}}

Delivery Method

Desired Delivery Method (Please tick one):

{{delivery_method_collection}} (Collection from HR Department)

{{delivery_method_post}} (Postal Mail to address below)

{{delivery_method_email}} (Email to registered employee email address - for uncertified copies only)

If postal mail, please provide address:

{{delivery_address}}

Declaration and Acknowledgment

I, {{employee_name}}, hereby declare that the information provided in this request is true and accurate. I understand that certified copies will be issued in accordance with company policy and relevant legal requirements.

I acknowledge that a processing fee may be applicable for notarized certifications or extensive requests, as per company guidelines. I agree to pay any such fees upon notification.

For Official Use Only

Request Received By: {{received_by_name}}

Date Received: {{received_date}}

Approving Officer: {{approving_officer_name}}

Approval Date: {{approval_date}}

Status: {{request_status}} (e.g., Approved, Denied, In Progress)

Notes: {{official_notes}}

Signature Block

_________________________

Employee Signature

Date: {{signature_date}}