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: records@cim.co.uk

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