Please supply me with a copy of *the article in the following periodical/the part of the
following published work, the particulars of which are:
and required by me for the purposes of research or private study (one requested item per form).
I declare that:
(a) I have not previously been supplied with a copy of the same material by you or any other librarian;
(b) I will not use the copy except for research for a noncommercial purpose or private study and will not supply a copy of it to any other person;
(c) to the best of my knowledge no other person with whom I work or study has made or intends to make, at or about the same time as this request, a request for substantially the same material for substantially the same purpose.
I understand that if the 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.