Proxy Borrower Form
(This form should be submitted to the Library Privileges Desk - Doe Library, floor 1)
To: Library Privileges Desk
As a University of California Faculty/Academic Staff member at Berkeley, I request that the Library permit the person named below to withdraw books in my name for use in research.
Name of proxy: ______________________________
Term of Proxy Card: __________________________ (not to exceed 30 June of the next calendar year)
I understand that I am responsible for all books borrowed under this privilege; that all recall notices will be sent to me; and that I am responsible for the return of all books or the payment of replacement bills for books that are lost or damaged.
Date: ________________________________
Signature: _____________________________
Print Name: ___________________________
Department: ___________________________
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