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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 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 to the copy supplied to me by you,  it will be an infringing copy and that I shall be liable for infringement of copyright as if I had made the copy myself.