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Glen Road, Plaistow LONDON, E13 8SL Readers name .................................................. Tel: 020 7363 8016 Fax: 020 7363 8087 Contact details .................................................... Date requested:.............................. Office Use: Vire.... Date Applied:.. Date received:............................ Request in sequence from: Date Supplied: Reason and date forwarded if not supplied: (1) (1) (1) (2) (2) (2) (3) (3) (3) (4) (4) (4) Photocopy requests - A signed copyright declaration is held by the requesting library. TO THE LIBRARIAN INTER-LIBRARY REQUEST TITLE of Journal/Book ....................................................................................................... YEAR .............. VOL. NO............. PART NO. .................... INCL. PAGES......................... AUTHOR .................................................. PUBLISHER (Books) ....................................... ARTICLE TITLE ................................................................................................................... Photocopy declaration: I declare that this item Requesting library :- NEW is required only for non commercial research or private study & I will not copy it to any other person. Requesting library address:- Knowledge & Library Service Newham Hospital Signature ........... Glen Road, Plaistow LONDON, E13 8SL Readers name .................................................. Tel: 020 7363 8016 Fax: 020 7363 8087 Contact details .................................................... Date requested ............................... Office Use: Vire.... Date Applied:.. Date received:............................. 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