Date :

Register Number Name

Semester Degree & BE / BTech / ME / MTech / MBA

VII / V / III Branch
(Pl. Tick)
(Pl. Tick) Branch : ______________________

Absent for
PT I PT - II

Reason for Absent 1) Medical 2) Inter- *

3) Others (Specify)
(Supporting Documents Ground Collegiate
to be attached) Competition
with prior
(Pl. Tick) permission from
Principal
Sl.
Course Code Course Title
No.
1

6
Name & Signature of the Faculty handling the Subject
(if registered for Single subject only)

Declaration: Verified that the student has

not appeared for the above said Periodical
Test and He/She satisfies the attendance Signature of the Head of the Department with Seal
requirements (if registered for Multiple subjects)

*
Approval by the Head of the Institution
(if Reason for Absent is Others)

Note: 1) Last Date of Submission to COE Office in Person: 09.08.2017 (Wed)

2) Registration form after the due date will not be accepted.