GOLDEN JUBILEE HOSTEL

G.B.P.U. AGRI. & TECH., PANTNAGAR

1. Name of the Student____________________________ I.D. ______________________

2. Hostel room no.______________ College _____________________________________
3. Dates on which leave is required___________________________________________
4. Reason for leave___________________________________________________________
5. Place for which you leave (full address) _____________________________________
______________________________________________________________________________
6. Date and time of leaving hostel_____________________________________________
7. Date and time of returning hostel__________________________________________

___________________________ __________________________
Signature of Advisor/Parent Signature of student
Permitted/Not permitted

_________________________
Signature of Warden

______________________________________________________________________________

GOLDEN JUBILEE HOSTEL

G.B.P.U. AGRI. & TECH., PANTNAGAR

1. Name of the Student_______________________ I.D.____________________________

2. Hostel room no. _________________ College __________________________________
3. Date and time of leaving hostel_____________________________________________
4. Date and time of returning hostel__________________________________________

_________________________
Signature of Warden