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INSTITUTE OF MANAGEMENT TECHNOLOGY

Survey No. 38, Cherlaguda Village, Shamshabad Mandal,


RR District
Hyderabad- 501218

__________________________________________________________________________________________________

Date : Aug 07,2019

APPLICATION FOR NIGHT OUT / LEAVE FROM HOSTEL

Name : Antony Lawrence Pulikottil Room No : Tungabhadra-A >> Third FLoor


>> HB/TBA/TF/S/435

Hostel : Tungabhadra-A Course : PGDM

Duration: From date : Aug 13,2019 Time : 06:35 PM

To Date : Aug 19,2019 Time : 06:35 AM

Parent Contact No : 7510220737

Reason : Visiting for family purpose

Approve / Rejected reason: Ok

Approve / Rejected by : Rambalak Yadav

Location : Kochi

Emergency Contact Name : Lawrence P.A Emergency Contact 9946203715


Number:

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