Annexure- IX

Indian Institute of Management

Application for the Medical Leave/Family Emergency
Name: Kothapalli Sai Sarada Mythili
Enrolment Number: MBA21094
Period of Leave: From 24th December,2021 to 25th December,2021
Describe the reason for leave (Attach documentary proof viz., Medical certificate etc.)

Visit to Shri Mata Vaishno Devi shrine

Whether recommended by the Chairperson (Student Affairs’) and Hostel Warden?

Particular Whether recommended or not? (with signatures)
Hostel Warden
Chairperson (Student Affairs)

Whether approved or not by the Chairperson (MBA)?

Chairperson (MBA)

Note:
For grounds other than sickness or family emergency, leave may not be granted for a period exceeding three
teaching days and even can be denied. Before applying for leave to the Chairperson (MBA), through Chairperson
(Student Affairs’) and Warden, student should contact his/her course instructors to ensure that s/he is not missing
any quizzes or examinations during the leave period. No attendance will be granted for such leaves. Students must
refrain from approaching the visiting and full time faculty members for any exemptions in attendance on any
grounds.
The PGP Office or the concerned faculty will not be responsible for the student losing any segment of evaluation on
account of his/her leave or not meeting the minimum desired attendance of 80%.

In general, for medical treatment in Jammu city or in any other city, student must be referred by the Institute's
Doctor/ Visiting Doctor / Health Centre. Resident Doctor's/Visiting Doctor’s reference may not be required only in
case of emergency.
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