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Leave Application Form

I am Mr/Ms SHREYA SATAM _ (Full Name of


Parents/Guardian) (relation) of
Mr/Ms
DEVANGI SATAM (Full Name of student) bearing SAP
ID 74022121393 requesting you to grant leaves to my ward for
FAMILY FRIEND (reason for leave) from / / 2023 to / /
2023 . The approx. in time would be 10:30 PM and approx. out time
would be .

Declaration

I declare that –

 I know the Rules & Regulations of Hostel and I agree to abide by them, failing which
my ward shall be liable to disciplinary action.
 I also know the minimum percentage criteria of attendance of my ward for giving the
exam, failing which my ward shall be liable to not give the exams.

I do hereby solemnly affirm and declare that I will be wholly & solely responsible for my ward
during his/her leaves.

(Authorised Signature)

Name of Parent / Guardian: SHREYA


SATAM
Date:
Place:
Contact Number:

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