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Hostel Leave Application Form H02-D

Rajul Ray, a student with enrollment number 2021PG112 staying in Boys Hostel, Block D, Room 258 at IIM Shillong, has applied for leave citing personal reasons. He is requesting leave from unspecified dates and has provided his address and contact numbers during leave as well as an emergency contact number. He has declared that there are no scheduled classes during the leave period. The application requires approval from the Hostel Warden.

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Rajul Ray
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140 views2 pages

Hostel Leave Application Form H02-D

Rajul Ray, a student with enrollment number 2021PG112 staying in Boys Hostel, Block D, Room 258 at IIM Shillong, has applied for leave citing personal reasons. He is requesting leave from unspecified dates and has provided his address and contact numbers during leave as well as an emergency contact number. He has declared that there are no scheduled classes during the leave period. The application requires approval from the Hostel Warden.

Uploaded by

Rajul Ray
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Ticket No.

Form H02 – D
If classes are off – and - leave is required for personal reasons

To,

The Hostel
Warden IIM
Shillong

Name (in BLOCK Letters): RAJUL RAY Enrol. No. 2021PG112

Hostel BOYS Block / Wing D Room No. 258

Specific Reason for leave

Period of leave: From: _ / / - to - / /

Address during leave

Contact no. during leave Emergency contact no.

Declaration:
I declare that there are no classes scheduled during the period of leave.

Signature of the Candidate


Date : …………………….

Place: …………………….

Approved / Not Approved

Hostel Warden
If approved, submit a copy to 1) Program Office and 2) Security at the Campus Main Gate

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