DHANALAKSHMI SRINIVASAN UNIVERSITY

SAMAYAPURAM
SCHOOL OF ALLIED HEALTH SCIENCE

B.SC., OPERATION THEATRE ANAESTHESIA TECHNOLOGY

UNDER GRADUATE TECHNOLOGIST

LOG BOOK

NAME ;……………………………………………………………………………………..

ROLL NO ;……………………………………………………………………………………..

BATCH /YEAR ; ……………………………………………………………………………………..

DHANALAKSHMI SRINIVASAN UNIVERSITY
SAMAYAPURAM
SCHOOL OF ALLIED HEALTH SCIENCE

DEPARTMENT OF ; …………………………………………………………………………………

NAME ;………………..………………………………………………………………

DEGREE ; ………………………………………………………………………………..

FROM ;…………………………………………. TO ;……………………………………….…….

 DHANALAKSHMI SRINIVASAN UNIVERSITY
SAMAYAPURAM
SCHOOL OF ALLIED HEALTH SCIENCESS

CERTIFICATE

Certified that this is the Bonafied Log Book of

................................................................................ Pursuing ........................................................

in the department of ..................................................................................

ASSOCIATE DEAN HEAD OF DEPARTMENT

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NAME ..........................................................................

Date of Birth ............................................................................

Permanent Address: ..............................................................................................

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..........................................................................................................................................................

Postal Address ....................................................................................................

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Contact Number: ...........................................................................................................

Blood Group:.........................................................................................................................
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