STUDENT'S STATION LEAVE APPLICATION

(Note: 1. Application will not be accepted 10 days prior to date of travel.

2. Approved station leave form to be submitted at the security main gate.)

1 Name UDISH SWAMI

2 Roll No. PGP/27/232
3 Hostel &Room Number Hostel L1, L1-106
4 Programme PGP
5 IIMK Email udishs27@iimk.ac.in
6 Email(Next of Kin) udishswami@gmail.com
7 Mobile No. 9910018066
8 Mobile No.(Next of Kin) 9911178066
9 Station leave:From 18-01-2024 07:00 AM
10 Station leave:To 29-01-2024 12:00 PM
11 Total no of days 12
12 Purpose of leave Visiting Family/Friend
13 Specify the Purpose Visiting family
14 Supporting documents,If any no
15 Any other documents No

UNDERTAKING
● I here by certify that the details mentioned above are true to the best of my knowledge/
belief.
● I am aware of the adverse effects on my academic and non-academic performance
performance due to my absence from the campus.
● I will not be claiming exemption for any academic or non-academic activities carried out
during my absence from the campus.
● I do not have any exams / test / quizzes / International immersion during the station leave
period and I will not be requesting for re-exams/test/quizzes.
● I understand that I am travelling at my own risk and the institute will not own the
responsibility for the same.
● I will not be extending my station leave period.
● I am aware that any false information /purpose of leave mentioned in the form will lead to
displinary actions.
● I am aware that the Institute reserves the rights to change the terms &conditions of station
leave or cancel the same without any reasons, even after the grant of permission.
● After Verification if the evidence provided is not satisfactory Diciplinary action will be
initiated.
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(For Office Use Only)

INDIAN INSTITUTE OF MANAGEMENT,KOZHIKODE

STUDENT'S STATION LEAVE APPLICATION

UDISH SWAMI, PGP/27/232 has been granted station leave from 18-01-2024 to 29-01-2024.

Date:17-01-2024 -sd-
Student's Affairs &Hostel Office
Serial no: SSLA42672/2023