INSTITU

TE HOSTEL LEAVE FORM

Name of the Hostel Inmate:Praveen Kumar.

Rollno:ME23B1024

Inmates Phone No:074491 98916

Hostel Name :Jasmine Annex

Room No:1227

Reason for Leave:

Date of Journey (exit from hostels):26/08/2023

Return Date:27/08/2023

Destination (complete address):No.118, The Wind Poomalai , Rathinasamy street , B.T.Nagar ,

Kolapakkam , Chennai - 600122

Parents / Guardians Mobile No:9444939107

Father:M R Manivasakam

Mother:K. Arthi

Guardians No:

Inmate’s Signature:

Approval of Wardens:

In the event of unplanned stays (Rules 4 to 6) text of Message to be acknowledged by

parent / guardian:

I M R Manivasakam Parent / Guardian of M Karun Bharath hereby acknowledge that my ward has
reached my place safely and we take responsibility of his / her well being.

For parents not comfortable with English, they may text the equivalent of above in their native
language. HO phone number: 8778400261