INDIAN MARITIME UNIVERSITY, VISAKHAPATNAM

CAMPUS
GANDHI GRAM , VISAKHAPATNAM

APPLICATION FOR LEAVE

NAME OF THE STUDENT :

ROLL NO. :

COURSE OF STUDY :

NO. OF DAYS : FROM TO

ADDRESS DURING THE LEAVE :

CONTACT TELEPHONE NO :

REASONS FOR LEAVE :

DATE : SIGNATURE OF THE STUDENT

Approval from Accadamic in Charge:

Approval from Hostel Warden :

Security Initial :

Academic section copy: Name & Roll No :

Class :

Leave period : From To

 P.T.O

Instructions

1. Students are to inform the Accadamic in Charge if they are missing

any accadamic sessions during their enjoyment of the leave .

2. Students should enter their Names in the Register kept with Mess in
Charge so
that, they are not having food on leave days , Failure to which will be
charged as food cost at student’s rates from the respective student.

3. Students are required to enter their names in the Log Book kept with
Security at Main Gate , Failure to which will be Adjudicated by
competent authority.

4 Students are insisted to Deposit the duely filled up and Approved

Leave Application forms at the Security in the Main Gate before
leaving the campus.