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West Bengal University of Technology 

USS NAME
Institution Name
Contact (Mobile) No 

DATE From To 1st  2nd  both Arrival Departure OIC Full Signature


(Residence) (Institute) half half time time
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
Day10
Day11
Day12
Day13
Day14
                                                                                                           
Full Signature
Date

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