Name of the student Name of the student

Register Number Register Number

Course & Year Course & Year

No. of Days Requested for leave No. of Days Requested for leave

Reason for leave Reason for leave

From / To From / To

Parent Contact No Parent Contact No

Student Contact No Student Contact No

Parents Signature Parents Signature

Student Signature Student Signature

Forwarded by - Class Tutor Forwarded by - Class Tutor

Approved By - HOD Approved By - HOD

East of TEKIC, SIDCO, Mudalipalayam, Tirupur - 641 606. East of TEKIC, SIDCO, Mudalipalayam, Tirupur - 641 606.