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GOA INSTITUTE OF MANAGEMENT

SANQUELIM, GOA - 403 505

LEAVE REQUEST FORM

ate: 10/o8/2022
Date:.

Nanme:
Name: ROSLHANI VARPEKAR
9922464475
Mob. No.i --

Roll No: 2021033


Section:

No. of days Leave 01


requested:
Batch: 2 0 2 1 - 2 3
Term:
From: o9/0 0 22-TO9o8 /20o22
Reason: D1TGRATNE HEASACHE
****************************.-i....----- - - - - - --------------

Name of the Courses you will be absent during the Leave period: cONSULTINT

Session No. Name of Course IT Faculty Signature


48 CONSULTIN

Applicait's signature and date:

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