National Institute of Technology Jamshedpur

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CONSENT FORM FOR PARENTS/GUARDIANS FOR OUTSTATION LEAVE OF THEIR

WARDS STAYING IN HOSTEL

Date: ………………….

To,
The Warden
Hostel - …….

Sir/Madam,

Kindly grant permission to my ward staying in your hostel to avail outstation leave as
per details given below:
Room No. : ……………………………………………………………………………………………
Name: …………………………………………………………………………………………………
Registration No: ……………………………………………………………………………………
Mobile No. ……………………………………………………………………………………………
Purpose for outstation leave: ……………………………………………………………………...
Period of outstation leave: From ……………….......... to ……………………………………..
Date and time of departure from the hostel: ………………………………………………….
Expected Date and time of arrival to the hostel: ………………………………………………
Place of visit (Address): ……………………………………………………………………………
Journey Details (Tickets): …………………………………………………………………………
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I hereby give my consent for availing outstation leave by my ward and take full
responsibility of him/her during her stay outside the hostel as per details mentioned
above.

• Kindly allow my ward to travel him/her alone as per above details.

OR
• Kindly allow me to accompany my ward from the hostel to the outstation.
(Strike off the line above which is not applicable)
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Name of the Parents/ Guardian: …………………………………………………………………
Relationship with the student: …………………………………………………………………..
Contact no. of Parents / Guardian : ………………………………………………………………
Signature of the Parents/Guardian with date: …………………………………………………
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