To,

The Head of the Department

Department of Computer Science Engineering
Chitkara Institute of Engineering & Technology,
Punjab

Date:

Subject: Request for Medical Leave

Dear Sir/Madam,

This is to request you to kindly grant my ward ________________________ College

Roll No._________________, Sem____________, Medical Leave from
_________________________ to _______________________ as per the norms of
University. He is suffering from ____________________________________ disease.

I hope you will consider my request. The medical certificate is attached herewith.

Your’s truly,

(Signature of Parent/Guardian)

(Name of Signatory in Capital Letters)

(Mobile Nos. ___________________________)

For Office Use

Mentor’s Remarks: -

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Signature of Mentor Dated:

(Full Name)