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Student'S Station Leave Application: Undertaking

Sagar Kamlesh Mehta, a student in the PGP program at IIM Kozhikode, has applied for 5 days of station leave from August 3rd to 7th 2023 to visit family and friends. If approved, he acknowledges that he is responsible for any academic or non-academic commitments missed during his absence. The application includes contact details for Sagar and his next of kin as well as a signed undertaking of the terms of station leave.

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Sagar
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157 views1 page

Student'S Station Leave Application: Undertaking

Sagar Kamlesh Mehta, a student in the PGP program at IIM Kozhikode, has applied for 5 days of station leave from August 3rd to 7th 2023 to visit family and friends. If approved, he acknowledges that he is responsible for any academic or non-academic commitments missed during his absence. The application includes contact details for Sagar and his next of kin as well as a signed undertaking of the terms of station leave.

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Sagar
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© © All Rights Reserved
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STUDENT'S STATION LEAVE APPLICATION

(Note: 1. Application will not be accepted 10 days prior to date of travel.

2. Approved station leave form to be submitted at the security main gate.)

1 Name SagarKamlesh Mehta


2 Roll No. PGP/26/464
3 Hostel &Room Number
4 Programme PGP
5 IIMK Email sagarkamleshm26@[Link]
6 Email(Next of Kin) m1961kamlesh@[Link]
7 Mobile No. 9699148583
8 Mobile No.(Next of Kin) 9322234674
9 Station leave:From 03-08-2023
10 Station leave:To 07-08-2023
11 Total no of days 5
12 Purpose of leave Visiting Family/Friend
13 Specify the Purpose Friend
14 Supporting documents,If any yes
15 Any other documents yes

UNDERTAKING
● I here by certify that the details mentioned above are true to the best of my knowledge/
belief.
● I am aware of the adverse effects on my academic and non-academic performance
performance due to my absence from the campus.
● I will not be claiming exemption for any academic or non-academic activities carried out
during my absence from the campus.
● I do not have any exams / test / quizzes / International immersion during the station leave
period and I will not be requesting for re-exams/test/quizzes.
● I understand that I am travelling at my own risk and the institute will not own the
responsibility for the same.
● I will not be extending my station leave period.
● I am aware that any false information /purpose of leave mentioned in the form will lead to
displinary actions.
● I am aware that the Institute reserves the rights to change the terms &conditions of station
leave or cancel the same without any reasons, even after the grant of permission.
● After Verification if the evidence provided is not satisfactory Diciplinary action will be
initiated.
*************************************************************************************************
(For Office Use Only)

INDIAN INSTITUTE OF MANAGEMENT,KOZHIKODE


STUDENT'S STATION LEAVE APPLICATION

SagarKamlesh Mehta, PGP/26/464 has been granted station leave from 03-08-2023 to 07-08-2023.

Date:02-08-2023 -sd-
Student's Affairs &Hostel Office
Serial no: SSLA13678/2023

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