INDIAN INSTITUTE OF MANAGEMENT CALCUTTA
POST GRADUATE DIPLOMA IN BUSINESS ANALYTICS
STUDENT LEAVE APPLICATION FORM
Date: ---------------------
DD/MM/YYYY
Name: -------------------------------------------------------------------------------------------------------------------------
Roll No. : ------------------------------- Hostel: -------------------------------------- Room No.:------------------------
Date and expected time of departure: -------------------------------------------------------------------------------------
Date and expected time of return: -----------------------------------------------------------------------------------------
Total period of leave: -------------------------------------------------------------------------------------------------------
Leave Address : ---------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------------
Contact mobile no. while on leave: ---------------------------------------------------------------------------------------
Reasons for leave application: --------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------------
Number and nature of enclosures, if any: --------------------------------------------------------------------------------
Signature of the Student
FOR PGDBA OFFICE USE
Leave sanctioned from --------------------------------------- to ---------------------------------------------------------
(PGDBA Rules for attendance and examinations missed during the leave period will be applicable)
Chairperson-PGDBA
Joining Report:
Date: ---------------------------------------------------- Time: -------------------------------------------------------------
Signature of the Student: Signature of AO-Hostel:
Copy to: 1. Personal File
2. Administrative Officer – Hostel
3. Security Officer
