Shri Vile Parle Kelavani Mandal’s
NARSEE MONJEE COLLEGE OF COMMERCE & ECONOMICS (Autonomous)
MUMBAI 400 056
APPLICATION FOR MEDICAL LEAVE
FOR OFFICE USE ONLY
Date From _____________ to ______________
Number of working days ______________
Reason : _______________________________
Remark : _______________________________
Sign __________________
From Mr./Miss.
Class: Div. Roll No.
Address: ____________________________________________________________
Date: ______________ Contact No. :
Student Number:
To,
The Principal,
Narsee Monjee College of Commerce & Economics, Autonomous
Mumbai 400 056.
Dear Sir,
I could not attend my regular classes from _____ __ to (both
days inclusive) on account of the following illness.
I have remained partially / totally absent from the _________________________
Examination / Test held on _____________ to ___________ on account of the
following health problem.
__________________________________________________________________
Medical Certificate dated _______________ issued by Dr. ______________________
as required by the rule is attached.
Any other reason of Absentee other than Medical reason:
_____________________________________________________________________
Yours faithfully,
(Signature of Student)
(Countersign of Guardian)
Rules:
1. Fully completed and signed application form along with photocopy of
medical certificate should be given in office during office hours on any
working day within THREE DAYS of resuming attendance.
2. The medical certificate submitted does not amount attending classes or
examination or test. It only explains the medical condition of student.
3. Medical Certificate without specifying the exact dates should not be accepted.
4. If student is absent for more than three days, photocopies of medical
report –pathology test, X-ray reports etc. should be submitted.
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