PSG POLYTECHNIC COLLEGE
PEELAMEDU - COIMBATORE - 641 004.
APPLICATION FOR LEAVE


  1. Name of the Student : RollNo :  
  2. Class & Branch : Sem     :  
  3. Leave required date on / from :     To  
  4. Reason :
  5. Date of online entry by student :  


Signature of the Student 
Date :

Date of approved by the tutor :


Signature of the Tutor