ANNEXURE 1 (a)

SYMBIOSIS INSTITUTE OF INTERNATIONAL BUSINESS (SIIB)

is a constituent of SYMBIOSIS INTERNATIONAL UNIVERSITY (SIU)
(Estd. Under section 3 of the UGC act 1956, notification no. F-9-12/2001-U-3 of the Govt. of India)
Accredited by NAAC with A grade

Students Application for Personal Leave

1. Name:

________________________________________________________________

2. PRN:

________________________________________________________________

3. Batch:

________________________________________________________________

4. Leave applied from ____________________

__________

to __________________ (Total Days)

5. Reason
for
taking
_________________________________________________________

Leave:

In case of Medical Leave, submit the medical Certificate from SCHC along with
the application
6. Address during Leave: __________________________________________________________
7. Contact No. ___________________________________________________________________

A)
B)
C)
D)

Declaration by the Student

During the period of Leave, I hereby accept full responsibility:
For losing Attendance due to my Absence
For missing any Internal Examinations
For missing any Summer/Final Placement opportunity.
For being responsible for my well -being and I fully indemnify SIIB for any
mishaps which occur to me during this period.
Signature of the Student:
Date:
________________________________________________________________________________
Signature of Concerned Academic Coordinator:
Date:
____________________________________________________________________________
___
Leave is Sanctioned / Not Sanctioned
Signature of Admin Officer:
Please Note:

Date:

It is the students responsibility to give one copy each of the Leave application to
the Concerned Academic Coordinator and Hostel Supervisor. One Copy will be
retained by the student.

ANNEXURE 1 (b)

SYMBIOSIS INSTITUTE OF INTERNATIONAL BUSINESS (SIIB)

is a constituent of SYMBIOSIS INTERNATIONAL UNIVERSITY (SIU)
(Estd. Under section 3 of the UGC act 1956, notification no. F-9-12/2001-U-3 of the Govt. of India)
Accredited by NAAC with A grade

Application for Student Going Out of Campus on Duty

Date:___________________
To,
The Director
SIIB
Dear Sir / Maam,
You are requested to accord permission to ______________No of students (list
attached) for going out of
Campus
from
_________________to
____________________________activity

_________________for

The details of anticipated expenditure are as under:

Signature of Student Coordinator:

Name
&
PRN
of
Student
_____________________________________________________

Coordinator:

Recommendation of Faculty / Coordinator in Charge:

Recommendation of Admin Officer:
Approval of Director:
____________________________________________________________________________________
Instruction to Students: Retain one Copy and give 1 Copy each to:
a) Academic Coordinator
b) Accounts

c) Campus Office

ANNEXURE 1 (c)

SYMBIOSIS INSTITUTE OF INTERNATIONAL BUSINESS (SIIB)

is a constituent of SYMBIOSIS INTERNATIONAL UNIVERSITY (SIU)
(Estd. Under section 3 of the UGC act 1956, notification no. F-9-12/2001-U-3 of the Govt. of India)
Accredited by NAAC with A grade

STUDENT NIGHT OUT FORM

Name
of
_____________________________________________________________________

Student:

PRN: _______________________________________________________________________________
Boys Hostel ____________, Room No. _____________
Girls Hostel ____________, Room No. _____________
The
above
student
is
permitted
(date)__________________________________

night

He
/
She
will
return
back
_________________________________________________

out

on

on

the

(Date

Purpose
for
Out:__________________________________________________________________

night

&

of

Time):

Night

Declaration by the Student:

During the above mentioned period I hereby accept full responsibility for my wellbeing and indemnify SIIB for any mishaps which might occur to me during this
period.

Signature of Student
Date

Signature of Admin Officer

Date
Note One copy to be handed over to Admin Office

 One copy to be handed over to the hostel warden before proceeding

One copy will be kept with the student.