ORIGINAL – LEAVE / EXCUSE REQUEST FORM 14 December 2022 PGMCDU, FMF ORIGINAL - LEAVE / EXCUSE REQUEST FORM Leave / Excuse request from* Lectures Presentation/ Assignment Student Name in Full*Registration No.*Email* Program*Batch*Duration*Reason for Absence*MedicalOfficialPersonalNOTE: STUDENT HAS TO PROVIDE SUPPORTING DOCUMENTS WHEREVER RELEVANT PRIOR TO THE CONCERNED DATEBrief Explanation*Supporting Documents Drop files here or Date* Approval (For office use only)EvidenceAttachedNot AttachedStatusAcceptedRejectedCoordinatorDate of Approval (HDC with Number / Coordinator / Lecturer)