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Returning information

Fill the form as required. Your cooperation would be appreciated!
Roll no. ( write as 2016001)
    ____________
Where are you now
in the campus
at home
Travelling in China (write down the city name)
Returnning date (if in the campus no need to fill)
日期    ____________
Reason for being late after 4th March (if be back before 4th March no need to fill)
    ____________
举报