Industrial Attachment Report Clearance Form
PHM3314 Industrial Training
Please fill in the form and delete if not applicable (*)
[A] Student particulars
Name
Matric no.
Training period
[B] Organisation particulars
Name of organisation
Address
Name of supervisor
Signature
Position
Approval for release of report and log book
To be filled in by an officer representing the organisation
I hereby declare that the report and the log book generated can/can not* be cleared to allow for
assessment as requested in the PHM3314 Industrial Training course.
Name
Position
Signature & company stamp
Date
Prepared by: Kausar Ahmad
Date created: 11-January-2005
Date of issue: 11-January-2005
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