To,
The Principal,
____________ (Name of the school),
____________ (Address)

Date: __/__/____ (Date)

From,
____________ (Name of the student),
____________ (Address)

Subject: Medical leave application

Respected Sir/Madam,

With due respect, I would like to state that I am _________ (Name) and I study in class __________ (Class) and have roll number __________ (Roll number).

I have been diagnosed with ___________ (Name of the disease) and the treatment as suggested by doctor needs ___________ (Days/Months) rest. As suggested by the doctor, ______ (I am supposed to have regular medical checkups as well). I will be attaching the medical certificate issued to me with this letter.

I request you to kindly give me medical leave from _________ (Date) to _______ (Date). Kindly accept my leave and emit me from paying the fine.

I shall be obliged.

Yours _________ (Obediently/Faithfully),
___________ (Name),
___________ (Class)

Enclosed: Medical Certificate