Scribd
Upload
11 views

Downloadapplication

Uploaded by

mdaltamash692
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
11 views

Downloadapplication

Uploaded by

mdaltamash692
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

Department of Empowerment of Persons with Disabilities,

Ministry of Social Justice and Empowerment, Government of India


Acknowledgement / Resident Copy

Person with Disability Registration

Enrolment No: 10130000022120447492 Enrolment Date: 07/12/2022

PERSONAL DETAILS

Full Name in Regional


Name of Applicant Md Jawed Hussain
Language
Applicant Father's Name Md Abid Ali Applicant Mother's Name Raushan Begum
Date of Birth 04/12/2000
Mobile Number 8271766683 E-Mail Id [email protected]
Gender Male Category
Relation with PwD
Blood Group
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / Caretaker / Attendant /
Related Related

Optional Details

Personal Income (Annual) Highest Qualification


Employed or Unemployed Employed

Proof of Identity Card (See Instructions)

Identity Proof Aadhaar No. ********4446

Address of Correspondence

Address Chandanpatti Chandan Patti


Hayaghat Darbhanga 846002,
Hayaghat Darbhanga
Bihar 846002
Nature of Document
for Address Proof

DISABILITY DETAILS

Do you have disability certificate? Yes Disability Type Locomotor Disability


Disability certificate uploaded? Yes Sr. No. / Registration No. of Certificate 1532
Date of Issuance of Certificate 01/04/2022 Details of Issuing Authority
Disability Percentage 45
Disability Due To
Hospital Treating State / UTs Bihar Hospital Treating District Darbhanga
Hospital Name Civil Surgeon Office, Darbhanga

For more information please scan the QR code to


visit 'PwD Login'
This is computer generated receipt and does not require any signature.

You might also like