Department of Empowerment of Persons with Disabilities,
Ministry of Social Justice and Empowerment, Government of India
Disability Certificate
Sub Division Hospital-gangarampur, Dakshin Dinajpur, West Bengal
Certificate No.: WB3130520180012803 Date: 13/11/2024
This is to certify that I/We have carefully examined Shri Tamim Islam Son of Shri Rafikul Islam, Date of Birth
29/01/2018, Male, Registration No. 1931/00000/0240/90000779, resident of Vill - Nandair, P. O - Jahangirpur,
P. S - Gangarampur - 733124, Sub District Gangarampur, District Dakshin Dinajpur, State / UT West Bengal
Whose photograph is affixed above, and I/We satisfied that:
(A) He is a case of Locomotor Disability
(B) The diagnosis in his case is RIGHT SIDED WEAKNESS
(C) He has 60% (in figure) sixty percent(in words) Temporary Disability in relation to his One Arm and One Leg
(OAL) as per the guidelines (Guidelines for the purpose of assessing the extent of specified disability in a person
included under RPwD Act, 2016 notified by Government of India vide S.O. 1338 (E) Dated 12.03.2024).
This certificate recommended for 3 year(s) , and therefore this certificate shall be valid till 13/11/2027
The applicant has submitted the following document(s) as proof of residence:
Nature of Document(s): Aadhaar card
Signature / Thumb Impression of the Person with Disability
Signature of notified Medical Authority Member
Sub Division Hospital-gangarampur
Dakshin Dinajpur, West Bengal
This Card/Certificate is meant to certify the disability of the person and is not an instrument for ID/Address Proof for any purpose.
