Scribd
Upload
42 views2 pages

Downloadapplication

The document is a registration acknowledgment for a person with a disability named Annu, enrolled on 21/11/2022. It includes personal details such as her father's and mother's names, date of birth, and contact information, as well as her disability type, which is Intellectual Disability. The document also provides information about her address and identity proof, indicating that she does not have a disability certificate.

Uploaded by

pbhim9981
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
42 views2 pages

Downloadapplication

The document is a registration acknowledgment for a person with a disability named Annu, enrolled on 21/11/2022. It includes personal details such as her father's and mother's names, date of birth, and contact information, as well as her disability type, which is Intellectual Disability. The document also provides information about her address and identity proof, indicating that she does not have a disability certificate.

Uploaded by

pbhim9981
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: 09660000022111382879 Enrolment Date: 21/11/2022

PERSONAL DETAILS

Full Name in Regional


Name of Applicant Annu अनू
Language
Applicant Father's Name Shyam Kumar Applicant Mother's Name Indrawati Devi
Date of Birth 02/04/1997
Mobile Number 9559371291 E-Mail Id
Gender Female Category ST
Relation with PwD
Blood Group Father
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / Shyam Kumar Caretaker / Attendant /
Related Related

Optional Details

Personal Income (Annual) Highest Qualification Illiterate


Employed or Unemployed

Proof of Identity Card (See Instructions)

Identity Proof Aadhaar Card Aadhaar No. ********5010

Address of Correspondence

Address Village- Kurauna Post -Sarauni


Thana- Jansa,
Rajatalab Varanasi
Uttar Pradesh 221302
Nature of Document Aadhaar card
for Address Proof

DISABILITY DETAILS

Do you have disability certificate? No Disability Type Intellectual Disability


Disability Due To
Hospital Treating State / UTs Uttar Pradesh Hospital Treating District Varanasi
Shree Shiv Prasad Gupt Divisional District
Hospital Name
Hospital, Kabirchaura

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