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This document is a registration acknowledgment for Arif Hussain, a person with a locomotor disability, issued by the Department of Empowerment of Persons with Disabilities, Government of India. It includes personal details such as his father's name, date of birth, and address, as well as information about his disability and the hospital treating him. The document serves as a proof of registration and does not require a signature.

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kaifansari05xx
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14 views2 pages

Application

This document is a registration acknowledgment for Arif Hussain, a person with a locomotor disability, issued by the Department of Empowerment of Persons with Disabilities, Government of India. It includes personal details such as his father's name, date of birth, and address, as well as information about his disability and the hospital treating him. The document serves as a proof of registration and does not require a signature.

Uploaded by

kaifansari05xx
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
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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: 08950000025040014832 Enrolment Date: 23/04/2025

PERSONAL DETAILS

Full Name in Regional


Name of Applicant Arif Hussain आिरफ हुसै न
Language
Applicant Father's Name Chand Mohammad Applicant Mother's Name
Date of Birth 11/05/1985
Mobile Number 9024208592 E-Mail Id
Gender Male Category
Relation with PwD
Blood Group Father
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / Chand Mohammad Caretaker / Attendant / 9024208592
Related Related

Optional Details

Personal Income (Annual) 0 Highest Qualification


Employed or Unemployed

Proof of Identity Card (See Instructions)

Identity Proof Aadhaar Card Aadhaar No. ********9337

Address of Correspondence

Address Ikram Mohalla, Rana Pratap


School Ke Pass, Ward No. 5,
Rawatbhata,Rawatbhata
Rawatbhata Chittorgarh
Rajasthan 323305
Nature of Document Aadhaar card
for Address Proof

DISABILITY DETAILS

Do you have disability certificate? No Disability Type Locomotor Disability


Disability Due To
Hospital Treating State / UTs Rajasthan Hospital Treating District Chittorgarh
Hospital Name District Hospital, Chittorgarh

For more information please scan the QR code to


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

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