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    esancbe786

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    Application

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    esancbe786
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    Copyright:

    © All Rights Reserved
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    15 views1 page

    Application

    Uploaded by

    esancbe786

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    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: 335690000024050004779 Enrolment Date: 18/05/2024

    PERSONAL DETAILS

    Full Name in Regional


    Name of Applicant M Prabu ம பிர
    Language
    Applicant Father's Name Maharajan Applicant Mother's Name Jothi
    Date of Birth 03/03/1999
    Mobile Number 9789498361 E-Mail Id
    Gender Male Category OBC
    Relation with PwD
    Blood Group O+ Father
    (Person with Disability)
    Name of Guardian / Contact No. of Guardian /
    Caretaker / Attendant / Maharajan Caretaker / Attendant / 9025440066
    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. ********5000

    Address of Correspondence

    Address 67 46 Karuppusamy Nagar


    Kavundampalayam ,Sanganur
    Coimbatore North Coimbatore
    Tamil Nadu 641030
    Nature of Document Aadhaar card
    for Address Proof

    DISABILITY DETAILS

    Do you have disability certificate? Yes Disability Type Hemophilia


    Disability certificate uploaded? Yes Sr. No. / Registration No. of Certificate CBEHE49714
    Date of Issuance of Certificate 23/03/2021 Details of Issuing Authority Chief Medical Office
    Disability Percentage
    Disability Due To
    Hospital Treating State / UTs Tamil Nadu Hospital Treating District Coimbatore
    Hospital Name General Hospital Coimbatore

    This is computer generated receipt and does not require any signature.

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