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    Copyright:

    © All Rights Reserved
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    5 views2 pages

    Downloadapplication

    Uploaded by

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    © All Rights Reserved
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    of 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: 08240000023091681336 Enrolment Date: 25/06/2024

    PERSONAL DETAILS

    Full Name in Regional


    Name of Applicant Imran Shah Imran Shah
    Language
    Applicant Father's Name Rafeek Hushain Applicant Mother's Name Mumtaz Banu
    Date of Birth 05/07/1989
    Mobile Number 8005595061 E-Mail Id [email protected]
    Gender Male Category OBC
    Relation with PwD
    Blood Group nul Self
    (Person with Disability)
    Name of Guardian / Contact No. of Guardian /
    Caretaker / Attendant / Rafeek Hushain Caretaker / Attendant / 8290415876
    Related Related

    Optional Details

    Below Rupees 10000 Per


    Personal Income (Annual) Highest Qualification Post Graduate
    Annum
    Employed or Unemployed Unemployed

    Proof of Identity Card (See Instructions)

    Voter ID/Election Commission


    Identity Proof Aadhaar No. ********9706
    ID Card

    Address of Correspondence

    Address S/O RAFEEK


    HUSSAIN,JAMAMasjid Ke Pass
    Potlan,Potlan
    Sahara Bhilwara
    Rajasthan 311806
    Nature of Document Aadhaar card
    for Address Proof

    DISABILITY DETAILS

    Do you have disability certificate? Yes Disability Type Low Vision


    Disability certificate uploaded? Yes Sr. No. / Registration No. of Certificate 1234
    Date of Issuance of Certificate 01/06/2007 Details of Issuing Authority Medical Authority
    Disability Percentage 50
    Disability Due To Congenital
    Hospital Treating State / UTs Rajasthan Hospital Treating District Bhilwara
    Hospital Name Mahatma Gandhi Government Hospital Bhilwara

    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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