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Person With Disability Registration

This document is a registration form for a person with a disability. It contains personal details for Helen Sheeba, including her name, date of birth, address, contact information, marital status, and education level. It notes that she has a hearing impairment disability since 2005 but does not have a disability certificate. Her occupation is listed as private jobs and her income level is reported. This computer-generated form provides an acknowledgement of her registration as a person with a disability.

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Sheeba
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1K views2 pages

Person With Disability Registration

This document is a registration form for a person with a disability. It contains personal details for Helen Sheeba, including her name, date of birth, address, contact information, marital status, and education level. It notes that she has a hearing impairment disability since 2005 but does not have a disability certificate. Her occupation is listed as private jobs and her income level is reported. This computer-generated form provides an acknowledgement of her registration as a person with a disability.

Uploaded by

Sheeba
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
  • Personal Information: This section records the personal details of the applicant such as name, parental information, and contact information.
  • Disability and Employment Details: Captures specifics about the disability, employment status, and identity details of the applicant.

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: 2918/00000/1912/0726577 Enrolment Date: 13/12/2019

PERSONAL DETAILS

Name of Applicant Helen Sheeba आवे दक का नाम Helen Sheeba

Applicant Father's Name Deeparaj M S आवे दक के िपता का नाम दीपराज म S

Applicant Mother's Name Mary Christina आवे दक के माता का नाम Mary Christina

Date of Birth 24/02/1981 Age 38 Year(s)

Gender Female E-Mail Id [email protected]

Mark of Identification --------- Category General

Mobile Number 7892692132 Blood Group B+

Marital Status Married Spouse Name Joseph Anthony Prakash

Relation with PwD


Self
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / --------- Caretaker / Attendant / ---------
Related Related

Address of Correspondence

Address 2174, 6th And 7th Cross, Yasin Nagar, Bangalore -, Bangalore North, Bengaluru Urban, Karnataka - 560043
पता 2174, 6th and 7th Cross, Yasin Nagar, Bangalore -, Bangalore North, Bengaluru Urban, Karnataka - 560043
Nature of Document Aadhaar Card
for Address Proof

Permanent Address

Address 2174, 6th And 7th Cross, Yasin Nagar, Bangalore -, Bangalore North, Bengaluru Urban, Karnataka - 560043
पता 2174, 6th and 7th Cross, Yasin Nagar, Bangalore -, Bangalore North, Bengaluru Urban, Karnataka - 560043

Educational Details

Highest Qualification Post Graduate

DISABILITY DETAILS

Do you have disability No Disability Type Hearing Impairment


certificate?
Disability Area Ears Disability Since 2005
Pension Card Number ---------
Hospital Treating
--------- Disability Due To Accident
Disability

EMPLOYMENT DETAILS

Employed or Unemployed Employed Occupation Private Jobs


BPL / APL NA
Personal Income (Annual) 100000 To 500000
Spouse Income (Annual) 100000 To 500000

IDENTITY DETAILS

Identity Proof Aadhaar Card TIN (NPR) ---------


Aadhaar No. 245956197027

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

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