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: 213450000024080047300 Enrolment Date: 26/08/2024
PERSONAL DETAILS
Full Name in Regional
Name of Applicant Ambika Pattnaik ଅମ୍ବକ
ି ା ପଟ୍ଟଏକ
Language
Applicant Father's Name Pyarimohan Mohanty Applicant Mother's Name Binodini Mohanty
Date of Birth 01/01/1988
Mobile Number 9348030787 E-Mail Id
Gender Female Category General
Relation with PwD
Blood Group B+ Husband
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / Rakesh Pattnaik Caretaker / Attendant / 6371500875
Related Related
Optional Details
Below Rupees 10000 Per
Personal Income (Annual) Highest Qualification Middle/Higher Primary
Annum
Employed or Unemployed Unemployed
Proof of Identity Card (See Instructions)
Identity Proof Aadhaar Card Aadhaar No. ********2634
Address of Correspondence
Address Kamakhinagar,khujenpali,balan
gir,Khujenpali
Balangir Balangir
Odisha 767002
Nature of Document Aadhaar card
for Address Proof
DISABILITY DETAILS
Do you have disability certificate? No Disability Type Mental Illness
Disability Due To Accident
Hospital Treating State / UTs Odisha Hospital Treating District Balangir
Hospital Name District Headquarters Hospital, Balangir
For more information please scan the QR code to
visit 'PwD Login'
This is computer generated receipt and does not require any signature.
