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: 09190000022122262024 Enrolment Date: 27/12/2022
PERSONAL DETAILS
Full Name in Regional
Name of Applicant Faizan फैजान
Language
Applicant Father's Name Jameel Ahmad Applicant Mother's Name Movin
Date of Birth 01/01/2002
Mobile Number 8393933248 E-Mail Id
Gender Male Category OBC
Relation with PwD
Blood Group B+ Father
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / Jameel Ahmad Caretaker / Attendant /
Related Related
Optional Details
Personal Income (Annual) Highest Qualification
Employed or Unemployed
Proof of Identity Card (See Instructions)
Identity Proof Aadhaar Card Aadhaar No. ********0743
Address of Correspondence
Address Mohalla Garhi Ward No 03
Shishgarh,
Meerganj Bareilly
Uttar Pradesh 243505
Nature of Document Aadhaar card
for Address Proof
DISABILITY DETAILS
Do you have disability certificate? Yes Disability Type Blindness
Disability certificate uploaded? Yes Sr. No. / Registration No. of Certificate 1357117
Date of Issuance of Certificate 06/11/2017 Details of Issuing Authority Chief Medical Office
Disability Percentage 100
Disability Due To
Hospital Treating State / UTs Uttar Pradesh Hospital Treating District Bareilly
Hospital Name COM office bareilly
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This is computer generated receipt and does not require any signature.
