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: 10130000022120447492 Enrolment Date: 07/12/2022
PERSONAL DETAILS
Full Name in Regional
Name of Applicant Md Jawed Hussain
Language
Applicant Father's Name Md Abid Ali Applicant Mother's Name Raushan Begum
Date of Birth 04/12/2000
Mobile Number 8271766683 E-Mail Id
[email protected]Gender Male Category
Relation with PwD
Blood Group
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / Caretaker / Attendant /
Related Related
Optional Details
Personal Income (Annual) Highest Qualification
Employed or Unemployed Employed
Proof of Identity Card (See Instructions)
Identity Proof Aadhaar No. ********4446
Address of Correspondence
Address Chandanpatti Chandan Patti
Hayaghat Darbhanga 846002,
Hayaghat Darbhanga
Bihar 846002
Nature of Document
for Address Proof
DISABILITY DETAILS
Do you have disability certificate? Yes Disability Type Locomotor Disability
Disability certificate uploaded? Yes Sr. No. / Registration No. of Certificate 1532
Date of Issuance of Certificate 01/04/2022 Details of Issuing Authority
Disability Percentage 45
Disability Due To
Hospital Treating State / UTs Bihar Hospital Treating District Darbhanga
Hospital Name Civil Surgeon Office, Darbhanga
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