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Disability Registration Receipt - India

This document is a registration acknowledgment for a person with disability, Khoisnam Omlashini Devi, with an enrolment number and date. It includes personal details such as her father's name, date of birth, contact information, and disability information indicating a locomotor disability due to infection. The document serves as a proof of registration and does not require a signature as it is computer-generated.

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107 views2 pages

Disability Registration Receipt - India

This document is a registration acknowledgment for a person with disability, Khoisnam Omlashini Devi, with an enrolment number and date. It includes personal details such as her father's name, date of birth, contact information, and disability information indicating a locomotor disability due to infection. The document serves as a proof of registration and does not require a signature as it is computer-generated.

Uploaded by

mil
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

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: 142560000024120002937 Enrolment Date: 16/12/2024

PERSONAL DETAILS

Full Name in Regional


Name of Applicant Khoisnam Omlashini Devi Khoisnam Omlashini Devi
Language
Khoisnam O Shijakhombi
Applicant Father's Name Khoisnam Chaoba Singh Applicant Mother's Name
Devi
Date of Birth 01/01/1970
Mobile Number 8787824976 E-Mail Id
Gender Female Category General
Relation with PwD
Blood Group Uncle
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / Kh Kunjabihari Singh Caretaker / Attendant / 8787824976
Related Related

Optional Details

Below Rupees 10000 Per


Personal Income (Annual) Highest Qualification Illiterate
Annum
Employed or Unemployed Unemployed

Proof of Identity Card (See Instructions)

Identity Proof Aadhaar Card Aadhaar No. ********0936

Address of Correspondence

Address 489050600936,Changangei
Patsoi Imphal West
Manipur 795140
Nature of Document Aadhaar card
for Address Proof

DISABILITY DETAILS

Do you have disability certificate? No Disability Type Locomotor Disability


Disability Due To Infection
Hospital Treating State / UTs Manipur Hospital Treating District Imphal West
Hospital Name Chief Medical Office, Imphal West Pool

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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