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Disability Registration Receipt for Dileep Kumar

This document is a registration acknowledgment for Dileep Kumar Modanwal, a person with a disability, issued by the Department of Empowerment of Persons with Disabilities in India. It includes personal details such as his father's and mother's names, contact information, and disability information indicating he is blind due to disease. The document also provides his address and states that he is currently unemployed with an annual income below 10,000 INR.

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38 views2 pages

Disability Registration Receipt for Dileep Kumar

This document is a registration acknowledgment for Dileep Kumar Modanwal, a person with a disability, issued by the Department of Empowerment of Persons with Disabilities in India. It includes personal details such as his father's and mother's names, contact information, and disability information indicating he is blind due to disease. The document also provides his address and states that he is currently unemployed with an annual income below 10,000 INR.

Uploaded by

pbhim9981
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: 09660000022101025847 Enrolment Date: 17/10/2022

PERSONAL DETAILS

Full Name in Regional


Name of Applicant Dileep Kumar Modanwal िदलीप कुमार मोदनवाल
Language
Applicant Father's Name Ramesh Modanwal Applicant Mother's Name Rajkumari Devi
Date of Birth 05/05/1996
Mobile Number 9580184109 E-Mail Id [email protected]
Gender Male Category OBC
Relation with PwD
Blood Group Mother
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / Rajkumari Devi Caretaker / Attendant /
Related Related

Optional Details

Personal Income (Annual) Below 10000 Highest Qualification Higher Secondary


Employed or Unemployed Unemployed

Proof of Identity Card (See Instructions)

Identity Proof Aadhaar Card Aadhaar No. ********9534

Address of Correspondence

Address Villageand Post- Jansa Police


Station- Jansa,Block- Sevapuri
Tehsil- Rajatalab,
Rajatalab Varanasi
Uttar Pradesh 221405
Nature of Document Aadhaar card
for Address Proof

DISABILITY DETAILS

Do you have disability certificate? No Disability Type Blindness


Disability Due To Diseases
Hospital Treating State / UTs Uttar Pradesh Hospital Treating District Varanasi
Shree Shiv Prasad Gupt Divisional District Hospital,
Hospital Name
Kabirchaura

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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