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Application

The document is a registration acknowledgment for a person with disability named Akshay A Patil, enrolled on June 19, 2023. It includes personal details such as his father's and mother's names, date of birth, contact information, and disability information indicating a 75% specific learning disability. The document also mentions the issuing authority and hospital details related to his disability certification.

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Akshay Patil
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105 views2 pages

Application

The document is a registration acknowledgment for a person with disability named Akshay A Patil, enrolled on June 19, 2023. It includes personal details such as his father's and mother's names, date of birth, contact information, and disability information indicating a 75% specific learning disability. The document also mentions the issuing authority and hospital details related to his disability certification.

Uploaded by

Akshay Patil
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: 29230000023061016665 Enrolment Date: 19/06/2023

PERSONAL DETAILS

Full Name in Regional ಅ ಎ ೕ


Name of Applicant Akshay A Patil
Language
Applicant Father's Name Arunkumar Patil Applicant Mother's Name Vijayalakshmi
Date of Birth 09/05/2001
Mobile Number 8281322660 E-Mail Id
Gender Male Category General
Relation with PwD
Blood Group B+ Mother
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / Vijayalakshmi Caretaker / Attendant / 9449696967
Related Related

Optional Details

Personal Income (Annual) Highest Qualification Post Graduate


Employed or Unemployed Unemployed

Proof of Identity Card (See Instructions)

Identity Proof Aadhaar Card Aadhaar No. ********4448

Address of Correspondence

Address 90 Siddalingeshwara Nagara


Bogadi 2Nd Stage,
Mysuru Mysuru
Karnataka 570026
Nature of Document Aadhaar card
for Address Proof

DISABILITY DETAILS

Do you have disability certificate? Yes Disability Type Specific Learning Disabilities
Disability certificate uploaded? Yes Sr. No. / Registration No. of Certificate 355291
Date of Issuance of Certificate 15/09/2021 Details of Issuing Authority Medical Authority
Disability Percentage 75
Disability Due To Congenital
Hospital Treating State / UTs Karnataka Hospital Treating District Mysuru
District Hospital And Epidemic Disease Hospital,
Hospital Name
Metagalli

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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