Notice
Notice
U/S 101 (1) OF THE RIGHTS OF PERSONS WITH DISABILITIES ACT, 2016
CHAPTER-I
PRELIMINARY
1. Short title and Commencement.- (1) These rules may be called the Jammu
and Kashmir Rights of Persons with Disabilities Rules, 2020.
(2) They shall come into force on the date of their publication in the Official
Gazette.
CHAPTER II
(4) No establishment shall compel a person with disability to partly or fully pay the
costs incurred for reasonable accommodation.
4. Union Territory Committee for Research on Disability.- (1) The
Committee for Research on Disability at the Union Territory Level shall consist
of the following members, namely:-
(a) Administrative Secretary, Health and Medical Education Department,
Government of Jammu and Kashmir or Head of an Institution dealing in
the field of Science and Medical research to be nominated by the
Government of Jammu and Kashmir, ex officio-Chairperson;
(b) Representative from the Directorate of Health Services, Government of
Jammu and Kashmir – Member;
(c) Representative from Government Medical College Jammu/Srinagar,
preferably a doctor with disability- Member;
(d) Five members as representatives from a registered Union Territory level
organization representing each of the five groups of specified disabilities
in the Schedule of the Act , to be nominated by the Government of
Jammu and Kashmir – Members:
Provided that at least one representative of the registered organizations is a
woman;
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disability shall be considered to be a subject of research except when the
research involves physical impact on his body.
6. Procedure to be followed by Executive Magistrate.- For the purposes of
dealing with the complaints under section 7 of the Act, the Executive Magistrate
shall follow the procedure provided in sections 133 to 143 of the Code of
Criminal Procedure, 1973 (2 of 1974).
CHAPTER-III
LIMITED GUARDIANSHIP
(6) While granting the support of such limited guardianship, the Court shall
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consider a suitable person to be appointed as a limited guardian in the
following preference of merit, namely:-
(a) The parents or adult children of the person with disability;
(b) Immediate brother or sister;
(c) Other Blood relatives or care givers or prominent personality of the
locality; and
(d) In case the family of the person with disability is not known,
Superintendent of the Government Institution or In charge of the
Registered organization under whose care the person with disability
is residing, may be considered.
(7) Only those individuals who are over the age of 18 years and who have
not been previously convicted of any cognizable offence as defined in the
Code of Criminal Procedure, 1973 (1 of 1974) shall be appointed as a
limited Guardian.
(8) The limited guardian appointed under sub-rule (1) shall consult the person
with disability in all matters before taking any legally binding decisions on
behalf of the person with disability.
(9) The appointed limited guardian shall ensure that the legally binding
decisions taken on behalf of the person with disability are in the interest
of the person with disability.
8. Appellate Authority. - The Appellate authority to appeal against any decision
of the Chief Judicial Magistrate for appointment of limited Guardian under sub-
rule (1) of rule 7, shall be the District Court.
9. Designated authority.- The Deputy Commissioners of the concerned District
Government of Jammu and Kashmir shall be the designated authority under
sub-section (1) of section 15 of the Act to take measures for creating social
awareness to support persons with disabilities in exercising their legal capacity.
CHAPTER IV
EDUCATION
CHAPTER V
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15. Computation of vacancies.- (1) Every Government establishment in order
to give effect to the reservation provided to the Persons with Disability as
provided in section 34 of the Act read with SO-127 dated 20th April 2020
shall take into account four percent of the total number of vacancies in the
cadre strength in each group of posts, for the purpose of computation of
vacancies for the persons with benchmark disabilities:
Provided that the reservation in promotion shall be in accordance with the
instructions issued by the appropriate Government from time to time.
(2) Every Government establishment shall maintain a vacancy based roster for the
purpose of calculation of vacancies for persons with benchmark disabilities in
the cadre strength as per the instructions issued by the appropriate
Government from time to time.
(3) While issuing advertisement to fill up vacancies, every Government
establishment shall indicate the number of vacancies reserved for each class of
persons with benchmark disabilities in accordance with the provisions of
section 34 of the Act.
(4) The reservation for persons with disabilities in accordance with the provisions
of section 34 of the Act shall be horizontal and the vacancies for persons with
benchmark disabilities shall be maintained as a separate class.
16. Interchange of vacancies:- The Government establishment shall
interchange vacancies in accordance with the provisions of section 34 of the Act,
only if due process of recruitment to fill up the vacancies reserved for persons
with benchmark disabilities has been complied with.
17. Submission of Returns on vacancies:- Every Government
Establishment shall furnish returns on the vacancies as prescribed by the Central
Government in the Rights of Persons with Disability Rules, 2017.
18. Form in which Record to be kept by an employer:- Every
Government Establishment shall maintained the record of Employee with disabilities
as prescribed by the Central Government in the Rights of Persons with Disability
Rules, 2017.
CHAPTER VI
19.(1) Any person with bench mark Disability who is having High support needs
or any person or organization on behalf of such person with bench mark
disability may approach the District Social Welfare Officer of the district in
which he ordinarily resides, who shall refer the case to the Assessment Board
consisting of such members as may be prescribed by the Central Government.
(2) The Government of Jammu and Kashmir shall frame schemes to provide
assistance to persons with bench mark disabilities having High Support needs,
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within six months of the notification of these rules wherein clear time limits
are set for provision of the assistance:
Provided that the schemes referred above, shall be framed after the Central
Government prescribes the constitution of the Assessment Board and the
manner of assessment.
CHAPTER VII
ACCESSIBILITY
20. Rules for Accessibility.- (1) Every establishment shall comply with the
following standards relating to physical environment, transport and
information and communication technology, namely :-
a. standard for public buildings as specified in the Harmonised Guidelines and
Space Standards for Barrier Free Built Environment for Persons with
Disabilities and Elderly Persons as issued by the Government of India,
Ministry of Urban Development in March, 2016;
b. standard for Bus Body Code for transportation system as notified by the
Government of India, Ministry of Road Transport and Highways, vide
notification number G.S.R. 895(E), dated the 20th September, 2016;
c. Information and Communication Technology,
i. website standard as specified in the guidelines for Indian
Government websites, as adopted by Department of
Administrative Reforms and Public Grievances, Government of
India;
ii. documents to be placed on websites shall be in Electronic
Publication (ePUB) or Optical Character Reader (OCR) based pdf
format:
(2) The respective Departments shall ensure compliance of the standards of
accessibility specified under this rule through the concerned domain regulators
or otherwise.
CHAPTER VIII
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Provided that in case no person is occupying the post of Joint Director the
competent authority, shall be the person occupying the post next in the
hierarchy.
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the same manner as the application for grant of certificate under sub-rule
(1) accompanied with the previous certificate of registration and a Union
Territoryment that the applicant is applying for renewal of the certificate so
accompanied:
Provided that such application shall be made before sixty days of the expiry of
the validity of such certificate:
Provided further that the competent authority may consider application for
renewal of the certificate of registration after 60 days but not later than 120
days, if he is satisfied that sufficient reasons have been provided for such
delay.
(6) If the application for renewal of certificate of registration is made before its
expiry as specified in the proviso to sub-rule (5), the certificate of registration
shall continue to be in force until orders are passed on the application and
the certificate of registration shall be deemed to have expired if application
for its renewal is not made within sixty days as specified in the said proviso.
(7) Every application made under sub-rule (1) or sub rule (5), in which the
competent authority referred to in sub- section (1) of section 51 of the Act, is
satisfied that the requirements for grant of certificate of registration under
the Act and these rules have been complied with, shall be disposed of by it
within a period of ninety days thereafter.
(8) Form of issue of Certificate of Registration, refusal and revocation.-
(a) Upon making suitable enquires into the functioning of the organization and
being satisfied that the organization can be registered under the provisions of
section 51, the competent authority shall issue the Certificate of registration
to the organization in Form–B.
(b) The Competent authority may refuse to grant the certificate of Registration
after suitable enquires and the same shall be communicated to the
organization within a period of ninety days of its application for registration in
Form-C.
Provided that such communication shall be preceded by the granting of
opportunity to the applicant organisation to Union Territory its case before
the competent authority on a date not later than 15 days from the date of
issue of the letter intimating the grant of opportunity.
CHAPTER IX
CERTIFICATE OF DISABILITY
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26.Issue of certificate of disability.- (1) On receipt of an application under
rule 24, the medical authority or any other notified competent authority shall,
verify the information as provided by the applicant and shall assess the
disability in terms of the relevant guidelines issued by the Central Government
and after satisfying itself that the applicant is a person with disability, issue a
certificate of disability in favor of the applicant in Form II,III & IV as the case
may be.
(2) The medical authority shall issue the certificate of disability within a month
from the date of receipt of the application.
(3) The medical authority shall, after due examination,-
(i) issue a permanent certificate of disability in cases where there are no
chances of variation of disability over time in the degree of disability; or
(ii) issue a certificate of disability indicating the period of validity, in cases
where there is any chance of variation over time in the degree of
disability.
If an applicant is found ineligible for issue of certificate of disability, the medical
(4)
authority shall convey the reasons to the applicant in writing under Form V within
a period of one month from the date of receipt of the application.
27.Validity of Certificate issued under rule 26 .- A person to whom the
certificate is issued under rule 26 shall be entitled to apply for all facilities,
concessions and benefits admissible for persons with disabilities under
schemes of the Government and of non-Governmental organizations funded
by the Government.
28.Validity of certificate of disability issued under the repealed Act.-The
certificate of disability issued under The Jammu and Kashmir Persons with
Disabilities Act, 2018 shall continue to be valid after commencement of the Act
for the period specified therein.
29.Appeal against the decision of the authority issuing certificate of
disability.- (1) Any person aggrieved with the decision of the certifying
authority issuing the certificate of disability may within ninety days from the
date of the decision, prefer an appeal to the appellate authority as notified by
the Government of Jammu and Kashmir for the purpose under sub-section
(1) of section 59 of the Act in the following manner:-
a. The appeal shall contain brief background and the grounds for making the
appeal;
b. The appeal shall be accompanied by a copy of the order of rejection issued by
the certifying authority:
Provided that where a person with disability is a minor or having any
disability which renders the person with disability unfit to make such an
appeal, the appeal on behalf of the person with disability may be made by
his legal or limited guardian as the case may be.
(2) On receipt of such an appeal, the appellate authority shall provide the
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appellant an opportunity to present the appellant’s case and thereafter
pass such reasoned and detailed order as it may deem appropriate.
(3) Every appeal preferred under sub-rule (1) shall be decided as
expeditiously as possible and not later than a period of sixty days from
the date of receipt of the appeal
CHAPTER X
32. Presiding Officer.- The Chairperson of the Board shall preside at every
meeting of the Board and in the absence of the Chairperson, the Vice-
Chairperson thereof shall preside, but when both the Chairperson and the
Vice-Chairperson of the Board are not present in the meeting, the
Chairperson may nominate any elected representative (member)/Senior
most official member to preside over the meeting. Where no such
nomination is provided, the members of the Board shall select one of the
members to preside at that meeting.
33. Quorum.- (1) One-third of the total members of the Board shall
form the quorum for any meeting.
(2) If at any time fixed for any meeting or during the course of any meeting
less than one-third of the total members of the Board are present, the
Chairperson thereof may adjourn the meeting to such hours on the
following or on some other future date as may be fixed by the Chairperson.
(3) No quorum shall be necessary for the adjourned meeting of the Board.
(4) No matter which had not been on the agenda of the ordinary or the special
meeting of the Board, as the case may be, shall be discussed at its
adjourned meeting.
(5) (a) Where a meeting of the Board is adjourned under sub-rule(2) for want
of quorum to the following day, notice of such adjourned meeting shall be
given to the members of the Board available at the place where the
meeting which was adjourned was to be held and it shall not be necessary
to give notice of the adjourned meeting to other members; and
(b) Where a meeting of the Board is adjourned under sub-rule(2) for want
of quorum not to the following day, but on a date with sufficient gap,
notice of such adjourned meeting shall be given to all the members of the
Board in the manner as specified in sub-rule (4) of rule 31.
34. Minutes.- (1) Record shall be kept of the names of all the members of the
Board who attended the meeting of the Board and of the proceedings at the
meetings in a book to be maintained for that purpose by the Member-
Secretary of the Board.
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(2) The minutes of the previous meeting of the Board shall be read at the
beginning of every succeeding meeting, and shall be confirmed and signed
by the presiding officer at such meeting.
(3) The proceedings shall be open to inspection by any member of the Board at
the office of the Member-Secretary of the Board during office hours.
35. Business to be transacted at meeting.- Except with the permission of the
presiding officer, no business which is not entered in the agenda or of which
notice has not been given by a member under sub-rule (5) of rule 31 shall be
transacted at any meeting of the Board.
36. Agenda for the meeting of the Union Territory Advisory Board.- At
any meeting of the Board, business shall be transacted in the order in which
it is entered in the agenda, unless otherwise resolved in the meeting with the
permission of the presiding officer:
Provided that either at the beginning of the meeting of the Board or after the
conclusion of the debate on a motion during the meeting, the presiding
officer or a member of the Board may suggest a change in the order of
business as entered in the agenda and if the Chairperson of the Board agrees,
such a change shall take place.
(2) The District Level Committee for each District shall be constituted by an order
issued by the Deputy Commissioner of the District and its tenure shall be for
a period of three years from the date of its constitution.
40. Functions of the Committee.- The District-Level Committee on disability
shall perform the following functions, namely:-
a. advise the District authorities on matters relating to rehabilitation and
empowerment of persons with disabilities;
b. monitor the implementation of the provisions of the Act and the rules;
c. assist the District authorities in implementation of schemes and
programmes of the Government for empowerment of persons with
disabilities;
d. look into the complaints relating to non- implementation of the provisions
of the Act by the District authorities and recommend suitable remedial
measures to the concerned authority to redress such complaints;
e. look into the appeal made by the employees of Government
establishments aggrieved with the action taken by the District level
establishments under sub-section (4) of section 23 of the Act and
recommend appropriate measures; and
f. any other functions as may be assigned by the Government of NCT of Jammu
and Kashmir.
CHAPTER XI
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relating to rehabilitation of persons with disabilities;
(ii) has not attained the age of sixty years on the 1st January of the year in
which the last date for receipt of applications, as specified in the
advertisement inviting applications for appointment of the Union Territory
Commissioner, occurs;
(iii) if in service under the Central Government or a Union Territory
Government, shall seek retirement from such service before being
appointed to the post; and
(iv) possesses the following educational qualifications and experience, namely:-
(a) Educational qualifications:-
(i) Essential: Graduate from a recognized university;
(ii) desirable: recognized degree or diploma in social work or law or
management or human rights or rehabilitation or education of disabled
persons.
(b) Experience: at least twenty years experience in a Group 'A' level or equivalent
post:-
(i) in Central or Union Territory Government or
(ii) Public Sector Undertakings or Semi Government or Autonomous Bodies
dealing with disability related matters or social sector or
(iii) works in the capacity of a senior level functionary in a registered Union
Territory or national or international level voluntary organization
working in the field of disability or social development:
Provided that out of the total twenty years experience mentioned in
this sub-clause, at least ten years of experience in the recent past
had been in the field of empowerment of persons with disabilities.
44. Salary and allowances of the Union Territory Commissioner.- (1) The
salary and allowances of the Union Territory Commissioner shall be the
salary and allowances as admissible to a Secretary to the Government of
Jammu and Kashmir.
(2) Where a Union Territory Commissioner, being a retired government servant
or a retired employee of any institution or autonomous body funded by the
Central or Union Territory Government, is in receipt of pension in respect of
such previous service, the salary admissible to the Union Territory
Commissioner under these rules shall be reduced by the amount of the
pension, and if in lieu of a portion of the pension, the commuted value
thereof has been received, by the amount of such commuted portion of the
pension.
CHAPTER XII
PUBLIC PROSECUTOR
CHAPTER XIII
52. Union Territory Fund for Persons with Disabilities and its
management.- (1) There shall be credited to the Union Territory Fund for
persons with disabilities hereinafter referred to as ‘ the Union Territory Fund -
a. all sums received by Union Territory Commissioner by way of grant, gifts,
donations, benefactions, bequests or transfers;
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b. all sums received from the Government of Jammu and Kashmir
including grants- in-aid; and
c. all sums received from Corporate houses/ PSUs under CSR or from such
other sources as may be decided by the Government of Jammu and
Kashmir.
d. All sums received from the Government of Jammu and Kashmir by way
of ‘Permanent Corpus’
(2) There shall be a governing body consisting of following members to manage the
Union Territory Fund, namely:-
(a) Administrative Secretary, Department of Social Welfare - Chairperson;
(b) One representative from the Department of Finance
(c) One representative from the Department of Planning Development and
Monitoring Department.
(d) One representative of the Department of Health and Family Welfare,
(e) One representative of the Department of School Education.
(f) One representative of the Department of Rural Development,
(g) One representative of the Department of Housing & Urban Development,
(not below the rank of a Additional Secretary)……………………..Members;
(h) two persons representing different types of disabilities to be nominated
by the Government of Jammu and Kashmir, by rotation – Members;
(i) Director(s), Social Welfare Jammu/ Kashmir – Convener and Chief
Executive Officer(as may be notified by the UT Government).
(3) The governing body shall meet as often as necessary, but at least once in every
financial year.
(4) The nominated members shall hold office for not more than three years.
(5) No member of the governing body shall be a beneficiary of the Fund
during the period such Member holds office.
(6) The nominated non-official members shall be eligible for payment of travelling
allowance and dearness allowance as admissible to a Group A officer of the
Government of Jammu and Kashmir for attending the meetings of the
governing body.
(7) No person shall be nominated under clause (b) and (c) of sub-rule 2 as a member
of the governing body who-
(a) is, or has been, convicted of an offence, which in the opinion of the
Government of Jammu and Kashmir involves moral turpitude; or
(b) is, or at any time has been, adjudicated as an insolvent.
53. Utilization of the Union Territory Fund.- (1) The Union Territory Fund
shall be utilized for the following purposes, namely:-
a. financial assistance in the areas which are not specifically covered
under any scheme and programme of the Government of Jammu and
Kashmir;
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b. administrative and other expenses of the Fund, as may be required to
be incurred by or under the Act; and
c. such other purposes as may be decided by the governing body.
(2) Every proposal of expenditure shall be placed before the governing body for its
approval.
(3) The governing body may appoint secretarial staff includin
accountants with such terms and conditions as it may think appropriate to
look after the management and utilization of the Union Territory Fund
based on need based requirement.
(4) The Union Territory Fund shall be invested in such manner as may be decided by
the governing body.
54. Budget.- The Chief Executive Officer of the Union Territory Fund shall
prepare the budget for incurring expenditure under the Union Territory Fund
in each financial year showing the estimated receipt and expenditure of the
Fund, in January every year and shall place the same for consideration of the
governing body.
55. Annual Report.- The annual report prepared by the Union Territory
Commissioner for persons with Disabilities shall include a chapter on the
Union Territory Fund.
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FORM- A
d. Phone /Fax/Telex/(Office)/email id :
(3) (i) Name of the Act under which the organization is registered:
(ii) Registration No. and date of registration: _
Name M/F Age Educational Address Contact Responsibilit Salary Aadhaar RCI
y
Qualification Details No. registration
no.
(enclosed
copy of RCI
registration
certificate)
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Form-B
Certificate of Registration
[Issued under the provision of rule 20(8)(a) of Jammu and Kashmir Rights of
Persons with Disabilities Rules, 2020]
The holder of the certificate of Registration shall apply for renewal of the
certificate not less than sixty days before the date of expiry of the period of
validity.
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Signature and Seal of the Competent Authority
Department of Social Welfare, Government of
Jammu and Kashmir
(1) The holder of this Certificate of Registration shall provide the beneficiaries of the
organization with :-
(a) Adequate accessible accommodation and accessible sanitary conditions.
(b) Proper medical care and treatment.
(c) Facilities for recreation.
(d) Education and vocational or professional training.
(2) Residential premises, if any, for girls shall be separate from residential premises
for boys.
(3) The holder of this Certificate of Registration shall not employ or shall allow
others to employ any beneficiary of the organization for any private
purposes whether of own or others.
(4) The incharge/Project Manager shall maintain a visitor’s book, which shall
contain the records of visit to the organization by the competent authority
or any person authorized by it to inspect the organization. The
incharge/Project Manager shall furnish to the competent authority a copy of
remarks if any recorded in the said book within seven days from the date of
visit, as also compliance report if any.
(5) The holder of this Certificate of Registration shall facilitate inquiry in
accordance with provisions of the Rights of Persons with Disabilities Act
2016 by the Competent Authority or any person authorized by it.
(6) The certificate shall be exhibited in a conspicuous place in the office of the
incharge/Project Manager.
(7) Any change in the office bearers shall be immediately intimated to the
Competent Authority and the concerned District Social Welfare Officer.
(8) The holder of this Certificate of Registration shall ensure the safety and
security of the beneficiaries against all forms of abuse, violence and
exploitation as per Section 6 & 7 of the Rights of Persons with Disabilities
Act’ 2016.
(9) The holder of this certificate should ensure that in case of foreign
volunteers, verification of credentials and criminal record from country of
origin or birth through the police has been conducted and verified before
giving permission for visit/stay in the institution/homes.
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(10) The holder of this Certificate of Registration shall ensure adequate safety
measure against man made /natural disasters such as fire, earthquake,
flood etc.
(11) The holder of this Certificate of Registration shall abide by the conditions of
this Certificate of Registration and the provisions of the Rights of Persons
with Disabilities Act’ 2016 and the rules/regulations and orders made there
under.
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Form-C
[Issued under the provision of rule 20(8)(b) of the Jammu and Kashmir Rights
of Persons with Disabilities Rules, 2020]
Date:……………
1.
2.
3.
hereby refuses to grant such certificate of registration under sub rule (8) of rule
20 of the Jammu and Kashmir Rights of Persons with Disabilities Rules 2020 and
directs that a fresh application be submitted through authorized representative of
the organization after removal of the said deficiencies.
Form-D
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Government of Jammu and Kashmir
Department of Social Welfare
[Issued under the provision of Rule 20(8)( c) of the Jammu and Kashmir Rights
of Persons with Disabilities Rules, 2020]
Date:
a)made a statement in relation to the application for the issue / renewal of the
registration certificate under sub section(1) of Section 51 of the Rights of Persons
with Disabilities Act 2016 , which is incorrect or false in material particulars: or
b) committed or has caused to be committed breach of rules or Terms and
conditions subject to which the certificate was granted.
Now therefore revokes the certificate of Registration granted to the organization
under the provision of sub rule(8) of rule 20 of the Jammu and Kashmir Rights of
Persons with Disabilities Rules 2020.
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FORM- I
[See Rule 24(1) of Jammu and Kashmir Rights of Persons with Disabilities
Rules, 2020
(1) Name: _ _
(First Name ) (Middle Name) (Surname)
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(9) Identification marks: (i)
(10) Nature of disability :
(11) Period since when disabled: From Birth/since year:
(12) (i) Did you ever apply for issue of a certificate of disability in the past
(ii) If yes, details:
(a) Authority to whom and district in which applied : (yes/no)
(b) Result of application : _ _
(13) Have you ever been issued a certificate of disability in the past? If yes, please
enclose a true copy.
_
Declaration: I hereby declare that all particulars stated above are true to the
best of my knowledge and belief, and no material information has been concealed
or misstated . I further Union Territory that if any inaccuracy is detected in the
application, I shall be liable to forfeiture of any benefits derived and other action
as per law.
Date :
Place:
Enclosures:
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Head Master of a Government school,
(i) In case of an inmate of a residential institution for persons with
disabilities, destitute, mentally ill, and other disability, a certificate of
residence from head of such institution.
(j) Aadhaar number or Aadhaar enrollment number, if any.
2. Two recent passport size photographs
-------------------------------------------------------------------------------------
Date:
Stamp
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Form-II
Certificate of Disability
[See Rule 24(1) of Jammu and Kashmir Rights of Persons with Disabilities Rules, 2020
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(D) The
applicant has submitted the following documents as proof of residence:-
Nature of Document Date of Issue Details of Authority issuing
Certificate
Signature / thumb
impression of the person
in whose favour
certificate of disability is
issued
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Form - III
Certificate of Disability
[See Rule 24(1) of Jammu and Kashmir Rights of Persons with Disabilities Rules 2020
son/wife/daughter of Shri
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4 Dwarfism
.
5 Cerebral Palsy
.
6 Acid attack Victim
.
7. Low vision
8. Blindness
9. Deaf
10. Hard of Hearing
11. Speech and
Language
disability
12. Intellectual Disability
13. Specific Learning
Disability
14. Autism Spectrum
Disorder
15. Mental illness
16. Chronic Neurological
Conditions
17. Multiple sclerosis
18. Parkinson’s disease
19. Haemophilia
20. Thalassemia
21. Sickle Cell disease
(B)In the light of the above, his/her over all permanent physical impairment as
per guidelines ( .......................................................................... number
and date
of issue of the guidelines to be
specified), is as follows : - In
figures -------------- percent
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therefore this certificate shall be valid till ----(DD/MM/YY)
Name and Seal of Member Name and Seal of Member Name and Seal of the
Chairperson
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Form –IV
Certificate of Disability
Recent passport
size attested
photograph
(Showing face only)
of the person with
disability
2. Muscular Dystrophy
3. Leprosy cured
4. Cerebral Palsy
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6. Low vision
7. Deaf
8. Hard of Hearing
9. Speech and
Language disability
10. Intellectual
Disability
11. Specific Learning
Disability
12. Autism Spectrum
Disorder
13. Mental illness
14. Chronic
Neurological
Conditions
15. Multiple sclerosis
16. Parkinson’s disease
17. Haemophilia
18. Thalassemia
19. Sickle Cell disease
(Please strike out the disabilities which are not applicable)
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Nature of document Date of issue Details of authority
issuing certificate
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FORM - V
No. _Dated :
To,
Sir/ Madam,
Yours faithfully,
(Authorized Signatory of the notified
Medical Authority) Name and seal
___________________________________________________________________
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