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: 187090000024060003683 Enrolment Date: 19/06/2024
PERSONAL DETAILS
Full Name in Regional
Name of Applicant Kaushik Paul कौिशक पाल
Language
Applicant Father's Name Nirmal Paul Applicant Mother's Name Jyotsna Paul
Date of Birth 18/02/2015
Mobile Number 9435254502 E-Mail Id nirmalpaul9537@gmail.com
Gender Male Category OBC
Relation with PwD
Blood Group A+ Father
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / Nirmal Paul Caretaker / Attendant / 8471988216
Related Related
Optional Details
Personal Income (Annual) 0 Highest Qualification Primary
Employed or Unemployed Unemployed
Proof of Identity Card (See Instructions)
Identity Proof Aadhaar Card Aadhaar No. ********5816
Address of Correspondence
Address Rai Bahadur Lane,
Hojai Hojai
Assam 782435
Nature of Document Aadhaar card
for Address Proof
DISABILITY DETAILS
Do you have disability certificate? No Disability Type Locomotor Disability
Disability Due To
Hospital Treating State / UTs Assam Hospital Treating District Hojai
Hospital Name DISTRICT CIVIL HOSPITAL,HOJAI
This is computer generated receipt and does not require any signature.
