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Application

This document is a registration acknowledgment for Kartikeswar Mohanty, a person with a disability, issued by the Department of Empowerment of Persons with Disabilities in India. It includes personal details, disability information, and contact information for the applicant and guardian. The applicant has a low vision disability with an 80% disability percentage and holds a disability certificate issued in 2013.

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ashwanimohanty151
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39 views2 pages

Application

This document is a registration acknowledgment for Kartikeswar Mohanty, a person with a disability, issued by the Department of Empowerment of Persons with Disabilities in India. It includes personal details, disability information, and contact information for the applicant and guardian. The applicant has a low vision disability with an 80% disability percentage and holds a disability certificate issued in 2013.

Uploaded by

ashwanimohanty151
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
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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: 213650000025010010315 Enrolment Date: 18/01/2025

PERSONAL DETAILS

Full Name in Regional


Name of Applicant Kartikeswar Mohanty କାତ୍ତିେକଶ୍ୱର ମହାତି
Language
Applicant Father's Name Jadabananda Mohanty Applicant Mother's Name
Date of Birth 01/01/1970
Mobile Number 9178402099 E-Mail Id
Gender Male Category
Relation with PwD
Blood Group Father
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / Jadabananda Mohanty Caretaker / Attendant / 9178402099
Related Related

Optional Details

Personal Income (Annual) 0 Highest Qualification


Employed or Unemployed

Proof of Identity Card (See Instructions)

Identity Proof Aadhaar Card Aadhaar No. ********6789

Address of Correspondence

Address At-beguniabani Po-tentuligaon


Dist-mayurbhanj
757083,Beguniabani
Barsahi Mayurbhanj
Odisha 757083
Nature of Document Aadhaar card
for Address Proof

DISABILITY DETAILS

Do you have disability certificate? Yes Disability Type Low Vision


Disability certificate uploaded? Yes Sr. No. / Registration No. of Certificate 684/VH
Date of Issuance of Certificate 20/12/2013 Details of Issuing Authority Chief Medical Office
Disability Percentage 80
Disability Due To
Hospital Treating State / UTs Odisha Hospital Treating District Mayurbhanj
Hospital Name District Headquarter Hospital, Mayurbhanj

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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