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Application

The document is a registration acknowledgment for a person with a disability named Sabir Ali Gazi, enrolled on 06/10/2024. It includes personal details such as contact information, income, education, and disability type, which is identified as speech and language disability. The document also provides information about the treating hospital and states that no disability certificate is available.

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sabiraligazi89
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50 views2 pages

Application

The document is a registration acknowledgment for a person with a disability named Sabir Ali Gazi, enrolled on 06/10/2024. It includes personal details such as contact information, income, education, and disability type, which is identified as speech and language disability. The document also provides information about the treating hospital and states that no disability certificate is available.

Uploaded by

sabiraligazi89
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: 193030000024100005121 Enrolment Date: 06/10/2024

PERSONAL DETAILS

Full Name in Regional


Name of Applicant Sabir Ali Gazi Sabir Ali Gazi
Language
Applicant Father's Name Kased Ali Gazi Applicant Mother's Name Rejina Bibi
Date of Birth 14/06/1989
Mobile Number 8509197925 E-Mail Id Sabiraligazi89@gmail.com
Gender Male
Relation with PwD
Self
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / Kased Ali Gazi Caretaker / Attendant / 8293189165
Related Related

Optional Details

Below Rupees 10000 Per


Personal Income (Annual) Highest Qualification Higher Secondary
Annum
Employed or Unemployed Employed

Proof of Identity Card (See Instructions)

Identity Proof Aadhaar Card Aadhaar No. ********6708

Address of Correspondence

Address Vill-paschim Jaynagar P.o-aturia


P.s-baduria Dist-north
24parganas West Bengal
Pin-743427,Paschim Jaynagar
Baduria North 24 Parganas
West Bengal 743427
Nature of Document Aadhaar card
for Address Proof

DISABILITY DETAILS

Do you have disability certificate? No Disability Type Speech and Language Disability
Disability Due To
Hospital Treating State / UTs West Bengal Hospital Treating District North 24 Parganas
Hospital Name District Hospital-Basirhat

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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