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: 2110/00000/2006/0505419 Enrolment Date: 21/06/2020

PERSONAL DETAILS

Name of Applicant Dibyashree Pradhan आवे दक का नाम DIBYASHREE PRADHAN

Applicant Father's Name Bijay Ketan Pradhan आवे दक के िपता का नाम ---------

Applicant Mother's Name Pranati Pradhan आवे दक के माता का नाम ---------

Date of Birth 21/01/1980 Age 40 Year(s)

dibyashreepradhan11@gma
Gender Male E-Mail Id
il.com

Mark of Identification Cut Mark In Right Knee Category General

Mobile Number 9437468491 Blood Group B+

Marital Status Married Spouse Name ---------

Relation with PwD

Other
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / Bijay Ketan Pradhan Caretaker / Attendant / 9437142978
Related Related

Address of Correspondence

Address At - Dihabalaram Pur, P.o. - Karilopatana, Dihabalarampur, Patkura , Kendrapara, Odisha - 754223
पता At - Dihabalaram Pur, P.O. - Karilopatana, Dihabalarampur, Patkura , Kendrapara, Odisha - 754223
Nature of Document for Electricity Bill (not Older Than Last Three Months)
Address Proof

Permanent Address

Address At - Dihabalaram Pur, P.o. - Karilopatana, Dihabalarampur, Patkura , Kendrapara, Odisha - 754223
पता Dihabalarampur, Patkura , Kendrapara, Odisha - 754223

Educational Details

Highest Qualification Diploma

DISABILITY DETAILS

Do you have disability No Disability Type Muscular Dystrophy

certificate?
Disability Area Left Leg Disability Since 2016
Pension Card Number ---------
Hospital Treating
--------- Disability Due To Accident
Disability

EMPLOYMENT DETAILS

Employed or Unemployed Unemployed

Unemployed Since ---------
BPL / APL NA
Personal Income (Annual) Below 10000
Spouse Income (Annual) ---------

IDENTITY DETAILS

Identity Proof Aadhaar Card TIN (NPR) ---------

Aadhaar No. 871770328215

This is computer generated receipt and does not require any signature.