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: 0933/00000/2104/0785978 Enrolment Date: 16/04/2021

PERSONAL DETAILS

Name of Applicant Abhay Verma आवे दक का नाम अभय वमा

Applicant Father's Name Ghanshyam Verma आवे दक के िपता का नाम घनयाम वमा

Applicant Mother's Name Renu Verma आवे दक के माता का नाम रे नू

Date of Birth 08/10/2002 Age 18 Year(s)

Gender Male E-Mail Id vkk181200@gmail.com

Mark of Identification Hand Burned Category Obc

Mobile Number 9554706596 Blood Group O+

Marital Status Unmarried

Relation with PwD

Father
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / Ghanshyam Verma Caretaker / Attendant / 9554706596
Related Related

Address of Correspondence

Address 429 B, Durga Vihar Jajmau, Kanpur, Maharajpur, Kanpur , Kanpur Nagar, Uttar Pradesh - 208010
पता ४२९ बी, दुगा िवहार जाजमऊ, कानपूर, Maharajpur, Kanpur , Kanpur Nagar, Uttar Pradesh - 208010

Nature of Document Aadhaar Card

for Address Proof

Permanent Address

Address 429 B, Durga Vihar Jajmau, Kanpur, Maharajpur, Kanpur , Kanpur Nagar, Uttar Pradesh - 208010
पता ४२९ बी, दुगा िवहार जाजमऊ, कानपूर, Maharajpur, Kanpur , Kanpur Nagar, Uttar Pradesh - 208010

Educational Details

Highest Qualification Higher Secondary

DISABILITY DETAILS

Do you have disability No Disability Type Muscular Dystrophy

certificate?
Disability Area Right Arm Disability Since 2007
Pension Card Number ---------
Hospital Treating
--------- Disability Due To ---------
Disability

EMPLOYMENT DETAILS

Employed or Unemployed Unemployed

Unemployed Since 23/10/2020
BPL / APL Antodya
Personal Income (Annual) Below 10000 Father Income (Annual) Below 10000

IDENTITY DETAILS

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

Aadhaar No. 208773472282

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