Certificate No: 83385, Date: 2008/2014 This is to certify that | have carefully examined Hon. Ortho Surgeon ShriSmt.Kum, Que Azalea Reg. No. G-31238 ‘sontwife/daughter of Shri weicleus Date of Bith (DD /MM/YYYY) 14/03/1982 Age 32 Years) . Male Registration No, AMR/14/00990451 Address getaus| wilz, Hella. Matirala, LATHL, AMREL! ‘whose photograph is affixed above, and am satisfied that (A) Helshe is @ case of Disability Affected part of Diagnosis Permanent physical Body impairment disability (in %) + [Locomotors Disability [Both Lower Limb |1) Sequelae of potomyelits [75 (Seventy Five) {A) He/She has 75%(in figure) Seventy Five percent (in words) permanent physical impairmentblindness in relation to his/her Both Lower Limb (part of body) a8 per guidelines (to be specified), 2. The applicant has submited the following document as proof of residence:~ Nature of Document Date of issue Details of authority issuing certificate Voter id Card 21/11/2008 Mamiatdar -Lathi Undertaking: | hereby declare that all the personal information stated above are tru tothe best of my knowledge ang belief. | further state that | have not availed any other disability certificate from the health department. fin case any inaccuracy is detected on my part, | shall be lable to forfeiture of any benefits derived and other action as per lew ‘agatha, (Sone ‘whose favour disabilty certiiate is issued Certificate Issuing Doctor |LHARKISHAN JAGDISHBHAI KALARIA (631238 ) Hospital. Amreli