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: 0944/00000/2212/0757135 Enrolment Date: 09/12/2022

PERSONAL DETAILS

Name of Applicant Mohd Yusuf आवे दक का नाम MOHD YUSUF

Applicant Father's Name Mohd. Ayoob आवे दक के िपता का नाम मोहद. AYOOB

Applicant Mother's Name Kaneeza Bibi आवे दक के माता का नाम कनीज़ा BIBI

Date of Birth 29/05/1981 Age 41 Year(s)

Gender Male E-Mail Id gulamanzer00@gmail.com

Mark of Identification Forehead Category General

Mobile Number 9919235566 Blood Group ---------

Marital Status Married Spouse Name Farha Siddiqui

Relation with PwD

Wife
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / Farha Siddiqui Caretaker / Attendant / 99191235566
Related Related

Address of Correspondence

Address 24b/10b, Allahabad, Allahabad, Uttar Pradesh - 211002

पता २४ब/10B, Allahabad, Allahabad, Uttar Pradesh - 211002

Nature of Document Aadhaar Card

for Address Proof

Permanent Address

Address 24b/10b, Allahabad, Allahabad, Uttar Pradesh - 211002

पता २४ब/10B, Allahabad, Allahabad, Uttar Pradesh - 211002

Educational Details

Highest Qualification Primary

DISABILITY DETAILS

Do you have disability certificate? No Disability Type Blindness

Disability Area BOTH EYE Disability Since 2018
Pension Card Number ---------
Hospital Treating Disability --------- Disability Due To ---------
Hospital Name ---------

EMPLOYMENT DETAILS

Employed or Unemployed Employed Occupation Self Employed

BPL / APL BPL
Personal Income (Annual) 100000 To 500000
Spouse Income (Annual) ---------

IDENTITY DETAILS

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

Aadhaar No. 860651874894

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