Ale No- 0308 200

Government of Maharashtra
Certificate of Mental Retardation for Government Benefits
ONG ENER
AL HOS

NAME OF THE HOSPITAL: Sasoon Hospitals, Pune UN

E-1.2

(Maharashtra, India)
Certificate Number: 438179
Date: 31/08/2017

This is to cetify that I have carefully examined.

Person ldentification Number: MR52100590742
Aadhar Number: N/A
Shri/Smt/Kum: JADHAV ASHISH KALURAM MANGAL
Pather Name: Shri/Smt/Kum. KALURAM JADIHAv
Date of Birth (dd/mm/yyyy): 29/10/1993
Age: 24 yeurs
Gender: Male
Permanent Address:
House Address: SR.NO.20/21. FLAT NO-34, TIRUPATI
HEIGHTS ,NEAR PAWAR II
BALAJI NAGAR DHANKAWADI
Village: Pune
Taluka: Pune
District: Pune Pincode
411043
whose photograph is affixed above, and am satisfied that he / she is a case of Mental Retardation
disabilty. His / Her extent of
percentage physical impairment/ disability has been evaluated
and is shown against the relevant disability in, the table below
as per guidelines

Disability Categorisation of Mental Retardation Diagnosis Disability (in

%)
Mental Moderate Mentul
Retardation Moderate 75
Retardation
2. The Above condition is Permanent,
3. Reassessment of
non-progressive, not likely to improve
disability
4. The applicant has
submited following documents as proof of residence:
Aadhar Card
5. The
applicant has submitted following documents as proof of Identity:
Aadhar Card

Signature and Seal of Authorised Signatory ofno Medical Authoriy)

Dr.MMape Savare Dr. Jaikisthh Patil Dr. Ajay áware

M0Pdetiegfpsor ih R.M.O.
Medical Superintendent and Chairman Disability
AssociäteUFëssot
DepartmrBFPsychiatry, Member Secretary
Board
President

heeysSRvt dediceReslege,PunRegn. No.:

2017/05/2309
Regn. No. : 2001/01/0298
Reg.No.2000/03/1650
Signature/Thumb
Note: This is
imprpsion
valid for
not
of the peResident.Maa aisissupd. Ajay aware
Medico LegalSessoon General iospitd EM
Pune4 Reg- No-2001 L01135
Superintendent

Sassoon General
Hospital Pune.
 twwAR
3TETT

SHTRGITY TGRE 3toe STTUT

Inique ldentification Authoritv af lndia
GOVerrnant
tatuaraT 37ATT/Enrollment No 1189/60010/09549
To,

Ashlsh Kaluram Jadhav

sn 20/21 flat no 43, tirupatlu heights
noar pawor hospltal dhankawadi
Pune Clly
Dhankawadi Pune City Pune
Maharashtra 411043
9604019019

Raf: 194/ 17J/ 191979 192309/P

SH409772334FT

3HTTCT ATeTT KAI5| Your Aadhaar No.

8774 8561 2016
3HTTR-HHIGY HIUHIT 3HTchR
Government of Indiar
Ashish Kaluram Jadhav
TFR ATTUIDOB 29/10/1993
EN Male

8774 8561 2016

3HTTR FTATFY HIUTHTET 3HT6IT