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: 0941/00000/2304/0692989 Enrolment Date: 14/04/2023

PERSONAL DETAILS

Name of Applicant Ashish Kumar आवे दक का नाम आशीष कुमार

Applicant Father's Name Satyendra Nath आवे दक के िपता का नाम सय द नाथ

Applicant Mother's Name Shyama Devi आवे दक के माता का नाम यामा दे वी

Date of Birth 11/05/1988 Age 34 Year(s)

ashishkumaragni@gmail.co
Gender Male E-Mail Id
m

Mark of Identification Nose Point Mark Category General

Mobile Number 9651455833 Blood Group AB+

Marital Status Married Spouse Name Beenu Shukla

Relation with PwD

Self
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / --------- Caretaker / Attendant / ---------
Related Related

Address of Correspondence

Address Shakurabad, Sarai Langar, Kora Jahanabad, Sarai Langer, Bindki, Fatehpur, Uttar Pradesh - 212659
पता शकुराबाद, सराय लं गर, कोड़ा जहानाबाद, Sarai Langer, Bindki, Fatehpur, Uttar Pradesh - 212659

Nature of Document for Aadhaar Card

Address Proof

Permanent Address

Address Shakurabad, Sarai Langar, Kora Jahanabad, Sarai Langer, Bindki, Fatehpur, Uttar Pradesh - 212659
पता शकुराबाद, सराय लं गर, कोड़ा जहानाबाद, Sarai Langer, Bindki, Fatehpur, Uttar Pradesh - 212659

Educational Details

Highest Qualification Post Graduate

DISABILITY DETAILS

Do you have disability certificate? No Disability Type Locomotor Disability

Disability Area LEFT HAND Disability Since
Pension Card Number ---------
Hospital Treating Disability --------- Disability Due To ---------
Hospital Treating State / UTs UTTAR PRADESH
Hospital Treating District FATEHPUR
Hospital Name DISTRICT HOSPITAL FATEHPUR

EMPLOYMENT DETAILS

Employed or Unemployed Unemployed

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

IDENTITY DETAILS

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

Aadhaar No. 609254681838

ASSESSMENT

Disability Type Sub Type Affected Part Diagnosis Remark

Deformity Present Left
Shoulder with Partial
Limitation of
Locomotor Disability ---------- Left Shoulder -
movements at Left
Shoulder (As on
17.04.2023)

VIEW RECOMMENDATION

Disability Disability Permanent / Reassessment Reassessment Reassessment

Disability Remark
Percent Condition Temporary Require Review Year Review Month
Locomotor
40 (Forty) ---------- ---------- ---------- ---------- ---------- -
Disability

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