ni on Form-Vil (As per RPWD Act, 2016) . CERTIFICATE OF DISABILITY GENERAL HOSPITAL, ERNAKULAM Hospital Road, Emakulam, Kerala, 680.012, India E-mail generalhospitalernakulam@gmal.com Website : wwv.generalhospitalernakulam com Ph : 0484-2386000 oa \o Form vit Certificate No.MB/788/2022 . Date:22-09-2022 This is to certify that I have carefully examined Sri. RISHAN VU , Son of Viju Kurian, Date of Birth 22-01-2009, Age 13 years, ‘Male Registration No, MB/788/2022 Permanent resident of House No. ., House Name. Palakalathil House,Ambatukavu affixed Ward/Village/Strect Thaikattukara, Post Office Thaikkattukara, District Ernakulam, State Kerala whose photograp! teennaslase—___sedatolaliy uM of permanent physical impairment/mentat disability has been evaluated as per guidelines,and is shown against the relevant .Disability.his extent above and are satisfied that he is a case of disability in the table below: T ] So | Disability Affected part of body Diagnosis Disability (in%) | (Percentage in Words) | 1. | Ucomotor eisabitty @ Rode Rasbral poly. Z| mactrpmvcony | OA Dine Apolzdaphya| 07s 3 Leprosyfeured ae | 4 warm 5. | Cerebral palsy prone | & | neta tn | = " 1. - - 10.) Hotofieigs | a1, | S9eechafd Language ipbiity fe : ~ | | 32. | tmotecdat esabiliny : 13. | Specific irning disability Scanned with CamScanner. — 5, er te ne | 16 wow fogeal v7 | mui sir 18 | parknsfa'sctseae _ a J 1. taefonbiia jaa | [20 | massena a. | Sickle Gell disease | ut —— a @ eg Leg Boin XrnsLegs, & (Please strikeout the isbtes which ve not aplicale) 2. Theabove condition is progressive /non-progressive/ikaly-te-4mprove//not likely to improve 3. Reassessment of disability is : Writ necessary or (iis shall be — 4. The applicant has submitted the following document as proof of residence: Name of the Document Date of issue i i ‘Aadhoar Card 878830011973 Autorised Signatory of Authorised Medical Authority (Name & Seal) pet. rate Details of Authority Issuing Certificate SDR SINDHU.K.NAIR Bes esasy CONSULTANT PUR mp Demet KERALA STATE HEALTH SERVICES Reg: No:19791 Dr. Asha K Joon Reg. No. 21089 ‘Superintendent-in-charge sabity issued General Hosplial Emalaam Countersignature & Seal ef the Superintendent Sienatuce/Thum® impression ofthe Detsonin whose favour of erticete of Scanned with CamScanner