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: 1823/00000/2307/0387752 Enrolment Date: 09/07/2023

PERSONAL DETAILS

Name of Applicant Deepraj Nath आवे दक का नाम दीपराज नाथ

Applicant Father's Name Saroj Nath आवे दक के िपता का नाम सरोज नाथ

Applicant Mother's Name Jayshree Nath आवे दक के माता का नाम जयी नाथ

Date of Birth 19/02/1992 Age 31 Year(s)

Gender M E-Mail Id dnath1845@gmail.com

Mark of Identification --------- Category Obc

Mobile Number 9365332393 Blood Group B+

Marital Status Unmarried

Relation with PwD

Self
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / Saroj Nath Caretaker / Attendant / 9101004371
Related Related

Address of Correspondence

Address Alpine Path Bankcolony, Jyotikuchi Guwahati, Bylane 5 House Number 3 Near Akshay Bhandar, Guwahati,
Guwahati, Kamrup Metro, Assam - 781034
पता अपाइन पथ ब ककॉलोनी, योितकुची गु वाहाटी, बाइले न 5 मकान नं बर 3 अय के पास, Guwahati, Guwahati, Kamrup Metro,
Assam - 781034
Nature of Document Aadhaar Card
for Address Proof

Permanent Address

Address Alpine Path Bankcolony, Jyotikuchi Guwahati, Bylane 5 House Number 3 Near Akshay Bhandar, Kamrup Metro,
Assam - 781034
पता अपाइन पथ ब ककॉलोनी, योितकुची गु वाहाटी, बाइले न 5 मकान नं बर 3 अय के पास, Kamrup Metro, Assam - 781034

Educational Details

Highest Qualification Graduate

DISABILITY DETAILS
Do you have disability certificate? Yes Disability Type Locomotor
Disability,Parkinson's
Disease
Sr. No. / Registration
Disability certificate uploaded? Yes 6657/14
No. of Certificate
Details of Issuing
Date of Issuance of Certificate 18/03/2019 Medical Authority
Authority
Disability Percentage 60%
BOTH LEG,BOTH LOWER LIMB,BOTH UPPER
Disability Area Disability Since 1992
LIMB,BOTH UPPER LIMB AND BOTH LOWER LIMB
Pension Card Number ---------
Hospital Treating Disability --------- Disability Due To Congenital
Hospital Treating State / UTs ASSAM
Hospital Treating District KAMRUP METRO
Hospital Name ---------

EMPLOYMENT DETAILS

Employed or Unemployed Unemployed

Unemployed Since ---------
BPL / APL APL
Personal Income (Annual) Below 10000

IDENTITY DETAILS

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

Aadhaar No. 730633213538

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