Certificate of Mental Retardation for Government Benefits

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Certificate

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Government of Maharashtra
Disability Certificate N

(Maharashtra, India)

Certificate Number: 4 1 6 119

Date: 19/06/2017

This is to certiff that I have carefully examined.

Person Identification Number: MR49
Aadh'ar Number: N/A
7 00 5 7 0 3 0 3

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Shri/Smt./Kum: SAWAD MASUDALI AMJADALI RABIY
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Father Name: Shri/Smt./Kum . AMJADALI ,4. EsJ*, ,,\,1-
Date of Birth (dd/mrr/yyyy): 2 2/0 6/1 9 5 I df4${,,,1--rF,+s", 59 years
Gender: Mule
Permanent Address:
House Address: musalmanmohalla navspur
Village: Nawapur Taluka: Nawapur
Dishict: Nandurbar Pincode: 425418
whose photograph is aflixed above, and am satisfied that he / she is a case of Mental Retsrdation
disability. His / Her extent of percentage physical impairment / disability has been evaluated as per guidelines
and is.shown against the relevant disability in the table below :-
1.

Disability Categorisation of Mental Retardation Diagnosis Disability (in %)

Mentul Retardation Severe Severe Mental Retardation 90
2. The Above condition is Permanent, non-progressive, not likely to improve
3. Reassessment of disability

4. The applicant has submitted following documents as proof of residence:

Aadhur CardrRation card

5. The applicant has submitted following documents as proof of Identiry:

Aadhar Card
-,fxhorised Signatory of notified Medi uthority)

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Dr Val{dana Sonone Dr. Rag[unath $$dye
Psychiatrist Class-[I Civil Surgeoh
Member Secretary President
Regn. No. :70494

https://sadm. m aharashtra.gov.i n/sadm/en/certifi cate.gov