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: 1822/00000/2311/2452420 Enrolment Date: 21/11/2023

PERSONAL DETAILS

Name of Applicant Mousom Baishya आवे दक का नाम MOUSOM BAISHYA

Applicant Father's Name Hemanta Baishya Applicant Mother's Name Dipti Mani Baishya

Date of Birth 23/05/2018 Age 5 Year(s)

Mobile Number 8724863972 E-Mail Id ---------

Gender Male Category General

Relation with PwD

Blood Group --------- Son
(Person with Disability)

Name of Guardian / Contact No. of Guardian /

Caretaker / Attendant / Hemanta Baishya Caretaker / Attendant / 8724863972
Related Related

Optional Details

Personal Income (Annual) --------- Highest Qualification ---------

Employed or Unemployed ---------

Proof of Identity Card (See Instructions)

Identity Proof Aadhaar Card Aadhaar No. 761449669471

Address of Correspondence

Address Vill-pingaleswar,po-pingaleswar,ps-baihata Chariali, Pingeleswar (pingaleswar), Kamalpur, Kamrup, Assam - 781381

Nature of Document for Aadhaar Card
Address Proof

DISABILITY DETAILS

Do you have disability certificate? No Disability Type Locomotor Disability

Disability Area ---------
Disability Due To ---------
Hospital Treating State / UTs ASSAM Hospital Treating District KAMRUP
Hospital Name North Guwahati BPHC

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