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: 2727/00000/2012/0685099 Enrolment Date: 20/12/2020

PERSONAL DETAILS

Name of Applicant Vishwajit Prakash Mendake आवे दक का नाम िवविजत काश म डके

Applicant Father's Name Prakash आवे दक के िपता का नाम काश

Applicant Mother's Name Aruna आवे दक के माता का नाम अणा

Date of Birth 10/04/2003 Age 17 Year(s)

Gender Male E-Mail Id ---------

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

Mobile Number 9834729933 Blood Group ---------

Marital Status Unmarried

Relation with PwD

Son
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / Todkar Mahesh Caretaker / Attendant / 9834729933
Related Related

Address of Correspondence

Address Gautam Nagar, Majalgaon, Manjlegaon, Manjlegaon, Beed, Maharashtra - 431131

पता गौतम नगर, माजलगाव, Manjlegaon, Manjlegaon, Beed, Maharashtra - 431131

Nature of Document for Aadhaar Card

Address Proof

Permanent Address

Address Gautam Nagar, Majalgaon, Manjlegaon, Manjlegaon, Beed, Maharashtra - 431131

पता गौतम नगर, माजलगाव, Manjlegaon, Manjlegaon, Beed, Maharashtra - 431131

Educational Details

Highest Qualification Primary

DISABILITY DETAILS

Do you have disability certificate? Yes Disability Type Hearing Impairment

Sr. No. / Registration
Disability certificate uploaded? Yes HI52300296193
No. of Certificate
 Details of Issuing
Date of Issuance of Certificate 13/09/2015 Medical Authority
Authority
Disability Percentage 100%
Disability Area Ears Disability Since 2003
Pension Card Number ---------
Hospital Treating Disability --------- Disability Due To ---------
Hospital Name ---------

EMPLOYMENT DETAILS

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

BPL / APL ---------
Personal Income (Annual) --------- Father Income (Annual) ---------

IDENTITY DETAILS

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

Aadhaar No. 601937304218

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