Department of Empowerment of Persons with Disabilities,

Ministry of Social Justice and Empowerment, Government of India

Acknowledgement / Resident Copy

Intimation of Rejection of Application for Disability

Certificate
Sub District Hospital, Muktainagar
Jalgaon, Maharashtra

Certificate No.: 2703/00000/2212/1161398 Date: 26/03/2024

To,
Hemant Pandit Dhade
PLOT NO 45,BHUSAWAL ROAD, GANGA NAGAR, YAWAL,
Chopda, JALGAON,
MAHARASHTRA

Subject: Rejection of Application for Disability Certificate

Sir / Madam,

Please refer your application dated 15/12/2022 for issue disability certificate for following disability:
Locomotor Disability

2. Pursuant to the above application, you have been examined by the undersigned / Medical Board on 09/06/2023,
and I/We regret to inform that, for the reasons mentioned below, it is not possible to issue a disability certificate in your
favour:

PWD has not Visited to Hospital For The Evaluation

3. In case you are aggrieved by the rejection of your application, you may represent to Sub District Hospital,
Muktainagar, Jalgaon, Maharashtra, requesting for review of this decision.

Yours faithfully,

Signatory of notified Medical Authority Member

Sub District Hospital, Muktainagar

Jalgaon, Maharashtra

This Card/certificate is meant to certify the disability of the person and is not an instrument for ID/Address Proof for any
purpose.
This is computer generated receipt and does not require signature.