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: 2703/00000/2403/1295860 Enrolment Date: 25/03/2024

PERSONAL DETAILS

Name of Applicant Shekhar Tulshiram Patil आवे दक का नाम शे खर तु ळशीराम पाटील

Applicant Father's Name Tulshiram Patil Applicant Mother's Name Sushilabai Patil

Date of Birth 01/06/1969 Age 54 Year(s)

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

Gender Male Category OBC

Relation with PwD

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

Name of Guardian / Contact No. of Guardian /

Caretaker / Attendant / Shekhar Tulshiram Patil Caretaker / Attendant / 9881085103
Related Related

Optional Details

Personal Income (Annual) Below 10000 Highest Qualification ---------

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

Proof of Identity Card (See Instructions)

Identity Proof Aadhaar Card Aadhaar No. 244917750241

Address of Correspondence

Address ,, Amalner, Jalgaon, Maharashtra - 425401

Nature of Document for Aadhaar Card
Address Proof

DISABILITY DETAILS

Do you have disability certificate? Yes Disability Type Locomotor Disability

Disability certificate uploaded? Yes Sr. No. / Registration No. of Certificate 269299
Date of Issuance of Certificate 25/09/2015 Details of Issuing Authority Chief Medical Office
Disability Percentage 45%
Disability Area ---------
Disability Due To ---------
Hospital Treating State / UTs MAHARASHTRA Hospital Treating District JALGAON
Hospital Name SUB DISTRICT HOSPITAL CHOPDA
This is computer generated receipt and does not require any signature.