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    Application 27130000019011391575 1585400551 PDF

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    Balraj Bawa
    This document is a registration form for a person with a disability, Ranjitsingh Rulduram Bawa. It provides his personal details such as name, father's name, date of birth, address, disability details, and identity proof. The form registers him as having a locomotor disability affecting his left leg and left arm since an unspecified date. It lists his wife, Inderjeet Kaur, as his emergency contact. The computer-generated document serves as an acknowledgement of his registration.

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    Application 27130000019011391575 1585400551 PDF

    Uploaded by

    Balraj Bawa
    49 views2 pages
    This document is a registration form for a person with a disability, Ranjitsingh Rulduram Bawa. It provides his personal details such as name, father's name, date of birth, address, disability details, and identity proof. The form registers him as having a locomotor disability affecting his left leg and left arm since an unspecified date. It lists his wife, Inderjeet Kaur, as his emergency contact. The computer-generated document serves as an acknowledgement of his registration.

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    This document is a registration form for a person with a disability, Ranjitsingh Rulduram Bawa. It provides his personal details such as name, father's name, date of birth, address, disability details, and identity proof. The form registers him as having a locomotor disability affecting his left leg and left arm since an unspecified date. It lists his wife, Inderjeet Kaur, as his emergency contact. The computer-generated document serves as an acknowledgement of his registration.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    49 views2 pages

    Application 27130000019011391575 1585400551 PDF

    Uploaded by

    Balraj Bawa
    This document is a registration form for a person with a disability, Ranjitsingh Rulduram Bawa. It provides his personal details such as name, father's name, date of birth, address, disability details, and identity proof. The form registers him as having a locomotor disability affecting his left leg and left arm since an unspecified date. It lists his wife, Inderjeet Kaur, as his emergency contact. The computer-generated document serves as an acknowledgement of his registration.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 2

    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: 2713/00000/1901/1391575 Enrolment Date: 23/01/2019

    PERSONAL DETAILS

    Name of Applicant Ranjitsingh Rulduram Bawa आवे दक का नाम रणजीतिसं ह दुराम बावा

    Applicant Father's Name Rulduram Baba आवे दक के िपता का नाम दुराम बाबा

    Applicant Mother's Name Gyanwati आवे दक के माता का नाम ानवती

    Date of Birth 01/01/1951 Age 68 Year(s)

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

    Mark of Identification --------- Category General

    Mobile Number 9372407759 Blood Group ---------

    Marital Status Married Spouse Name Inderjeet Kaur

    Relation with PwD


    Wife
    (Person with Disability)
    Name of Guardian / Contact No. of Guardian /
    Caretaker / Attendant / Inderjeet Kaur Caretaker / Attendant / 8411098235
    Related Related

    Address of Correspondence

    Address At. Gurudwara, Gurunanak Darbar, Gopal Nagar, Tukum, Chandrapur, Chandrapur, Chandrapur, Maharashtra -
    442401
    पता मु . गु ारा, गु  नानक दरबार, गोपाल नगर, तु कुम, चं दपु र, Chandrapur, Chandrapur, Maharashtra - 442401

    Nature of Document for Aadhaar Card


    Address Proof

    Permanent Address

    Address At. Gurudwara, Gurunanak Darbar, Gopal Nagar, Tukum, Chandrapur, Chandrapur, Chandrapur, Maharashtra -
    442401
    पता मु . गु ारा, गु  नानक दरबार, गोपाल नगर, तु कुम, चं दपु र, Chandrapur, Chandrapur, Maharashtra - 442401

    Educational Details

    Highest Qualification ---------

    DISABILITY DETAILS
    Do you have disability No Disability Type Locomotor Disability
    certificate?
    Disability Area Left Leg,Left Arm Disability Since
    Pension Card Number ---------
    Hospital Treating
    --------- Disability Due To ---------
    Disability

    EMPLOYMENT DETAILS

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


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

    IDENTITY DETAILS

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


    Aadhaar No. 473623833268

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

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