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Department of Empowerment of Persons with Disabilities,
Ministry of Social Justice and Empowerment, Government of lndia

Disability Certificate
lssuing Medical Authority, Kushi Nagar, Uttar pradesh

Certificate No,: UP581t 219970050646 Dare: 16/09/2015

This is to certify that l/we have carefully examined Shri Sumit Shukla, 5on of Shri Suresh Shuka, Date of Birth
30lOGlL997 , Age 23, Male, Registration No. 0958i00000/2002/3193850, resident of House No. Vitt-morwan, post-
ramkola, Dist-kushinagar - 274305, Sub District Hata, District Kushi Nagar, State / UT Uttar pradesh, whose
photograph is affixed above, and lam/we are satisfied that:

(A) of Chronic Neurological Conditions

He is a case
(B) The diagnosis in his case is PPRPright lower limb
(c) He has 45olo{in figure) Forty Five percent(in words) Permanent Disability in relation to his Right Leg,Foot as per
the guidelines {Guidelines for the purpose of assessing the extent of specified disability in a person includld under
RPWD Act, 2016 notified by Government of tndia vide S.O. 76(E) dared 04/01/2018).

The applicant has submitted the following document(s) as proof of residencer

Nature of Document(s)i Aadhaar card

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Signature / Thumb lmpressi0n of the Person with Disability

Signatory of notified Medical Authority Member(s)

lssuing [4edical Authority, Kushi Nagar, Uttar Pradesh

This Card/Certificate is meant to ce.tify the disability of the person and i-. ^:.: :- -r:.--enr for lD/Address Proof fo. any purpose.