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: 0926/00000/2207/1290112 Enrolment Date: 15/07/2022

PERSONAL DETAILS

Name of Applicant Sushila Devi आवे दक का नाम सु शीला दे वी

Applicant Father's Name Loknath आवे दक के िपता का नाम लोकनाथ

Applicant Mother's Name Poonam Devi आवे दक के माता का नाम पूनम दे वी

Date of Birth 14/04/1988 Age 34 Year(s)

Gender Female E-Mail Id ---------

Mark of Identification --------- Category Sc

Mobile Number 9807998115 Blood Group ---------

Marital Status Married Spouse Name Jitendra

Relation with PwD

Husband
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / Jitendra Caretaker / Attendant / ---------
Related Related

Address of Correspondence

Address Basant Vihar Colony, Semra Gaudhi, Madiyaon Mohibullapur Lucknow, Lucknow, Lucknow, Uttar Pradesh -
226012
पता बसं त िवहार कालोनी, से मरा गौढी, मिडयां व मोिहबु लापु र लखनऊ, Lucknow, Lucknow, Uttar Pradesh - 226012

Nature of Document for Aadhaar Card

Address Proof

Permanent Address

Address Basant Vihar Colony, Semra Gaudhi, Madiyaon Mohibullapur Lucknow, Lucknow, Lucknow, Uttar Pradesh -
226012
पता बसं त िवहार कालोनी, से मरा गौढी, मिडयां व मोिहबु लापु र लखनऊ, Lucknow, Lucknow, Uttar Pradesh - 226012

Educational Details

Highest Qualification ---------

DISABILITY DETAILS

Do you have disability certificate? Yes Disability Type Locomotor Disability

 Sr. No. / Registration
Disability certificate uploaded? Yes 3360
No. of Certificate
Details of Issuing
Date of Issuance of Certificate 25/09/2009 Chief Medical Office
Authority
Disability Percentage 50%
Disability Area --------- Disability Since
Pension Card Number ---------
Hospital Treating Disability --------- Disability Due To ---------
Hospital Name ---------

EMPLOYMENT DETAILS

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

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

IDENTITY DETAILS

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

Aadhaar No. 330448351218

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