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: 0122/00000/2211/1208816 Enrolment Date: 18/11/2022

PERSONAL DETAILS

Name of Applicant Neelam Kumari आवे दक का नाम नीलम कुमारी

Applicant Father's Name Bhikham Singh आवे दक के िपता का नाम भीखम िसं ह

Applicant Mother's Name Darshana Devi आवे दक के माता का नाम दशन दे वी

Date of Birth 23/12/1969 Age 52 Year(s)

narainiakdsingh77@gmail.c
Gender Female E-Mail Id
om

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

Mobile Number 7006505180 Blood Group ---------

Marital Status Married Spouse Name Harpal Singh

Relation with PwD

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

Address of Correspondence

Address Patti, Rahya, Bari Brahmana, Patti, Samba, Samba, Jammu And Kashmir - 181143
पता पट् टी, रा, बरी ब ाण, Patti, Samba, Samba, Jammu And Kashmir - 181143

Nature of Document Aadhaar Card

for Address Proof

Permanent Address

Address Patti, Rahya, Bari Brahmana, Patti, Samba, Samba, Jammu And Kashmir - 181143
पता पट् टी, रा, बरी ब ाण, Patti, Samba, Samba, Jammu And Kashmir - 181143

Educational Details

Highest Qualification Senior Secondary

DISABILITY DETAILS

Do you have disability certificate? Yes Disability Type Muscular Dystrophy

Sr. No. / Registration
Disability certificate uploaded? Yes CMO/S/DB/338
No. of Certificate
 Details of Issuing
Date of Issuance of Certificate 30/09/2019 Chief Medical Office
Authority
Disability Percentage 50%
Disability Area Left Leg Disability Since 1970
Pension Card Number ---------
Hospital Treating Disability --------- Disability Due To ---------
Hospital Name ---------

EMPLOYMENT DETAILS

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

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

IDENTITY DETAILS

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

Aadhaar No. 956242352824

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