Department of Empowerment of Persons with Disabilities,

Ministry of Social Justice and Empowerment, Government of India

Acknowledgement / Resident Copy

Intimation of Rejection of Application for Disability

Certificate
Issuing Medical Authority, Bhadrak, Odisha

Certificate No.: 2109/00000/2102/2119227 Date: 02/06/2023

To,
Udayanath Nayak
SOHARA BALIPADA, DHAMNAGAR, BHADRAK,
Dhamanagar, BHADRAK,
ODISHA

Subject: Rejection of Application for Disability Certificate

Sir / Madam,

Please refer your application dated 26/02/2021 for issue disability certificate for following disability:
Mental Illness

2. Pursuant to the above application, you have been examined by the undersigned / Medical Board on 11/08/2022,
and I/We regret to inform that, for the reasons mentioned below, it is not possible to issue a disability certificate in your
favour:

Rejected

3. In case you are aggrieved by the rejection of your application, you may represent to Issuing Medical Authority,
Bhadrak, Odisha, requesting for review of this decision.

Yours faithfully,

Signatory of notified Medical Authority Member

Issuing Medical Authority, Bhadrak, Odisha

This Card/certificate is meant to certify the disability of the person and is not an instrument for ID/Address Proof for any
purpose.
This is computer generated receipt and does not require signature.