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Note: ‘This condiion is progresive/ noa-progressive/Uely to improve /n 2. Recasscsmot ic not recommenda is recommended after a period of. ‘Months /years.* + Strike ou which is not applicable (Recent stested photograph showivg the disability affixed here) Drthopedic/ Senior Specialist Chairperson Distt eye/ ENT /Peyehatrist Meatber, Medical Surgeon Distt, Member, Medical Board Dstt Heeptat Beat ‘Signature /Thumb impression ef he disabled personwrong —6 (GOVERNMENTOF KARNATAKA, DEPERTMENT OF SALNIK WELFARE AND RESETTLEMENT ie deputy rector, department of Sai Welhire Resettlement (Karmataks) Oommcer ot CERTIFICATE, ‘Ts certy tat Se /St/ Kum 11s. an applicant for 1s the Spouse Son /Daughter of No rank ~Ot Army Navy / Air Fave yb isan Ex-Servicen Name coring 1 he ‘oft ahd dowa by the Mister of Defense, Government of Tada, He served fromm To. “The Kx-Serviceman fad declare his home iow in Karaka at the time of etry ite service as per records & hence eligible to avail reserved seas ander Ex-Service quota His, ‘permanent bomesddres athe tone of erry Int service Wass under: Siguature of the Deputy Director lflare& Reastdement Department of Saatverte -7 CERTIFICATE, ‘Tlf cet at SH /SIOE/ KUM cone Is.anspplicant for Ts the Spouse Son (Daughter NO eunvr nA oe - ‘Who Died Disb while inservice according t certfeate ised by Defence Authority. He Died / Diabled on ‘The bomenddress ofthe inci record 8: 1 Narne tal atthe time af joining etonce Service a per the Signature of ie Deputy Director Place Department of Suinik Welfare & Resetdement Date : District one ¢n ope chet eclerteteh, ine evel me ge aaaustuod 8 ded eto ais, & - 88 see / sarees an, mas He on Servorsard ug ch salt Bec stg arto seams AM ao sedosnganheRE She tere lwalgeig trots esieeriagrbce coms slosoerafehy emit atthe shined BF (BFS sa vee SEC HR Howto, we oa ee raed uggswaives 9 BREEN HORNE acd gas ep|gri dees mpMONTON RKoKeINES DO{SHINS / Gaiass eae ashes 86 an PSHE Remo / Meremiesan ObrRr LAER, aoa diced Ha sos Cod Heenan sen ed eo RES ROBIN LAGS DOIN, Aeeewe ah eA cnc ir A KOH, | Renato oe Heat aERNG, AS Stowe mapRONY aint, a 2h ns aan, aghapes eh ead a swe Rogues Dao. Oeorweg 10 vem ghia 2g se ae a Bod | ot wo eon oat 3 (totes wee a Hoey anne UR mevenurncens / SEFLRERS Doc A sane qpemeennd. 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