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dF"rtJd iE"rdd eQddd qidd loeld:Aetpqils id$ 2005, aNood:19.11.2005

CERTIFICATE FOR THE PERSONS WITH DISABILITTES

This is to certify that Sri/Smt/Kum fe/daughter of

Shri Agg old,
male/female/Resitration No ts of
He/she is physically disabled/visual disabled/speech &
hearing disabled and has %(-percent)Permanent(Physicat impairment
visual impairment speech & hearing impairment) in relation to his/her

Note:-
1. This condition is progressive/non-progressive/likely
to improve/not likety to improve.*
2. Re-assessment is not recommended/is recommended after a period of
month/years
*Strike out which is not applicable
(Recent Attested Photograph
Showing the disability affixed here)

sd/-
Orthopaedic/Senior specialist Chairperson

District eye/ENT/Psychiatrist member

Medical Surgeon District

Member, Medical Board District Hospital Board

Signatu re/Thumb impression

Of the disabled person
Explanation:- As per Notification No DPAR 50 SRP 2000dated 03.09.2005 "Physically Handicapped
candidates" or "person with disability' means a person suffering from not less than forty percent
of any of the following disabilities:- (1) Blindness (2) Low Vision (3) Hearing impairment (4)
Locomotor disability (5) Leprosy cured {6) Mental retardation (7} Mental illness.
(1) Blindness refers to a condition where a person suffers from any of the following conditions,
namely :- (a) Total absence of sight: or (b) Visual acuity not exceeding 6150 or 201200 (snellen)
in the better eye with correcting lenses: or (c) limitation of the field of vision subtending an
angle cif 20 degree or worse : (2) Person with low vision means a person with impairment of
visual functioning even after treatment or standard refractive correction, but who uses or is
potentially capable of using vision for the planning or execution of a task with appropriate
assistive devicei (3) Hearing impairment means loss of sixty decibels or with more in the
better ear in the conversational range of frequencies. (4) Locomotor disability means
disability of the bones, joints or muscles leading to substantial restriction of the movement of
the limbs or any form of cerebral palsy. (5) Leprosy curedr means any person who has been
cured of Leprosy, but is suffering from(i) Loss of sensation in hands or feet as well as loss of
sensation & paresis in the eye & eyelid, but with no manifest deformity : (ii) mahifest
deformity & paresis but having sufficient mobility in their hands & feet to enable them to
engage in normal economic activity: (iii) extreme physical deformity as well as advanced age
which prevents him from undertaking any gainful occupation: and the expression "Leprosy
cured" shall be construed accordingly: (6) Mental Retardation:- means a condition of
arrested or incqmplete development of mind of a person who is specially characterized by sub
normality of intelligence: (7) Mental llness;- means any mental disorder other than mental
retardation.
 24

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 25

ANNEXURE-03
GOVERN M ENT OF KARNATAKA
DEPARTMENT OF SAINIK WELFARE AND RESETTLEMENT

Office of the Deputy Director

Department of sainik Welfare and
Resettlement( Ka rnata ka)

No. Date-
CERTIFICATE
This is to certify that Sri/Smt/Kum is an applicant for
the spouse/son daughter of No
is Rank _ Name
of Army/Navy/Air Force, who is annex-serviceman according to the
definition laid down by the Ministry of Defence, Government of India. He served
from _ to
The Ex-serviceman had declared his home town in Karnataka at the time of entryinto
service as per records and hence eligible to avail reserved seat under Ex-serviceman
quota. His permanent home address at the time of entry into service was as under.
Home Address before joining Service.

Place: Signature of the Deputy Director

Date: Department of sainik Welfare and resettlement
(Dist)

--------oR--
CERTIFICATE

is to certify that Shri/Smt/Kum--- is an applicant for

the spouse/son/daughter of No._

ls Rank_ Name
Who died/disabled while in seervice according to the certificate issued by the Defence
Authority. He died/ disabled on

The home address of the Individual at the time of joininf Defence as per records is as under

Place: Signature of the Deputy Director

Date: Department of sainik Welfare and resettlement
(Dist)