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: 2725/00000/2401/0383387 Enrolment Date: 06/01/2024

PERSONAL DETAILS

Kishan Akhileshkumar
Name of Applicant आवे दक का नाम िकशन अिखले शकुमार यादव
Yadav

Applicant Father's Name Akhileshkumar Yadav Applicant Mother's Name Shyam Kumari

Date of Birth 11/07/2005 Age 18 Year(s)

yadavkishanakhileshkumar
Mobile Number 9890429802 E-Mail Id
@gmail.com

Gender Male Category OBC

Relation with PwD

Blood Group --------- Other
(Person with Disability)

Name of Guardian / Contact No. of Guardian /

Caretaker / Attendant / Father Caretaker / Attendant / 9890429802
Related Related

Optional Details

Personal Income (Annual) --------- Highest Qualification Higher Secondary

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

Proof of Identity Card (See Instructions)

Identity Proof Aadhaar Card Aadhaar No. 308553235984

Address of Correspondence

Address S No 46/3/9 Bharat Nagar, Nimbalkar Wasti, Near S K Enterprise, Katraj, Pune City, Pune, Maharashtra - 411046,
Gujar Nimbalkarwadi, Haveli, Pune, Maharashtra - 411046
Nature of Document for Aadhaar Card
Address Proof

DISABILITY DETAILS

Do you have disability certificate? No Disability Type Locomotor Disability

Disability Area ---------
Disability Due To Congenital
Hospital Treating State / UTs MAHARASHTRA Hospital Treating District PUNE
B J Government Medical College And Sassoon
Hospital Name
General Hospital Pune

ASSESSMENT
 Disability Type Sub Type Affected Part Diagnosis Remark
Congenital bilateral
ectrodactyly (Lobster
Claw Hands).
Congenital bilateral
Permanent disability.
Locomotor Disability ---------- Both hands ectrodactyly (Lobster
Permanent disability of
Claw Hands)
67% (sixty seven
percent). not likely to
improve.

VIEW RECOMMENDATION

Disability Disability Permanent / Reassessment Reassessment Reassessment

Disability Remark
Percent Condition Temporary Require Review Year Review Month
Locomotor 67 (Sixty
---------- ---------- ---------- ---------- ---------- 67%
Disability Seven)

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