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: 19190000023070841197 Enrolment Date: 10/06/2024

PERSONAL DETAILS

Full Name in Regional

Name of Applicant Sanchari Mondal Sanchari Mondal
Language
Applicant Father's Name Samiran Mondal Applicant Mother's Name Triyasha Maity Mondal
Date of Birth 27/06/2018
Mobile Number 9679615524 E-Mail Id
Gender Female Category SC
Relation with PwD
Blood Group O+ Father
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / Samiran Mondal Caretaker / Attendant / 9679615524
Related Related

Optional Details

Personal Income (Annual) 0 Highest Qualification Primary

Employed or Unemployed Unemployed

Proof of Identity Card (See Instructions)

Identity Proof Aadhaar Card Aadhaar No. ********3340

Address of Correspondence

Address Laluageria,P.O.-Kishorchak,P.S.-
Moyna,Laluageria
Moyna Purba Medinipur
West Bengal 721642
Nature of Document Aadhaar card
for Address Proof

DISABILITY DETAILS

Do you have disability certificate? Yes Disability Type Intellectual Disability

Disability certificate uploaded? Yes Sr. No. / Registration No. of Certificate 950
Date of Issuance of Certificate 13/06/2023 Details of Issuing Authority Medical Authority
Disability Percentage 50
Disability Due To Congenital
Hospital Treating State / UTs West Bengal Hospital Treating District Purba Medinipur
Hospital Name District Hospital-Purba Medinipur (Tamluk)

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