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Application

This document is an acknowledgment of the registration of Vinod Balkrushna Katkar as a person with a disability, with an enrollment number and date provided. It includes personal details such as date of birth, contact information, and address, as well as information about his disability, which is a hearing impairment. The document is a computer-generated receipt and does not require a signature.

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chsexperts24
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6 views1 page

Application

This document is an acknowledgment of the registration of Vinod Balkrushna Katkar as a person with a disability, with an enrollment number and date provided. It includes personal details such as date of birth, contact information, and address, as well as information about his disability, which is a hearing impairment. The document is a computer-generated receipt and does not require a signature.

Uploaded by

chsexperts24
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

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: 27250000021030262486 Enrolment Date: 04/03/2021

PERSONAL DETAILS

Full Name in Regional


Name of Applicant Vinod Balkrushna Katkar
Language
Applicant Father's Name Balkrushna Katkar Applicant Mother's Name
Date of Birth 12/11/1964
Mobile Number 9921522781 E-Mail Id
Gender Male
Relation with PwD
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / Null Caretaker / Attendant /
Related Related

Proof of Identity Card (See Instructions)

Identity Proof Aadhaar No.

Address of Correspondence

Address Achary Atre Road, New Sainath


Laundry135, Bhoi Ali, Khandala,
Mawal Mawal Pune 410301 ,
Mawal Pune
Maharashtra 410301
Nature of Document
for Address Proof

DISABILITY DETAILS

Do you have disability certificate? No Disability Type Hearing Impairment


Disability Due To
Hospital Treating State / UTs Maharashtra Hospital Treating District Pune
Byramjee Jeejeebho (B.J) Government Medical College
Hospital Name
& Sassoon General Hospital, Pune

For more information please scan the QR


code to visit 'PwD Login'

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

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