Section 12-DP (E&R) Ordinance, 1981
Form NCRDP III/
Referred to in Rule 23(2)
REPORT OF ASSESSMENT REGISTERED DISABLED PERSONS
BY THE DISTRICT ASSESSMENT BOARD
1. Name of Disabled Person:____________________________________________________________
2. Father’s Name:____________________________________________________________________
3. Identity Card No:___________________________________________________________________
4. Date of Birth:______________________________________________________________________
5. Education Status:___________________________________________________________________
6. Permanent Address:_________________________________________________________________
Present address: ____________________________________________________________________
7. Previous Training Traders /Skills, if any___________________________________________________
8. Registration No. and Name of __________________________________________________________
Registration Department: ______________________________________________________________
Where Registered ____________________________________________________________________
9. Nature of disability Claimed_____________________________________________________________
Not Disabled / Disabled Person
Yes / No
10. Finding Board:
I. Fit to Work
If it Specify Job____________________________________________________________________
II. Prosthesis if any required____________________________________________________________
III. Training if any required for working (Specify)
Nature and duration________________________________________________________________
IV. Protective Equipment if any
Recommended avoid hazard__________________________________________________________
V. Medical Treatment if any
Recommended_____________________________________________________________________
Signature
Medical Superintendent
District Headquarters Hospital
Chairman of the Board_______________________________________________________________________
Vocational Guidance Officer /Lecturer
in Applied Psychology (Member)_______________________________________________________________
Representative of Technical Training
Wing of Directorate of Manpower
And Training (Member)______________________________________________________________________
District Officer,
Social Welfare (Secretary Member):____________________________________________________________
Section 12-DP (E&R) Ordinance, 1981
Form NCRDP-I
(Referred to in Rule 22)
(Insignia)
APPLICATION FOR REGISTRATION
Photograph
To
The Manager, Employment Exchange (Service),
Lahore
Dear Sir,
I requested that my name, address and qualification, as stated, may be registered on the register of
Employment Exchanges / Lahore for reference to Punjab Provincial Council for RDP as a disabled and that I
may be furnished with a Certificate of Registration.
1. Name in full (in blockletters)___________________________________________________________
2. Father’s Name:______________________________________________________________________
3. Type of Disability____________________________________________________________________
4. Date of Birth:_______________________________________________________________________
5. Marital Status_______________________________________________________________________
6. No. of dependent family______________________________________________________________
7. PermanentAddress:_____________________________________________________________________
__________________________________________________________________________________
8. Nationality_________________________________________________________________________
9. District of Domicile__________________________________________________________________
10. Religion__________________________________________________________________________
11. Particulars of qualification / Training
Name of the Examination Year Division / Subject / Certificate /
University / passed grade Training Diplomat
College / Degree
Institute
i. Literate upto
ii. Professional affiliation with status
12. Detail of Specialization (if any)__________________________________________________________
13. Detail of Occupation
Name of Post held From To Description of Last pay drawn
Employer Job with
achievement
14. Occupation / Job (for which
You consider yourself fit)
15. Any other information which
may be helpful in assessing
your suitability for a job.
16. I certify that the above particulars mentioned by me are correct. I undertake to inform the Manager,
Employment Exchange / Lahore where my name is registered as disabled person, of any change in my
postal address and profession. I further submit that I have neither APPLIED for registration nor am
already registered under the Ordinance with any other Employment Exchange / and shall not make any
application in this respect to any other employment Exchange / without intimation to the Employment
Exchange / to which the present application in being made.
Yours faithfully,
Signature of Attesting Officer Signature / thumb Impression_________________
With seal of office
Identity Card No.__________________________
Date_____________________________________
INSTRUCTIONS
As far possible this application form will be filled by the applicant in this own handwriting or typed. The form
and the certificates attached shall be attested by a Gazetted Officer of the provincial / Federal government.
Photostat attested copies are to be enclosed as under.
i) Copies of the Degrees / Diplomas/ Certificates and experience Certificates.
ii) Copies of the National Identity Card. In case, the identity card has not been obtained for any reason a
Photostat copy of the receipt of application form for identity card as issued by the Regional Officer
concerned may be submitted.
iii) Two copies of passport size photographs duly attested by a Gazetted Officer.
*******************************
OFFICE OF THE MANAGER EMPLOYMENT EXCHANGE SERVICE LAHORE FORM NO. NCRDP-II
(Referred to in Rule 22 (2)
Particulars of Disabled Persons Registered During the Fortnight Ending on _______________________________
Registration Date of Name of Father’s Name Date of Birth / Marital Status No. of Name of Qualification
No. Registration Disabled age of Dependent Extent of
Persons Disabled Family Disability
Person Members
1 2 3 4 5 6 7 8 9
Specialization Permanent Address Present Address Professional Occupation for which No. & Date of No. & Date of
Training / Affiliation with the Disabled Person is Reference to the the Advice of
Attainment Status a Candidate Council Council
10 11 12 13 14 15 16
Endorsement on the basis of Advice of the Council
17
Found Fit for the Recommended Not Found Fit for Not Found a
Job of Training in the any Job Disabled Person
Occupation of