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: 08240000023091681336 Enrolment Date: 25/06/2024
PERSONAL DETAILS
Full Name in Regional
Name of Applicant Imran Shah Imran Shah
Language
Applicant Father's Name Rafeek Hushain Applicant Mother's Name Mumtaz Banu
Date of Birth 05/07/1989
Mobile Number 8005595061 E-Mail Id ik786.ik18@[Link]
Gender Male Category OBC
Relation with PwD
Blood Group nul Self
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / Rafeek Hushain Caretaker / Attendant / 8290415876
Related Related
Optional Details
Below Rupees 10000 Per
Personal Income (Annual) Highest Qualification Post Graduate
Annum
Employed or Unemployed Unemployed
Proof of Identity Card (See Instructions)
Voter ID/Election Commission
Identity Proof Aadhaar No. ********9706
ID Card
Address of Correspondence
Address S/O RAFEEK
HUSSAIN,JAMAMasjid Ke Pass
Potlan,Potlan
Sahara Bhilwara
Rajasthan 311806
Nature of Document Aadhaar card
for Address Proof
DISABILITY DETAILS
Do you have disability certificate? Yes Disability Type Low Vision
Disability certificate uploaded? Yes Sr. No. / Registration No. of Certificate 1234
Date of Issuance of Certificate 01/06/2007 Details of Issuing Authority Medical Authority
Disability Percentage 50
Disability Due To Congenital
Hospital Treating State / UTs Rajasthan Hospital Treating District Bhilwara
Hospital Name Mahatma Gandhi Government Hospital Bhilwara
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