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: 081020000024100002797 Enrolment Date: 01/10/2024
PERSONAL DETAILS
Full Name in Regional
Name of Applicant Dilshad Qureshi िदलशाद कुरै शी
Language
Applicant Father's Name Akil Qureshi Applicant Mother's Name Afsana
Date of Birth 01/02/2005
Mobile Number 8949803963 E-Mail Id
Gender Male Category General
Relation with PwD
Blood Group Other
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / Akil Caretaker / Attendant / 6378441157
Related Related
Optional Details
Below Rupees 10000 Per
Personal Income (Annual) Highest Qualification Primary
Annum
Employed or Unemployed Unemployed
Proof of Identity Card (See Instructions)
Identity Proof Aadhaar Card Aadhaar No. ********5390
Address of Correspondence
Address 300, Char Darwaza, Jaipur,
Jaipur Jaipur
Rajasthan 302002
Nature of Document Aadhaar card
for Address Proof
DISABILITY DETAILS
Do you have disability certificate? No Disability Type Locomotor Disability,Muscular Dystrophy
Disability Due To
Hospital Treating State / UTs Rajasthan Hospital Treating District Jaipur
Hospital Name SATELLITE BANI PARK
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This is computer generated receipt and does not require any signature.