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Application

This document is a registration acknowledgment for a person with a disability named Samir Mohabbat Ali Shah, enrolled on September 19, 2019. It includes personal details such as date of birth, contact information, and disability specifics, indicating a hearing impairment and speech and language disability. The document is generated by the Department of Empowerment of Persons with Disabilities, Government of India, and does not require a signature.

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sameershah86042
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8 views1 page

Application

This document is a registration acknowledgment for a person with a disability named Samir Mohabbat Ali Shah, enrolled on September 19, 2019. It includes personal details such as date of birth, contact information, and disability specifics, indicating a hearing impairment and speech and language disability. The document is generated by the Department of Empowerment of Persons with Disabilities, Government of India, and does not require a signature.

Uploaded by

sameershah86042
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: 27230000019091413137 Enrolment Date: 19/09/2019

PERSONAL DETAILS

Full Name in Regional


Name of Applicant Samir Mohabbat Ali Shah समीर शाह
Language
Applicant Father's Name Mohbbat Ali Applicant Mother's Name Mohbbat Ali
Date of Birth 01/01/1995
sameershah86042@gmail.c
Mobile Number 7905750439 E-Mail Id
om
Gender Male
Relation with PwD
Father
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / Mohabbat Ali Shah Caretaker / Attendant / 9702914803
Related Related

Proof of Identity Card (See Instructions)

Identity Proof Aadhaar Card Aadhaar No. ********8717

Address of Correspondence

Address Room No B-335,amboj


Wadi,azad Nagar,gate No 8,
Ambedkar Chowk,malwani,
Malad West,Malad
Borivali Mumbai Suburban
Maharashtra 400095
Nature of Document Aadhaar card
for Address Proof

DISABILITY DETAILS

Do you have disability certificate? No Disability Type Hearing Impairment,Speech and Language
Disability
Disability Due To Congenital
Hospital Treating State / UTs Maharashtra Hospital Treating District Mumbai Suburban
Dr. Rustam Narsi Cooper Municipal General Hospital,
Hospital Name
Mumbai Suburban

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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