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Disability Registration Receipt for Sanam Piyada

This document is an acknowledgment of registration for a person with disabilities, Sanam Piyada, with an enrollment number and date. It includes personal details such as family information, contact details, and addresses, as well as disability information indicating an intellectual 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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shahriyarsamim0
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224 views2 pages

Disability Registration Receipt for Sanam Piyada

This document is an acknowledgment of registration for a person with disabilities, Sanam Piyada, with an enrollment number and date. It includes personal details such as family information, contact details, and addresses, as well as disability information indicating an intellectual 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

shahriyarsamim0
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: 193040000024098080457 Enrolment Date: 24/09/2024

PERSONAL DETAILS

Full Name in Regional


Name of Applicant Sanam Piyada Sanam Piyada
Language
Applicant Father's Name Saidur Rahaman Piyada Applicant Mother's Name Rojiba Piyada
Date of Birth 14/06/2017
Mobile Number 8536058971 E-Mail Id
Gender Female Category General
Relation with PwD
Blood Group Self
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / Caretaker / Attendant /
Related Related

Optional Details

Personal Income (Annual) Highest Qualification Primary


Employed or Unemployed Unemployed

Proof of Identity Card (See Instructions)

Identity Proof Aadhaar Card Aadhaar No. ********5025

Address of Correspondence

Address Vill - Purkait Gheri Po -


Kumarapara Ps - Raidighi,
Mathurapur - Ii South 24
Parganas
West Bengal 743383
Nature of Document Certificate of address issued by Village Panchayat head or its equival
for Address Proof

DISABILITY DETAILS

Do you have disability certificate? No Disability Type Intellectual Disability


Disability Due To
Hospital Treating State / UTs West Bengal Hospital Treating District South 24 Parganas
Diamond Harbour Government Medical College &
Hospital Name
Hospital

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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