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: 2911/00000/1908/0835300 Enrolment Date: 14/08/2019

PERSONAL DETAILS

Name of Applicant Gadeppa K ಅರರ ಸರು ಪ 

Applicant Father's Name Lavappa ತಂಯ ಸರು ಅರರ ಲವಪ

Applicant Mother's Name Nagamma ಯ ಸರು ಅರರ ಗಮ

Date of Birth 01/06/1987 Age 32 Year(s)

Gender Male E-Mail Id ---------

Mark of Identification No Category Obc

Mobile Number --------- Blood Group ---------

Marital Status ---------

Relation with PwD

---------
(Person with Disability)
Name of Guardian / Contact No. of Guardian /
Caretaker / Attendant / --------- Caretaker / Attendant / ---------
Related Related

Address of Correspondence

Address Main, Chitiginahalu, Havinahal Veerapura, Bellary , Bellary, Karnataka - 583113

ಸ ೦, ೕ, ನಳು, Havinahal Veerapura, Bellary , Bellary, Karnataka - 583113

Nature of Document for Aadhaar Card

Address Proof

Permanent Address

Address Main, Chitiginahalu, Havinahal Veerapura, Bellary , Bellary, Karnataka - 583113

ಸ ೦, ೕ, ನಳು, Havinahal Veerapura, Bellary , Bellary, Karnataka - 583113

Educational Details

Highest Qualification Middle/higher Primary

DISABILITY DETAILS

Do you have disability Yes Disability Type Locomotor Disability

certificate?
Disability certificate Sr. No. / Registration No.
Yes 22808
uploaded? of Certificate
Date of Issuance of Details of Issuing
27/04/2018 Chief Medical Office
Certificate Authority
Disability Percentage 45%
Disability Area --------- Disability Since 1987
Pension Card Number ---------
Hospital Treating
--------- Disability Due To Infection
Disability

EMPLOYMENT DETAILS

Employed or Unemployed Unemployed

Unemployed Since 01/08/2003
BPL / APL BPL
Personal Income (Annual) Below 10000

IDENTITY DETAILS

Identity Proof Aadhaar Card TIN (NPR) ---------

Aadhaar No. ---------

This is computer generated receipt and does not require any signature.