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Disability Registration/Enrolment Form
First Name (*)
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Middle Name
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Last Name
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Gender (*)
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Date of Birth (*)
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Marital Status
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Educational Qualification
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Occupation
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Address (*)
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State/UT
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City / District
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Town
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Village
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Pin Code
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Landline Number
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Mobile Number
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E Mail ID
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Type of disability (*)
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How the disability occurred (*)
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Have you received the disability certificate (*)
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Are you aware of various schemes available for disabled?
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