(Download) Format for Disability Certificate

(Download) Format for Disability Certificate

(IN CASE OF AMPUTATION OR COMPLETE PERMANENT PARALYSIS OF LIMBS AND IN CASES OF BLINDNESS)

(See rule 4)

This is to certify that I have carefully examined Shri/Smt/Kum____________________Son/wife/daughter_________________________
Date of Birth________________ Age _______________years, male/Female___________
Registration No.___________________ permanent resident of Home No._____________________
Ward/Village/Street____________________Post Office_______________ District_____________
State____________________.

Whose photograph is affixed above, and an satisfied that :

(A) he/she is a case of:

  • locomotor disability
  • blindness

(Please tick as applicable)

(B) the diagnosis in his/her case _____________________________
(A) He/She has __________________________% (in figure)___________________ percent(in words) permanent physical impairment/blindness in relation to his/her__________________(part of body) as per guidelines(to be specified).

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Courtesy: SSC


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