The annual report prepared by the State Commissioner for persons with Disabilities shall include a chapter on the State Fund.
By Order and in the Name of Lieutenant Governor of National Capital Territory of Delhi, Dr. A. MADHAVI, Sr. Superintendent (Persons with Disabilities Welfare Branch) FORM- A Application for Certificate of Registration [See rule 22(1) of Delhi Rights of Persons with Disabilities Rules, 2018]
(1) Name of the Organization :
___________________________________________________________
(2) Institution/ Project in respect of which application is made : _________________________ a. Address & Ph. No. (Registered Office ) : _____- ____________________________________________________________ b. Name of Project Office :_ _________________________________________________________________ c. Address (Project Office) : _____- _____________________________________________________________ d. Phone /Fax/Telex/(Office)/email id : __________________________ (Project) 46 DELHI GAZETTE : EXTRAORDINARY PART IV]
(3) (i) Name of the Act under which the organization is registered:______________________
(ii) Registration No. and date of registration: _________________________________________ (Please attach a photocopy)
(4) Memorandum of Association and Bye-laws of the organization: (Please attach a photocopy)
(5) Name, address, occupation and other particulars of the members of the Board of Management/Governing Body of the organization: _____________________________________________
(6) Present Activities of the Organization:
(7). List of documents to be attached:
(a) A copy of the annual reports for the last three years,
(b) Audited Statement of accounts (receipt and payment , income and expenditure and Balance sheet) for the last three financial years duly certified by Chartered Accountant with membership no. and seal.
(8) Nature of the organisation (Please indicate precisely :
whether it is educational or training or residential institution or a workshop for visually/ hearing impaired/physically challenged /mentally Challenged persons, etc.)
(9) Whether the institution is located in its own building /Rented building/ building allotted by any agency):
(Necessary evidence to be attached).
(10) If hostel is maintained, then number of hostellers :
(11) Details of barrier free environment for persons with disabilities :
(a) Area of the Building _________________
(b) Rooms available for activities/residential use _______________ ( c) Rooms for administrative use: _________________
(d) No. of accessible toilets _________________
(e) Other accessible features available (lift/ramp/tactile path/railing): ________________
(f) Whether accessible transport facility available: ____________________________ If yes, give details :__________________________________
(12)Details of staff employed by the institution in following format;
Name M/F Age Educational Qualification Address Contact Details Responsibility Salary Aadhaar No.
RCI registration no. (enclosed copy of RCI registration certificate) Note: In case of foreign volunteers, verification of credentials and criminal record from country of origin or birth through the police is mandatory.
(13) Details of covered /proposed beneficiaries to be covered by the institution and nature of disability in following format;
Sl.No. Name Father’s name M/F Age Address Contact Details Type of Disability Aadhaar No.
(Name, Designation and signature of the authorized signatory with seal ) [PART IV DELHI GAZETTE : EXTRAORDINARY 47 Form-B Government of National Capital Territory of Delhi Department of Social Welfare, Government Lady Noyce School Complex, Delhi Gate, New Delhi-110002 Certificate of Registration [Issued under the provision of rule 22(8)(a) of Delhi Rights of Persons with Disabilities Rules, 2018] Registration No. ……………………… Date:
Certified hereby that ___________________________________(Name of the NGO)as registered under Society Registration Act, 1860/Trust Act has completed all the formalities and procedures for issuance of registration certificate under sub –section( 2) of section 51 of the Rights of Persons with Disabilities Act, 2016.
This registration certificate issued on date ___________________ is valid till date______________.
1. Name and registered address of the organization:________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________
2. Name and address of the branch/projects of the organization:_______________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________
3. Full Name and Address of the Authorized representative of the Organization :__________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ This registration certificate is issued on Day _____________ Month________ Year____________ by the authorized signatory /competent authority of the Department of Social Welfare, Government of National Capital Territory of Delhi subject to compliance of the Terms and Conditions laid down herein, by the authorized representative of the organization.
The holder of the certificate of Registration shall apply for renewal of the certificate not less than sixty days before the date of expiry of the period of validity.
Signature and Seal of the Competent Authority Department of Social Welfare, Government of National Capital Territory Terms and Conditions of Registration Certificate
(1) The holder of this Certificate of Registration shall provide the beneficiaries of the organization with :-
(a) Adequate accessible accommodation and accessible sanitary conditions.
(b) Proper medical care and treatment.
(c) Facilities for recreation.
(d) Education and vocational or professional training.
(2) Residential premises, if any, for girls shall be separate from residential premises for boys.
48 DELHI GAZETTE : EXTRAORDINARY PART IV]
(3) The holder of this Certificate of Registration shall not employ or shall allow others to employ any beneficiary of the organization for any private purposes whether of own or others.
(4) The incharge/Project Manager shall maintain a visitor’s book, which shall contain the records of visit to the organization by the competent authority or any person authorized by it to inspect the organization. The incharge/Project Manager shall furnish to the competent authority a copy of remarks if any recorded in the said book within seven days from the date of visit, as also compliance report if any.
(5) The holder of this Certificate of Registration shall facilitate inquiry in accordance with provisions of the Rights of Persons with Disabilities Act 2016 by the Competent Authority or any person authorized by it.
(6) The certificate shall be exhibited in a conspicuous place in the office of the incharge/Project Manager.
(7) Any change in the office bearers shall be immediately intimated to the Competent Authority and the concerned District Social Welfare Officer.
(8) The holder of this Certificate of Registration shall ensure the safety and security of the beneficiaries against all forms of abuse, violence and exploitation as per Section 6 & 7 of the Rights of Persons with Disabilities Act’
2016.
(9) The holder of this certificate should ensure that in case of foreign volunteers, verification of credentials and criminal record from country of origin or birth through the police has been conducted and verified before giving permission for visit/stay in the institution/homes.
(10) The holder of this Certificate of Registration shall ensure adequate safety measures. against man made /natural disasters such as fire, earthquake, flood etc.
(11) The holder of this Certificate of Registration shall abide by the conditions of this Certificate of Registration and the provisions of the Rights of Persons with Disabilities Act’ 2016 and the rules/regulations and orders made there under.
Form-C Government of National Capital Territory of Delhi Department of Social Welfare, Government Lady Noyce School Complex, Delhi Gate, New Delhi-110002 Refusal to grant Certificate of Registration [Issued under the provision of rule 22(8)(b) of the Delhi Rights of Persons with Disabilities Rules, 2018] Date:…………… Whereas Sh.----------------------------( Authorised representative ) of the organization-(Name and registered address of the organization)---------------------------------- has applied for issuance of registration certificate under sub –section( 2) of section 51 of the Rights of Persons with Disabilities Act, 2016 for the project (Name and address of the branch/projects of the organization )---------------------------------, and whereas the competent authority, not being satisfied upon causing enquiries to be made about the eligibility of the organization for such issuance due to the following deficiencies:
1.
2.
3.
hereby refuses to grant such certificate of registration under sub rule (8) of rule 22 of the Delhi Rights of Persons with Disabilities Rules 2018 and directs that a fresh application be submitted through authorized representative of the organization after removal of the said deficiencies.
Signature and Seal of the Competent Authority Department of Social Welfare, Government of National Capital Territory [PART IV DELHI GAZETTE : EXTRAORDINARY 49 Form-D Government of National Capital Territory of Delhi Department of Social Welfare, Government Lady Noyce School Complex, Delhi Gate, New Delhi-110002 Revocation of Certificate of Registration [Issued under the provision of Rule 22(8)( c) of the Delhi Rights of Persons with Disabilities Rules, 2018] Date:
Whereas Sh.----------------------------( Authorized representative ) of the organization- (Name and registered address of the organization)---------------------------------- had applied for issuance of / renewal of registration certificate under sub – section( 2) of section 51 of Rights of Persons with Disabilities Act, 2016 for the project (Name and address of the branch/projects of the organization )---------------------------------, and whereas the competent authority, had issued the certificate of Registration under the relevant provisions of the Act and Rules on date------------- and whereas now, the competent authority has reason to believe that the holder of the certificate of Registration hada) made a statement in relation to the application for the issue / renewal of the registration certificate under sub section(1) of Section 51 of the Rights of Persons with Disabilities Act 2016 , which is incorrect or false in material particulars: or b) committed or has caused to be committed breach of rules or Terms and conditions subject to which the certificate was granted.
Now therefore revokes the certificate of Registration granted to the organization under the provision of sub rule(8) of rule 22 of the Delhi Rights of Persons with Disabilities Rules 2018.
Signature and Seal of the Competent Authority Department of Social Welfare, Government of National Capital Territory FORM–I (Persons with Disabilities Employer’s Return) [See Rule 17 (1) of Delhi Rights of Persons with Disabilities Rules, 2018 and Rule 13(1) of Rights of Persons with Disabilities Rules, 2017] Six monthly return to be submitted to the Special Employment Exchange for the half year ended………………………………………………………………… Name and Address of the Employer…………………………………………………… Whether - Head Office…………………………………………… Branch Office…………………………………… Nature of business/principal activity:…………………………………………………
1. Employment
(a) Total number of persons including working proprietors/ partners/ commission agents/contingent paid and contractual workers, on the pay rolls of the Government establishment excluding part-time workers and apprentices. (The figures should include every person whose wage or salary is paid by the Government establishment).
50 DELHI GAZETTE : EXTRAORDINARY PART IV] On the last working day of the previous half year Blindness and low vision Deaf and hard of hearing Locomotor disability including cerebral palsy, leprosy cured, dwarfism, acid attack victims and muscular dystrophy Autism, intellectual disability, specific learning disability and mental illness Multiple disabilities from amongst persons with disabilities under columns (1) to (4) including deaf-blindness
(1) (2) (3) (4) (5) On the last working day of the half year under report Blindness and low vision Deaf and hard of hearing Locomotive disability including cerebral palsy, leprosy cured, dwarfism, acid attack victims and muscular dystrophy Autism, intellectual disability, specific learning disability and mental illness Multiple disabilities from amongst persons with disabilities under columns (1) to (4) including deaf-blindness
(1) (2) (3) (4) (5) Men with disability Women with disability Total ------------------------------------------------------
(b) Please indicate the main reasons for any increase or decrease in employment if the increase or decrease is more than 5% during the half year.
2. Vacancies.- Vacancies carrying total emoluments as per prevailing minimum wage per month and of over six months duration.
(a) Number of vacancies occurred and notified during the half year and the number filled during the half year (Separate figures may be given for men with disability and women with disability).
Number of vacancies which come within the purview of the Act Occurred Notified Filled Source (Describe the source from which filled) Local/Special Employment Exchange General Employment Exchange
(b) Reasons for not notifying all vacancies occurred during the half year under report vide 2(a) ………………………
3. Manpower Shortages Vacancies/posts unfilled because of shortage of suitable applicants.
Name of the occupation Number of unfilled vacancies/posts disability wise or Designation essential qualification essential experience/experience of the posts not necessary 1 2 3 4 [PART IV DELHI GAZETTE : EXTRAORDINARY 51 Please list any other occupations for which this Government establishment had recently any difficulty in obtaining suitable applicants.
Signature of employer Dated…….
To The Employment Exchange ----------------------------- ------------------------------ Note.- This return relates to half yearly ending 31st March/30th September and shall be rendered to the local Special Employment Exchange within thirty days after the end of the half year concerned.
Form -II (Persons with Disabilities Employer’s Return) [See rule 17 (1) of Delhi Rights of Persons with Disabilities rules, 2018 and rule 13(1) of Rights of Persons with Disabilities rules, 2017] Occupational return to be submitted to the local Special Employment Exchange once in two years.
Name and Address of the Employer………………………………………………………………….
Nature of business______________________________ (describe what the Government establishment makes or does as its principal activity)
1. Total number of persons on the pay rolls of the Government establishment on (Specify date)…………(This figure should include every person whose wage or salary is paid by the Government establishment)(Separate figures for men with disability and women with disability may be given).
2. Occupational classification of all employees as given in item -1 above.
(please give below the number of employees in each occupation separately) Occupation Number of Employees Use exact terms Men with disability Women with disability Total Such as Engineer (Mechanical);
Please give as far as possible approximate number of vacancies in each occupation you are likely to fill during the next calendar year due to retirement.
Teacher (domestic/science);
Officer on duty (actuary);
Assistant Director (Metallurgist);
Scientific Assistant (chemist); Research Officer (economist);
Instructor (carpenter);
Supervisor(tailor);
Fitter(internal 52 DELHI GAZETTE : EXTRAORDINARY PART IV] Combustion engine);
Inspector Sanitary); Superintendent Office; apprentice Electrician).
Total Dated……………………….. Signature of employer To The Employment Exchange (please fill in here the address of your local Special Employment Exchange) Note: Total of column 5 under item 2 should correspond to the figure given against item-1.
FORM–III (Persons with Disabilities Employer’s Return) [See rule 18 of Delhi Rights of Persons with Disabilities Rules, 2018 and Rule 14 of Rights of Persons with Disabilities Rules, 2017] Name and Address of the Employer…………………………………………………… Whether - Head Office…………………………………………… Branch Office…………………………………… Nature of business/principal activity: …………………………………… Total number of persons on the pay rolls of the Government establishment (This figure should include every person whose wage or salary is paid by the Government establishment).
Total number of persons with disabilities (disability-wise) on the payroll of the Government establishment (This figure should include every person with disability whose wage or salary is paid by the Government establishment).
(a) Occupational qualification of all employees (Please give below the number of employees in each occupation separately.
Occupation Number of Employees Use exact terms Men with disabilities Women with disabilities Total Such as Engineer (Mechanical);
Please give as far as possible approximate number of vacancies in each occupation you are likely to fill during the next calendar year due to retirement.
Teacher (domestic/science); Officer on duty (actuary);
Assistant Director (Metallurgist);
Scientific Assistant (chemist); Research Officer (economist); Instructor (carpenter);
Total [PART IV DELHI GAZETTE : EXTRAORDINARY 53
(b) Please indicate the main reasons for any increase or decrease in employment if the increase or decrease is more than 5% during the half year…………………………..
2. Vacancies: Vacancies carrying total emoluments as per prevailing minimum wage per month and of over six months duration.
(a) Number of vacancies occurred and notified during the half year and the number filled during the half year.
Number of vacancies which come within the purview of the Act Occurred Notified Filled Sources Local Special Employment Exchange General employment (Describe the source form which filled 1 2 3 4 5 Total
(b) Reasons for not notifying all vacancies occurred during the half year under report vide (a) 2……………….above.
3. Manpower shortages Vacancies/posts unfilled because of shortage of suitable applicantions Name of the occupation or Number of unfiled vacancies/posts Designation of the posts ----------------------------------------------------------- Essential Essential Experience qualification experience Not necessary
1. 2. 3. 4.
Please list any other occupations for which this Government establishment had recently any difficulty in obtaining suitable applicants.
Signature of employer Dated….
FORM- IV Application for Obtaining Certificate of Disability by Persons with Disabilities [See Rule 24(1) of Delhi Rights of Persons with Disabilities Rules, 2018 and Rule 17(1) of Rights of Persons with Disabilities Rules, 2017]
(1) Name : ________________ __________________ _________________ (Surname) (First Name) (Middle Name)
(2) Father's Name : ___________________ Mother's Name: ________________
(3) Date of Birth : __________/____________/_____________ (Date) (Month) (Year) 54 DELHI GAZETTE : EXTRAORDINARY PART IV]
(4) Age at the time of application : ___________________ years
(5) Sex: Male/Female/Transgender: __________________
(6) Address:
(a) Permanent address (b) Current Address (i.e. for communication) __________________ __________________ __________________ __________________
(c) Period since when residing at current address: __________________
(7) Educational Status (please tick as applicable)
(i) Post Graduate
(ii) Graduate
(iii) Diploma
(iv) Higher Secondary
(v) High School
(vi) Middle
(vii) Primary
(viii) Non-literate
(8) Occupation: ____________________________________
(9) Identification marks: (i) __________________ (ii) __________________
(10) Nature of disability :
(11) Period since when disabled: From Birth/since year: ________________
(12) (i) Did you ever apply for issue of a certificate of disability in the past ___ (yes/no)
(ii) If yes, details:
(a) Authority to whom and district in which applied : ________
(b) Result of application : ____________________________________
(13) Have you ever been issued a certificate of disability in the past? If yes, please enclose a true copy.
__________________________________________________________________________________________ Declaration: I hereby declare that all particulars stated above are true to the best of my knowledge and belief, and no material information has been concealed or misstated. I further state that if any inaccuracy is detected in the application, I shall be liable to forfeiture of any benefits derived and other action as per law.
____________________ (signature or left thumb impression of person with disability, or of his/her legal guardian in case of persons with intellectual disability, autism, cerebral palsy and multiple disabilities, etc) Date :
Place:
Enclosures:
1. Proof of residence (Please tick any one, as applicable).
(a) Ration card,
(b) Voter identity card,
(c) Driving license,
(d) Bank passbook,
(e) PAN card,
(f) Passport, [PART IV DELHI GAZETTE : EXTRAORDINARY 55
(g) Telephone, electricity, water and any other utility bill indicating the address of the applicant,
(h) A certificate of residence issued by a Panchayat, municipality, cantonment board, any gazetted officer, or the concerned Patwari or Head Master of a Government school,
(i) In case of an inmate of a residential institution for persons with disabilities, destitute, mentally ill, and other disability, a certificate of residence from head of such institution.
(j) Aadhaar number or Aadhaar enrollment number, if any.
2. Two recent passport size photographs ---------------------------------------------------------------------------------------------- (For office use only) Date:
Place: Signature of issuing authority Stamp Form-V Certificate of Disability (In cases of amputation or complete permanent paralysis of limbs or dwarfism and in case of blindness) [See Rule 26(1) of Delhi Rights of Persons with Disabilities Rules, 2018 and Rule 18(1) of Rights of Persons with Disabilities Rules, 2017] (Name and Address of the Medical Authority issuing the Certificate) Recent passport size attested photograph (Showing face only) of the person with disability.
Certificate No. Date:
This is to certify that I have carefully examined Shri/Smt./Kum.
____________________________son/wife/daughter of Shri __________________ Date of Birth (DD/MM/YY) ____________ Age ______ years, male/female __________________ registration No. ______________permanent resident of House No. ___________ Ward/Village/Street __________________ Post Office _______________ District __________ State ________________, whose photograph is affixed above, and am satisfied that:
(A) he/she is a case of:
• locomotor disability • dwarfism • blindness (Please tick as applicable) (B) the diagnosis in his/her case is __________________ (A) he/she has ________ % (in figure) __________________ percent (in words) permanent locomotor disability/dwarfism/blindness in relation to his/her ______ (part of body) as per guidelines ( ……………number and date of issue of the guidelines to be specified).
56 DELHI GAZETTE : EXTRAORDINARY PART IV]
2. The applicant has submitted the following document as proof of residence:- Nature of Document Date of Issue Details of authority issuing certificate (Signature and Seal of Authorised Signatory of notified Medical Authority) Signature/thumb impression of the person in whose favour certificate of disability is issued Form - VI Certificate of Disability (In cases of multiple disabilities) [See Rule 26(1) of Delhi Rights of Persons with Disabilities Rules, 2018 and Rule 18(1) of Rights of Persons with Disabilities Rules, 2017] (Name and Address of the Medical Authority issuing the Certificate) Recent passport size attested photograph (Showing face only) of the person with disability.
Certificate No. Date:
This is to certify that we have carefully examined Shri/Smt./Kum.
_____________________________________son/wife/daughter of Shri _____________________________________Date of Birth (DD/MM/YY) ____________ Age _____ years, male/female ______________.
Registration No. _______________ permanent resident of House No. ____________ Ward/Village/Street ____________ Post Office ____________ District ____________ State ____________, whose photograph is affixed above, and am satisfied that:
(A) he/she is a case of Multiple Disability. His/her extent of permanent physical impairment/disability has been evaluated as per guidelines (……………number and date of issue of the guidelines to be specified) for the disabilities ticked below, and is shown against the relevant disability in the table below:
S. No. Disability Affected part of body Diagnosis Permanent physical impairment/mental disability (in %)
1. Locomotor disability @
2. Muscular Dystrophy
3. Leprosy cured
4. Dwarfism
5. Cerebral Palsy
6. Acid attack Victim [PART IV DELHI GAZETTE : EXTRAORDINARY 57
7. Low vision #
8. Blindness #
9. Deaf £
10. Hard of Hearing £
11. Speech and Language disability
12. Intellectual Disability
13. Specific Learning Disability
14. Autism Spectrum Disorder
15. Mental illness
16. Chronic Neurological Conditions
17. Multiple sclerosis
18. Parkinson’s disease
19. Haemophilia
20. Thalassemia
21. Sickle Cell disease (B) In the light of the above, his/her over all permanent physical impairment as per guidelines (……….number and date of issue of the guidelines to be specified), is as follows : - In figures : - ------------------ percent In words :- --------------------------------------------------------------------------- percent
2. This condition is progressive/non-progressive/likely to improve/not likely to improve.
3. Reassessment of disability is :
(i) not necessary, or
(ii) is recommended/after ............... years ................ months, and therefore this certificate shall be valid till ---- - ----- ------ (DD) (MM) (YY) @ e.g. Left/right/both arms/legs # e.g. Single eye £ e.g. Left/Right/both ears
4. The applicant has submitted the following document as proof of residence:- Nature of document Date of issue Details of authority issuing certificate
5. Signature and seal of the Medical Authority.
Name and Seal of Member Name and Seal of Member Name and Seal of the Chairperson Signature/thumb impression of the person in whose favour certificate of disability is issued.
58 DELHI GAZETTE : EXTRAORDINARY PART IV] Form – VII Certificate of Disability (In cases other than those mentioned in Forms V and VI) (Name and Address of the Medical Authority issuing the Certificate) (See Rule 26(1) of Delhi Rights of Persons with Disabilities Rules, 2018 and Rule 18(1) of Rights of Persons with Disabilities Rules, 2017) Certificate No. Date:
This is to certify that I have carefully examined Shri/Smt/Kum__________________________________________ son/wife/daughter of Shri __________________________________________ Date of Birth (DD/MM/YY)_____ _____ ____ Age _______ years, male/female _________ Registration No. __________________ permanent resident of House No. ___________ Ward/Village/Street _____________________ Post Office _________________ District ________________ State ____________________, whose photograph is affixed above, and am satisfied that he/she is a case of ______________________________ disability. His/her extent of percentage physical impairment/disability has been evaluated as per guidelines (…………………………..number and date of issue of the guidelines to be specified) and is shown against the relevant disability in the table below:- S. No. Disability Affected part of body Diagnosis Permanent physical impairment/mental disability (in %)
1. Locomotor disability @
2. Muscular Dystrophy
3. Leprosy cured
4. Cerebral Palsy
5. Acid attack Victim
6. Low vision #
7. Deaf €
8. Hard of Hearing €
9. Speech and Language disability
10. Intellectual Disability
11. Specific Learning Disability
12. Autism Spectrum Disorder
13. Mental illness
14. Chronic Neurological Conditions Recent passport size attested photograph (Showing face only) of the person with disability [PART IV DELHI GAZETTE : EXTRAORDINARY 59
15. Multiple sclerosis
16. Parkinson’s disease
17. Haemophilia
18. Thalassemia
19. Sickle Cell disease (Please strike out the disabilities which are not applicable)
2. The above condition is progressive/non-progressive/likely to improve/not likely to improve.
3. Reassessment of disability is:
(i) not necessary, or
(ii) is recommended/after _______ years ______________ months, and therefore this certificate shall be valid till (DD/MM/YY) ____ ____ ____ @ - eg. Left/Right/both arms/legs # - eg. Single eye/both eyes € - eg. Left/Right/both ears
4. The applicant has submitted the following document as proof of residence:- Nature of document Date of issue Details of authority issuing certificate (Authorised Signatory of notified Medical Authority) (Name and Seal) Countersigned {Countersignature and seal of the Chief Medical Officer/Medical Superintendent/ Head of Government Hospital, in case the Certificate is issued by a medical authority who is not a Government servant (with seal)} Note.- In case this certificate is issued by a medical authority who is not a Government servant, it shall be valid only if countersigned by the Chief Medical Officer of the District.
Signature/thumb impression of the person in whose favour certificate of disability is issued 60 DELHI GAZETTE : EXTRAORDINARY PART IV] FORM - VIII [Intimation of rejection of Application for Certificate of Disability] [See Rule 26 (4) of Delhi Rights of Persons with Disabilities Rules, 2018 and Rule 18(4) of Rights of Persons with Disabilities Rules, 2017] No. ________________________ Dated :
To, (Name and address of applicant for Certificate of Disability) Sub: Rejection of Application for Certificate of Disability Sir/ Madam, Please refer to your application dated______ for issue of a Certificate of Disability for the following disability:
_________________________________________________
2. Pursuant to the above application, you have been examined by the undersigned/ Medical Authority on________ , and I regret to inform that, for the reasons mentioned below, it is not possible to issue a Certificate of Disability in your favour:
(i)
(ii)
(iii)
3. In case you are aggrieved by the rejection of your application, you may represent to________________ , requesting for review of this decision.
Yours faithfully, (Authorized Signatory of the notified Medical Authority) (Name and Seal) Uploaded by Dte. of Printing at Government of India Press, Ring Road, Mayapuri, New Delhi-110064 and Published by the Controller of Publications, Delhi-110054.
2018-12-29T18:44:51+0530 MANOJ KUMAR VERMA