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(iii) Relationship Certificate for parents/family members of person with disability<br />

This is to certify that I, Mr./Ms./Mrs. ...................................................................................................<br />

is father/mother/sibling/grandfather/grandmother/other relation of the child with disability living in the same household<br />

as child/adult with disability. The name of the person with disability is Mr./Ms. ...........................................................<br />

S/He is ..........................................<br />

years of age and is attending school/other services at ....................................................................... (Name of<br />

the organisation)..<br />

<br />

Signature of Candidate<br />

Attested by Head of Organization where<br />

child is availing services<br />

Date : Date :<br />

Place : Place :<br />

Seal/Stamp)<br />

<br />

(Please get this relationship certificate attested by the head of the organisation, where the child with disability is<br />

attending school/services. Then get the certificate counter signed by a gazetted officer. In case the child with<br />

disability is not attending any school/services, get this certificate signed by a gazzeted officer only.<br />

Sign and stamp of gazetted officer<br />

<br />

<br />

(iv) Disability Certificate for Learners with disability<br />

In case you are a person with disability, attach an attested copy of your disability certificate, issued by competent<br />

authority.<br />

68

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