New Application form for disability certificate & Identity card

kmaqly\oXn hIp∏v
tIcf kmaqly kpc£manj≥
At]£m \º¿: tSm°¨ \º¿:
Hm^okv BhiyØn\pam{Xw
t^mdw 1
hyXykvXtijnbp≈h¿°p≈ k¿´n^n°‰n\pw Xncn®dnb¬ Im¿Un\pap≈ At]£
(As per Sub Rule (2) of Rule 5 of the Persons with Disabilities (Equal Opportunities,
Protection of Rights and Full Participation) Kerala Ruels, 2000)
]pXnb At]£Iƒ
Xncn®dnb¬ Im¿Upw saUn°¬
k¿´n^n°‰pw ]pXpt° ≠h¿
40% Øn\v apIfn¬ saUn°¬
k¿´n^n°‰v am{Xw ssIhiap≈h¿
(\n_‘\Iƒ ]q¿Æambpw hmbn®tijw At]£ ]qcn∏n°pI)
Pn√ : ....................................................................................................
\nbak`m afiew : ....................................................................................................
tªm°v/hnt√Pv : ....................................................................................................
]©mbØv/ap≥kn∏men‰n/tIm¿∏tdjs‚ t]cv : ....................................................................................................
hm¿Uv \ºcpw t]cpw : ....................................................................................................
t]cpw ta¬hnemkhpw (aebmfØn¬)
t]cpw ta¬hnemkhpw (Cw•ojn¬)
t^m¨ \º¿ :
samss_¬ \º¿ :
*hnemkw sXfnbn°p∂ tcJIfpsS km£ys∏SpØnb Hcp ]I¿∏v At]£tbmsSm∏w Dƒs°m≈nt° ≠XmWv. (Ce£≥
Xncn®dnb¬ Im¿Uv, _mv ]mv_p°v, Fkv.Fkv.F¬.kn. _p°v, ss{UhnwKv ssek≥kv, B[m¿ Im¿Uv) ChbntesXnepw.

-
1 hn`mKw() tcJs∏SpØpI ]pcpj≥ kv{Xo
2. hbpw P\\ØobXnbpw
hbv Znhkw amkw h¿jw
3
*At]£Is\ {]Xn\n[m\w sNøpItbm H∏w hcnItbm
sNøp∂ amXm]nXm°ƒ/c£I¿Ømhv As√n¬
ASpØ _‘phns‚ t]cpw ta¬hnemkhpw.
sSet^m¨ \º¿:
samss_¬ \º¿:
4. hyXykvXtijnbpsS kz`mhw () tcJs∏SpØpI
Aÿn
kw_‘
amb _p≤n
ap´pIƒ
ImgvN
°pdhv
tIƒhn°pdhv/
kwkmctijn
°pdhv
am\
knI
tcmKw
_p≤n
amµyw
5.
hyXykvXtijn Xmev°menItam/ÿnctam ( )
tcJs∏SpØpI
Xm¬°menIw
ÿncw
6.
hyXykvXtijn P∑\mbp≈tXm/B¿÷nXtam
() tcJs∏SpØpI
P∑\mbp≈Xv
B¿PnXw
7.
hyXykvXtijn B¿PnXamsWn¬ hniZhnhcw
{]Xn]mZn°pI
8. sshhmlnI\ne Bhiyan√mØv sh´n°fbpI
(AhnhmlnX¿/hnhmlnX¿/hnhml_‘w
th¿s]SpØnbh¿/hn[h)
9.
hy‡nsb Xncn®dnbp∂Xn\p≈ ASbmf߃
(2 FÆw)
1.
2.
10. ªUv {Kq∏v () tcJs∏SpØpI
F _n F_n H +
˛
11. hnZym`ymk tbmKyX
12. sXmgn¬

13. At]£Is‚ {]Xnamkhcpam\w
14.
Fwtπmbvsa‚v FIvkvtN©n¬ t]cv cPnÿ
sNbvXn´pt ≠m
D≠ v
cPnkvt{Sj≥ \º¿ :
C√
15. kvs]jy¬ Fwtπmbvsa‚v cPnkvt{Sj≥ \º¿
16.
Xmƒ apºv hyXykvXtijn k¿´n^n°‰n\v
At]£n®n´pt ≠m?
17.
Xmƒ°v apºv kmaqlyt£ahIp∏n¬ \n∂p≈
saUn°¬ t_m¿Uv k¿´n^n°‰pw Xncn®dnb¬ Im¿Upw
e`n®n´pt ≠m?
F) Ds ≠n¬ hyXykvXtijnbpsS iXam\w/Imemh[n
D≠ v
C√
_n) hyXykvXtijn k¿´n^n°‰v XobXn
kn) Xncn®dnb¬ Im¿Uns‚ \º¿
18. At]£m XobXn
19. At]£Is‚ H∏v
kXy{]kvXmh\
Rm≥ ...............................................................................................................................................
.............................................................................. (t]cpw ta¬hnemkhpw) apIfn¬ {]kvXmhn®n´p≈ F√m Imcyßfpw
Fs‚ Adnhnepw DØahnizmkØnepw kXyamsW∂v CXn\m¬ km£ys∏SpØp∂p. ""t]¿k¨kv hnØv Untk_nen‰okv
(CuIz¬, Hm∏¿NyqWn‰okv, s{]m´£≥ Hm^v ssd‰vkv B‚v ^pƒ ]m¿´nknt∏j≥) BIvSv 1995 s‚ sk£≥ 59'' {]Imcw
sX‰mb hnhc߃ \¬In saUn°¬ t_m¿Uv k¿´n^n°‰pw Xncn®dnb¬ Im¿Upw Icÿam°p∂Xv Ip‰IcamsW∂v
F\n°v Adnhp≈XmIp∂p.)
XobXn: .............
At]£Is‚ H∏v/hnceSbmfw
At]£tbmsSm∏w D≈S°w sNtø≠ tcJIƒ
1. tdj≥Im¿Uv/Xncn®dnb¬ Im¿Uv/P\\k¿´n^n°‰v ChbntesXnepw tcJbpsS Kk‰Uv Hm^ok¿
km£ys∏SpØnb ]I¿∏v.
2. hyXykvXtijnbpsS k¿´^n°‰v Ds≠ n¬ AXns‚ Kk‰Uv Hm^ok¿ km£ys∏SpØnb ]I¿∏v.
3. hbv sXfnbn°m≥ Fkv.Fkv.F¬.kn. _p°v, Ce£≥ Xncn®dnb¬ Im¿Uv, B[m¿ Im¿Uv, P\\k¿´n^n°‰v
a‰v GsXnepw B[nImcnItcJbpsS Kk‰Uv Hm^ok¿ km£ys∏SpØnb ]I¿∏v.