Department of Empowerment of Persons with Disabilities,
Ministry of Social Justice and Empowerment, Government of India
Disability Certificate
Issuing Medical Authority, Bengaluru Urban, Karnataka
Certificate No.: KA1890619530056884 Date: 02/03/2020
This is to certify that I/We have carefully examined Shri Chandrasekar K Son of Shri Kandhasamy Date of Birth
17/09/1953 Age 65 Year(s) Male, Registration No. 2918/00000/1905/2586140 resident of House No. 55/2, 6th
Main Road, 3rd Cross, Venkatappa Layout,, Sanjay Nagar - 560094 Sub District Bangalore North District
Bengaluru Urban State / UTs Karnataka
Whose photograph is affixed above, and I/We satisfied that:
(A) He is a case of Locomotor Disability
(B) The diagnosis in his case is POST GANGRENOUS BELOW KNEE AMPUTEE RIGHT AND LEFT FORE FOOT
AMPUTEE EXPECT GREAT AND 2ND TOE
(C) He has 70%(in figure) Seventy percent(in words) Permanent in relation to his (part of body) as per guidelines
(to be specified).
The applicant have been submitted the following document(s) as proof of residence
Nature of Document(s): Aadhaar card
Signature / Thumb impression of the Person With Disability
Signatory of notified Medical Authority Member
Issuing Medical Authority, Bengaluru Urban, Karnataka
This Card/Certificate is meant to certify the disability of the person and is not an instrument for ID/Address Proof for any
purpose.
