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Fresh Application For CWD Identity Card
Personal Details
Disability Details
Employment Details
Identity Details
Personal Details
Student Name
Applicant Middle Name
Applicant Surname
Father Name
Mother Name
Udise Code
Class
Section
Admission Number
Address
Date Of Birth
Age
Gender
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Male
Female
Other
Mobile Number Of Guardian
Alternate Mobile Number Of Guardian
Email ID
Mark of Identification
Applicant Image
Upload Image
Applicant Image
Upload Signature
Category
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General
OBC
SC
ST
MINORITY
Blood Group
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O+
O-
A+
A-
B+
B-
AB+
AB-
Marital Status
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Married
Unmarried
Widow
Divorced
Divorcee & Widower
Spouse Name
Relation with PwD (Person with Disability)
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Father
Mother
Uncle
Aunty
Sister
Daughter
Self
Son
Other
Name of Guardian / Caretaker / Attendant / Related person
Contact No. of Guardian / Caretaker / Attendant / Related person
Address for Correspondence
Address Line 1
Address Line 2
Address Line 3
State / UTs
ODISHA
District
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ANGUL
BALESHWAR
BARGARH
BHADRAK
BOLANGIR
BOUDH
CUTTACK
DEOGARH
DHENKANAL
GAJAPATI
GANJAM
JAGATSINGHAPUR
JAJPUR
JHARSUGUDA
KALAHANDI
KANDHAMAL
KENDRAPARA
KENDUJHAR
KHORDHA
KORAPUT
MALKANGIRI
MAYURBHANJ
NABARANGAPUR
NAYAGARH
NUAPADA
PURI
RAYAGADA
SAMBALPUR
SONEPUR
SUNDARGARH
Address Type
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ULB
Block
Block
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Municipality
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City / Sub District / Tehsil
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Village
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Pincode
Nature of Document for Address Proof
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Aadhaar Card
Address card with photo issued by Deptt. Of Posts, Govt. of India
Arms License
Cast and Domicile Certificate with address and photo issued by State G
Certificate of address having Photo issued by MP/MLA/Group-A Gazetted
Certificate of address issued by Village Panchayat head or its equival
Certificate of address with photo from Govt. recognized educational in
CGHS/ECHS Card
Credit Card Statement (not older than last three months)
Current Passbook of Post Office/any Schedule Bank
Driving License
Electricity Bill (not older than last three months)
Freedom Fighter Card with address
Income Tax Assessment Order
Kissan Passbook with address
Other (Domicile Certificate)
Passport
Pensioner’s Card with address
Photo Identity Card having address (of Central Govt./PSU or State Govt
Ration Card
Registered Sale/Lease Agreement
Sri Lankan Refugees Identity Card
Telephone Bill of Fixed line (not older than last three months)
Vehicle Registration Certificate
Voter Id
Water Bill (not older than last three months)
Upload Proof of Correspondence Address
(Only PDF less than 500 KB allowed)
Permanent Address
Address Line 1
Address Line 2
Address Line 3
State / UTs
ODISHA
District
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ANGUL
BALESHWAR
BARGARH
BHADRAK
BOLANGIR
BOUDH
CUTTACK
DEOGARH
DHENKANAL
GAJAPATI
GANJAM
JAGATSINGHAPUR
JAJPUR
JHARSUGUDA
KALAHANDI
KANDHAMAL
KENDRAPARA
KENDUJHAR
KHORDHA
KORAPUT
MALKANGIRI
MAYURBHANJ
NABARANGAPUR
NAYAGARH
NUAPADA
PURI
RAYAGADA
SAMBALPUR
SONEPUR
SUNDARGARH
Address Type
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ULB
Block
Block
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Municipality
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City / Sub District / Tehsil
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Village
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Pincode
Educational Details
Highest Qualification
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Primary
Middle/Higher Primary
Senior Secondary
Higher Secondary
Diploma
Graduate
PG Diploma
Post Graduate
Doctorate
Illiterate
Disability Details
Do you have disability certificate?
Yes
No
Disability Certificate
(Only PDF less than 500 KB allowed)
Sr. No. / Registration No. of Certificate
Date of Issuance of Certificate
Details of Issuing Authority
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Chief Medical Office
Medical Authority
Disability Percentage (%)
Disability Type
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Low Vision
Leprosy Cured Person
Locomotor Disability
Muscular Dystrophy
Acid Attack Victim
Dwarfism
Cerebral Palsy
Deaf
Speech & Language Disability
Hard of Hearing
Blindness
Mental Illness
Specific Learning Disability
Intellectual Disability
Autism Spectrum Disorder
Thalassemia
Sickle Cell Disease
Haemophilia
Parkinsons Disease
Multiple Sclerosis
Multiple Disability Including Deaf & Blindness
Chronic Neurological Conditions
No Disease
Others
Disability Since
Disability By Birth
Disability Since
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2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Disability Area
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Abdomen
Brain
Chest
Ears
Elbow
Foot
Hospital Treating Disability
Pension Card Number
Disability Due To
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Accident
Congenital
Diseases
Hereditary
Infection
Medicine
Hospital
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Capital
Apollo
Sparsh
Hi-Tech
SUM
AIIMS
AMRI
KIIMS
CARE
Aditya Care
Kalinga
Swarna
Sunshine
Neelachal
Employment Details
Employed or Unemployed
-Select-
Employed
Unemployed
Occupation
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Government Jobs
Professionals and Technical
Private Jobs
Service and Shops
Agriculture
Craft / Trade workers
Plant / Factory
Daily Wages Worker
PSU Jobs
Self Employed
Freelancer
Housewife
Students
Others
Other Occupation
Unemployed Since
BPL / APL
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NA
APL
BPL
Antodya
Personal Income (Annual)
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Below 10000
From 10000 To 100000
From 100000 To 500000
Above 500000
Father Income (Annual)
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Below 10000
From 10000 To 100000
From 100000 To 500000
Above 500000
Spouse Income (Annual)
-Select-
Below 10000
From 10000 To 100000
From 100000 To 500000
Above 500000
Identity Details
Identity Proof
-Select-
Aadhaar Card
Address card with photo issued by Deptt. Of Posts
Arms License
Cast and Domicile Certificate with photo issued by
Certificate of address having Photo issued by MP/M
Certificate of address with photo from Govt. recog
Certificate of photo identity issued by Village Pa
CGHS/ECHS Card
Current passbook of Post Office/any scheduled bank
Driving License
Freedom Fighter Card having photo
Income Tax PAN Card
Kissan Passbook having photo
Passport
Pensioner Card having photo
Photo Credit Card
Photo Identity Card (of Central Govt./PSU or State
Photo Identity Card issued by Govt. recognized edu
Ration Card with Photo
Smart card issued by CSD, Defence/ Paramilitary
Sri Lankan Refugees Identity Card
Voter ID/Election Commission ID Card
Identity Proof same as Proof of Correspondence Address
*
(Only PDF less than 500 KB allowed)
TIN (NPR)
Aadhar Number
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