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Pwds needing High Support
Applicant Name
Aadhar No
DOB
AGE
Gender
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Male
Female
Other
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Mobile No
Father's/Spouse Name
Social Category(Caste)
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General
OBC
SC
ST
MINORITY
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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
Block/ Muncipality:
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Gp/Ward:
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Village
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House No/Plot No
PIN
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 percentage
UDID Certificate Number
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Permanent
Temporary
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