SSEPD::Social Security & Empowerment of Persons With Disabilities Department

Screen Reader Access
Help Line: 18003457150
Email Id: ssepdsec[dot]od[at]nic[dot]in

TRANSGENDER PERSON REGISTRATION FORM

Personal Details

Birth Name

Transgender Name

Transgender to be printed

Birth Name Transgender Name

Father's Name

Mother's Name

Guardian Name

Note: Enter atleast any one of these Names (Father's/Mother's/Guardian's)

Gender (Assigned at Birth)

Requested in the application

DOB

Photo

Upload Image

AGE

Mobile No

Educational Qualification

Name of Educational Institute

Birth Place

Whom do you stay or live with?

Specify Relation

Permanent Address

State

District

Sub-division

Address Type

Block

Village

ULB Type

Municipality

City/Town

Ward No

House No/Plot No

Current Address

Current Address Same As Permanent Address

State

District

Sub-division

Address Type

Block

Village

ULB Type

Municipality

City/Town

Ward No

House No/Plot No

Disability Details

Have Disability Certificate

Reg. No. of Certificate

Date of Issue

Disability Percentage (%)

Disability Type

Disability By Birth

Disability Due to

Source Of Income

Employment Details

Employed With

Employment Details

If you have a source of income, state your annual income:

Under Rs 1,00,000; Between Rs 1,00,001 and 3,00,000 Above Rs 3,00,000

Specify amount

Do you have any of the following documents?

1. Date of birth certificate

2. Aadhaar card

3. PAN card

4. Election Voter Identity Card

5. Ration card

6. Passport

7. Bank passbook

8. MNREGA Card

9. Any other (Please specify)

Medical history (for those applying under section 7 of the Transgender Persons (Protection of Rights) Act, 2019

Have you undergone any medical surgery in the context of transgender transition

Yes No

Name and complete address of the hospital

Name of the issuing authority

Document :

Upload Aadhar Scan Copy

Upload Age Proof

10th certificate/12th Certificate

College Degree Certificate

Bank Passbook (front page)

PAN Card/VOTER CARD

Affidavit

Back

Disclaimer: This is the Official Web Portal of Social Security & Empowerment of Persons With Disabilities Department(SSEPD), Odisha. SSEPD, Odisha is the owner of the Website, the contents in this Website is a collaborative effort of SSEPD, Odisha.

Developed by: