Particulars of the Outstanding Creative Adult Persons with Disabilities for National Awards (Annexure-L)
|1.||Name of the person in Hindi & English (In BLOCK Capital letters)|
|2.||Residential address along with telephone no. and fax number, if any.|
|3.||E-mail address, if any|
|4.||Web-site address, if any|
|5.||Date of Birth/Age|
|6.||Nature and degree of disability (attach Disability Certificate)|
|9.||Particulars of the creative work for which award is to be considered|
Signature of the applicant with date
Signature, name & designation of the recommending authority with date
- Three copies of the photographs clearly showing disability of recommended person with disabilities, to be enclosed with bio-data.
- Application should be supported by a Medical certificate indicating the degree of total disability.