DECLARATION OF BRIDEGROOM & BRIDE We declare that the particulars furnished above are true and correct. This is the first claim and not claimed previous from any other District. In case the claim proved false at later date we are liable for any action taken by the Government and the amount payable recovered from us immediately. Signature of (1) ____________________ (Disabled person) Both Persons (2) ____________________ (Normal person) NOTE: Following shall be enclosed to the application. 1. Medical Certificate are obtained from Medical Board. a) Orthopaedically surgeon for Orthopaedically handicapped. b) Opthalmologist for Visually Handicapped. c) E.N.T. Surgeon for Deaf & Mute. 2. Wedding Card. 3. Three copies of photos of couple attested by a Gazetted Officer. 4. Marriage Certificate obtained from a Gazetted Officer. (In the prescribed Proforma) C E R T I F I C A T E O F M A R R I A G E Certificate that Sri/Smt __________________________________________ S/o,D/o ______________________________________________ if Orthopaedically Handicapped, Deaf and Mute / Blind the resident of ______________________ has married Sri/Smt _________________________________________________ S/o, D/o ___________________________________________ is a normal person. The resident of __________________________________________________ on date ______________ and this is the first marriage for both of them. Date: Signature of the Gazetted Place: Officer with Seal. CERTIFICATE OF ASST. DIRECTOR FOR THE WELFARE OF HANDICAPPED Certified that Sri/Smt _______________________ has applied for the Incentive Award for Marriage between Disabled and Normal person for the first time. He/She has not been paid previously as per the records available and photo to the couple is affixed against their name sin the Register maintained in this office. APPLICATION FORM FOR INCENTIVE AWARD FOR MARRIAGES BETWEEN DISABLED & NORMAL PERSONS Affix attested photo 1. Name of the Disabled Person 2. Father's Name 3. Nature of disability (Specify percentage of disability in case of Orthopaedically Handicapped 4. (a) present Address : : : 5.If employed give full details of employment including monthly income 6. Name of Normal person 7. Father's Name 8. If employed give full details of employment including monthly income. 9. (a) Present Address 10. Date of Marriage 11. Place of Marriage 12. Signature of : : : Date : Place: Office of the Assistant Director Welfare of Handicapped Hyderabad District. (b) Permanent Address (b) Permanent Address (1) Disabled person (2) Normal Person
