APPLICATION FORM FOR ALLOWANCE FOR THE UNEMPLOYED DISABLED PERSONS 1. Name and address in full (Block Letter) 2. (a) Age (b) Sex 3. Date of birth 4. Father/Mother's name with address: 5. Married/Unmarried: 6. Nature of Disabilities (Medical certificate should be attached) 7. Educational qualification (attested copy of certificate/mark sheet to be enclosed) 8. Employed Exchange Registration No., if any 9. Unemployed Certificate from the DC of the District concerned attached 10. Schedule Caste/ Schedule Tribe (certificate should be attached) Signature of the Candidate
