Ministry of Social Justice and Empowerment (MSJE)

Niramaya Application Form for Enrolment of PwD

General
Details

Legal Guardian
Details

Bank
Details

Attachments
Details

Enrolment Fee
Payment Details

Payment
Verification

Name of referring RO *:

The National Trust Registration Number of RO *:

Name of PwD *:

UDID Number :

Aadhar Number *:

Address and Contact Details

Address* :

State * :

District * :

City * :

Pin code *:

Contact No. (Mobile) *:

Date of Birth
(MM/DD/YYYY)*:

Gender *:

Disability Type * :

Disability % * :

Guardian Type *:

Name*:

Marital Status of PwD *:

Educational Qualifications of PwD *:

Please fill all * Marked mandatory fields