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Disability Certification Guide

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shravan.hegde
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440 views1 page

Disability Certification Guide

Uploaded by

shravan.hegde
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

FORM NO.

10-IA
[See sub-rule (2) of rule 11A]

Certificate of the medical authority for certifying ‘person with disability’, ‘severe
disability’ for purposes of section 80DD and section 80U

Certificate No. 3MU044657


Date : 12/06/2023

This is to certify that Shri. Satyadeep N Hegde son of Shri. Narayan S Hegde , age
years 24 male residing at Ummachgi, Uttara Kannada, Reg No. 0013A262 is a person
with severe disability suffering from cerebral palsy and Loco Movement Disability.
2. This condition is progressive and not likely to improve.
3. Reassessment is recommend after a period of Nine Months.

Surgeon(Ramesh Kamat) Sd/-


Neurologist
(Neurologist/Pediatric Neurologist/Civil Surgeon/
Chief Medical Officer*)
Name : Ramesh Kamat
Address of Institution/Government hospital : TSS Government Hospital,Sirsi

Qualification/designation of specialist : Senior Neurologist, Neural Division

SEAL

Signature/Thumb impression* of the patient


Note : *Strike out whichever is not applicable.

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