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Hearing Aid Registration Form – Gadchiroli
(श्रवणयंत्र नोंदणी फॉर्म - गडचिरोली)
लाभार्थ्याचे नाव
*
लाभार्थ्याचे आडनाव
*
मोबाईल नंबर
*
0 / 10
जिल्हा
*
जिल्हा
गडचिरोली
वय
*
Gender / लिंग
*
Male - पुरुष
Female - महिला
UDID Number
आधार कार्ड
*
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दिव्यांगत्वाचा प्रकार
*
Hearing Impairment
Other
दिव्यांग प्रमाणपत्र
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लाभार्थ्याचा फोटो
*
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राशन कार्ड
*
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उत्पन्न प्रमाणपत्र
*
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डॉक्टरांचे प्रिस्क्रिप्शन
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Submit
