Grievance - MLA Dharmasala

Disability Certificate

Letter No./Date

Full Name*

Father Name*

Email*

Mobile *

Gender

Male Female

District*

Zone *

Grampanchayat *

Village/Locality

Pin Code*

Address*

Aadhar Card *

Only .pdf,.doc,.docx,.xls,.xlsx and max size 2 MB files allowed.

Passport Photo *

Only .pdf,.doc,.docx,.xls,.xlsx and max size 2 MB files allowed.