Beneficiary Registration
Note:
Responsible person should fill the form.
All fields marked with asterik (
*
) are mandatory.
Registration Steps
You cannot edit the details, once you have continue to the next step.
After submitting the Registration Form, an OTP verification will be sent to your Entered Mobile no.
Once ALIMCO approves your request, you will get a message as your
Registration is Approved.
Beneficiary Details
UDID Number / Disability ID
Aadhaar Card Number
*
Mobile Number
*
Personal Details
Beneficiary's first Name
*
Beneficiary's middle Name
*
Beneficiary's last Name
*
Father's Name
Mother's Name
Gender:
*
Male
Female
Transgender
Date of Birth
*
Age(in year)
Category:
*
Please Select Category
SC
ST
OBC
General
Address
*
Tehsil/Block
Pincode
*
State:
*
District:
*
Family Income(monthly in Rs)
*
Type of Disability
*
Percentage of Disability(in %):
*
Applying for Assistive device:
*
Upload Certificates and Image
Disability Certificate:
*
(Only .pdf allowed)
Income Certificate:
*
(Only .pdf allowed)
Upload Photo:
*
(Only .jpg image allowed)
I hereby declare that the
terms and conditions
and information furnished above is true, complete, and correct to the best of my knowledge and belief. I understand that if my information is found false or incorrect at any stage, my request/application for providing aids & assistive devices under the ADIP Scheme shall be canceled. I also declare that I have not received any aids & assistive devices for the same disability in the past three years.
*
Submit