Hearing Aid Beneficiary under ADIP Scheme
Institution Details
| District |
Institution Name |
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Basic Details
| Candidate Name |
Candidate Fname |
Candidate Dob |
Candidate Age(As on 01-03-2023) |
Candidate Address |
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| Candidate Mobile |
Category |
Aadhar No |
Income Details |
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Upload Document
| Upload - Aadhar Card |
Upload - Caste Certificate |
Upload - Income Certificate |
Upload - Hearing Disability Certificate |
Upload - Passport Size Photograph |
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Details of Hearing Impairment
| Right Ear Hearing Loss Type |
Right Ear Hearing Loss(Degree) |
Left Ear Hearing Loss Type |
Left Ear Hearing Loss(Degree) |
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| % of Hearing Disability |
Date of Hearing Testing |
No. of Hearing aids Required |
Ear Specific Requirement |
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| Any assistance received for the same purpose in last 3 years (ii)? |
If Yes (ii), Mention Date |
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Entry User Details
| Entry User - Name |
Entry User - Designation |
Entry User - Mobile |
Entry User - District |
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