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Disability Certificate Application — English Format
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STAMP PAPER
Disability Certificate Application
To,
The Chief Medical Officer,
________, ________, ________
Subject: Application for Issuance of Disability Certificate
Respected Sir/Madam,
I, ________, S/o D/o ________, aged ________ years, resident of ________, ________, ________ - ________, Aadhaar: ________.
I have ________ disability. ________
Kindly conduct my medical examination and issue a Disability Certificate.
Date: 21 March 2026
Signature: _______________
Name: ________
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Disability Certificate Application — State-wise Format
DelhiUttar PradeshMaharashtraRajasthanMadhya PradeshBiharGujaratKarnatakaTamil NaduTelanganaAndhra PradeshWest BengalPunjabHaryanaJharkhandOdishaKeralaChhattisgarhAssamUttarakhandHimachal PradeshGoaArunachal PradeshManipurMeghalayaMizoramNagalandSikkimTripuraChandigarhAndaman and Nicobar IslandsDadra and Nagar Haveli and Daman and DiuLakshadweepPuducherryLadakhJammu and Kashmir
Frequently Asked Questions — Disability Certificate Application
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