Registration of Disabled preson's


	"New horizon for disabled persons"

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Registration of Disabled Person's

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Fist Name:

Last Name:

Country:

Date of Birth:

Gander:

N.I.C.

Religion:

Provrince:

City:

Street:

Mobile:

Land Line:

E-mail:

Web:

Education

Highest degree:

Major:

Activities

Hobbies:

Sports Activities:

Social Activities:

Other Activities:

Skills & Specialties:

Aim in Life/Future Plans

Profession

Company/Organization:

Designation:

Financially Dependent or Independent:

No Yes

If you are Financially Independent then how many people depends on you:

Marital Status:

if married then do you have Children:

Disability Details

Disability type:

By Birth By Accident

If disable by accident, then tell its duration:

Problems faced due to disability:

More about you:

Your Massage:

Where From you listen about us?

News Paper: T.V. Interent: Others:


Type Code Shown:

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