OFFICE OF THE ASSISTANT DIRECTOR, SOCIAL WELFARE, LAHORE

Form No. NCRDP-II

[Referred to in Rule 22 (2)]

Particulars of Disabled person registered during the fortnight ending on ______________________

Registration
No.

Date of
Registration

Name of the Disabled

Person

Fathers Name

Date of birth/age
of Disabled Person

Marital
Status

Specialization,
Training/Attainment

Permanent Address

Present Address

10

11

12

Professional
Affiliation with
status
13

No. of
Dependent
family members
7

Occupation for which

the disabled person is a
candidate
14

FOR OFFICIAL USE ONLY

Endorsement on the basis of advice of the Council
17
Find fit for the Job of

Recommended for training in

the occupation of

Not found fit for any job

Not found a Disabled Person

Nature of
Disability

Qualification

No. & date of

Reference to
the Council
15

No. & date of

Advice of the
Council
16

SECTION

NCRDP-I
Application for Registration

To
District Officer,
Social Welfare WD & BM,
Lahore.
Dear Sir,
I request that my name, address and qualification, as states may be
registered on the Register of Social Welfare for reference to the Provincial Council for RDP
as disabled and that I may be furnished with Certificate of Registration.
1. Name (in block letters):

----------------------------------------------------------------------

2. Fathers Name:

----------------------------------------------------------------------

3. Type of Disability:

----------------------------------------------------------------------

4. Date of Birth:

----------------------------------------------------------------------

5. National Identity Card No. ---------------------------------------------------------------------6. Permanent Address:

-------------------------------------------------------------------------------------------------------------------------------------------

7. Present Postal Address:

(in which correspondence
is to be made)

----------------------------------------------------------------------

8. Nationality:

----------------------------------------------------------------------

9. Domicile:

----------------------------------------------------------------------

10. Religion:

----------------------------------------------------------------------

----------------------------------------------------------------------

11. Particulars of Qualification / Training:

Examination
Passed

Year

Division/
Grade

12. Details of Specialization:

(if any)

Subjects/Training

Certificate/
Diploma/Degree

----------------------------------------------------------------------------------------------------------------------------------Continued

13. Details of Employment (if any):

Name of Employer

Post held

From

To

Description

Last Pay

draw

14. Occupation /
Job you consider to be fit:
15. Married / Unmarried:

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

16. No. of Dependent Family

Members:

------------------------------------------------------------------

17. Any other information

may be helpful in assessing
your suitable job:

-----------------------------------------------------------------Phone No. ----------------------------------------------------

18. I certify that the above particulars mentioned by me are correct. I undertake to
inform the District Officer, Social Welfare where my name is registered as disabled
of any change in my postal address and profession. I have neither APPLIED for
registration not am already registered under the Ordinance with any Registration
Department without intimation to the Social Welfare Department to which the
present application is being made.
Yours Faithfully,

Signature of Attesting Officer

with seal of Office

Signature / Thumb Impression

-------------------------------------

Dated: -------------------------------

INSTRUCTIONS
As far as possible the application form will be filled by the applicant in his own
handwriting or typed. The form and the certificate attached shall be attested by a Gazetted
Officer of the Provincial/Federal Government. Photostat attested copies are to be enclosed
as under:i.
ii.

Copies of Degrees / Diplomas / Certificates and Experience Certificates.

Copy of National Identity Card. (If Card has not been obtained for any reasons, a
Photostat copy of the receipt of Application Form for Identity Card, issued by the
Registration Office concerned may be submitted).
iii. Three (3) copies of passport size photographs duly attested by a Gazetted Officer.

Form No. NCRDP-II

Referred to Rule 13
REPORT OF ASSESSMENT OF THE REGISTERED DISABLED PERSON
BY THE DISTRICT ASSESSING BOARD
1. Name of Disabled Person: ----------------------------------------------------------------------2. Fathers Name:

-----------------------------------------------------------------------

3. Identity Card No.

-----------------------------------------------------------------------

4. Date of Birth:

-----------------------------------------------------------------------

5. Educational Status:

-----------------------------------------------------------------------

6. Permanent Address:

-----------------------------------------------------------------------

Present Address:

-----------------------------------------------------------------------

7. Previous Training/ Trades/Skills (if any): ----------------------------------------------------8. Registration No. and Name of
Registration Department
where registered
9. Nature of Disability Claimed

AD.SW.LHR
--------------------------------------------------------------DATED:
--------------------------------------------------------------SOCIAL WELFARE DISTRICT LAHORE.
----------------------------------------------------------------------------------------------------------------------------Not Disabled / Disabled
Yes / No

10. Findings of the Board:

i.

Fit to work, if fit, specify job:---------------------------------------------------------------

ii.

Prosthesis if any required:-------------------------------------------------------------------

iii. Training if any required for working (specify nature and duration):
----------------------------------------------------------------------------------------------------iv. Protective equipment if any recommended to avoid hazard:
----------------------------------------------------------------------------------------------------v.

Medical treatment if any recommended:

----------------------------------------------------------------------------------------------------SIGNATURES

1) Medical Superintendent
District Headquarter Hospital
Chairman of Board
2) Vocational Guidance Officer/
Lecturer in Applied Psychology
(Member)

-------------------------------------------------------

-------------------------------------------------------

3) Representative of Technical Training

Wing of the Directorate of
Manpower & Training (Member) -------------------------------------------------------

4) Assistant Director
Social Welfare
(Secretary/Member)

-------------------------------------------------------