Name of the Beneficiary (required) E-mail (required) Name of the Parents/ Legal Guardian (required) Phone(WhatsApp number if possible) (required) Application Status (required) New Enrollment Renewal Enrollment Type of Disability of beneficiary (required) Autism (A/U) Cerebral Palsy (C/P) Mental Retardation (M/R) Multiple Disabilities (M/D) Gender (required) Male Female Other Age (required) State Select State City Select City Address (required) UDID Number (required) Niramaya Card Number (required) Niramaya Card Issue Date (required) Attach Niramaya Card (required) Attach UDID (required) Attach Income Proof (required) Attach Photograph of Beneficiary (required) Hitarth Sahayak Details: Name of Hitarth Sahayak (required) Email of Hitarth Sahayak (required) Phone of Hitarth Sahayak (required) I confirm that information submitted is accurate.