Registration for:(

Please Choose One Marriage Computer Training Registration with NCRDP Employment Other (Guidelines/Counseling) Other (Intimacy)

I'm a:(

Please Choose One Disable Man Disable Female Normal Man Normal Female

Seeking for:(

Please Choose One Disable Woman with Choices Normal Woman Disable Man with Choices Normal Man Normal Widow/Divorcee (no kids) Normal Widow/Divorcee (with kids) Free Computer Training Employment under NCRDP NCRDP Registration Information/Guidelines Sharing Success Story

Choice:

Please Choose One No Choice Any compensating match Using Crutches/Stick Deaf or Dumb Blind Amputee - Arm Amputee - Leg

National I.D.Card No.:(

Full Name:(

Father's Name:(

Mother's Name:(

Your Siblings:(

Brothers: Choose None 1 2 3 4 5 6 7 8 9 10   Sisters: Choose None 1 2 3 4 5 6 7 8 9 10

Your Date of Birth:

Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947

Or Age:(

Choose One Less than 20 21 years 22 years 23 years 24 years 25 years 26 years 27 years 28 years 29 years 30 years 31 years 32 years 33 years 34 years 35 years 36 years 37 years 38 years 39 years 40 years 41 years 42 years 43 years 44 years 45 years 46 years 47 years 48 years 49 years 50 years 51 to 55 years 56 to 60 years

Gender:(

Choose One Male Female

Marital Status:(

Please Choose One Never Married Engaged Separated Divorced (after nikah but before rukhsati) Divorced (with children) Divorced (without children) Widowed (after nikah but before rukhsati) Widowed (with children) Widowed (without children)

Religion & Sect:(

Muslim Christian Other  Sect:

Caste (zaat):(

Choose One Araien Beig Butt Chaudhary Chugtai Khan Khawaja Malik Mir Rajput Rathore Shiekh Waien Other Specify:

Preferred Caste to Marry:(

Choose One Don't belive in caste Any caste In my own caste

Accommodation:(

Please Choose One Livining with Parents Living in Joint Family Living with Brother Living with Sister Living with Friend Living with someone without rent Living Alone Living in Hostel Living in NGO premises Other

Personal Transport:(

Please Choose One Power Wheelchair Bicycle Hand-driven Tricycle Tri-wheeled Auto Bike Car/Van Other None

Can travel all alone?:(

Yes No

Special Equipment in use:(

Please Choose One Wheelchair Walker Walking Stick Blind Stick Hearing Aid Transfer Board Patient Lifter Other None

Occupation:(

Please Choose One Unemployed Own Business Joint Business Working with Father Working with Brother Government Service Private Service Applied for Service Waiting for Interview After Interview, Waiting for Response Studying Getting Vocational Training Getting Technical Training

Monthly Income Rs.:(

Do you get Zakat?:

Yes No

Nature of Disability:(

Please Choose One Physically Handicap Muscular Dystrophy Wheelchair Bounded Using Crutches/Stick Bed Ridden Blind Deaf & Dumb Amputee (Arm/Hand) Amputee (Leg/Foot) Other No Disability (Normal)

Cause of Disability:(

Please Choose One By Birth By Polio By Road Accident By Bomb Blasting By Unsuccessful Operation By Quarrelling/Fighting Other Incident No Disability (Normal)

Period of Disability:(

Please Choose One Less than 1 year 1 to 4 years 5 to 10 years 11 to 15 years 16 to 20 years 21 to 25 years 26 to 30 years 31 to 35 years 36 to 40 years 41 to 45 years 46 to 50 years No Disability (Normal)

Medical Diagnosis:(

Registered with NCRDP?:(

Please Choose One Yes No Form Submitted Waiting for Checkup Waiting for Certificate Need Guidelines Other

Home Address:(

Address (cont.)

City:

Country

Home Landline Phone #:(

Office Landline Phone #:

Mobile #1:(

Mobile #2:(

E-mail:(

Academic Qualification:(

Please Choose One Read and Write Primary Level Middle Level Matric F.A (equivalent) B.A (equivalent) M.A (equivalent) Other None

Technical Course:(

Please Choose One Yes No Studying Waiting Result Other

Vocational Training:(

Please Choose One Yes No Studying Waiting Result Other

 Computer Training:(

Please Choose One Basic Know-how Diploma Course Microsoft Certification Studying Waiting Result Other None

 Work Experience:(

Please Choose One No Experience Just Started Less than 1 year 1 to 4 years 5 to 10 years 11 to 15 years 16 to 20 years 21 to 25 years 26 to 30 years 31 to 35 years 36 to 40 years 41 to 45 years 46 to 50 years