Directorate of Sports and
Youth Welfare Madhya Pradesh
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नया पंजीकरण (SIGN UP)
Directorate of Sports and Youth Welfare, Bhopal, Madhya Pradesh
Profile of Para Sports Person
Note: (*) These fields are mandatory.
Personal Details
Name Of Para Sport:
*
Name in English(Capital):
*
Name in Hindi:
*
Father’s/Husband’s name:
*
Mother’s name:
*
Date of Birth:
*
Age in completed years:
Sex:
*
Male
Female
Class Studying in:
*
Contact Number(Mobile):
*
Landline :
Aadhaar Number:
*
PAN:
Passport No. (if any):
Date of Expiry (Passport):
Address:
*
Pincode:
*
Type of disability:
*
-Select-
Mental
Physical
Visual
Percentage / class of disability:
*
Do you use wheelchair?
*
Yes
No
Whether you can take care of yourself alone without any escort:
*
Yes
No
Service Details
Whether in Service:
*
Yes
No
If Yes, details of service (Post & Department etc.):
Sports and Achievements Detail
Any State/National level Award you received:
Any other Para Sport you play:
How many tournaments / championships you play annually? (Only Numbers like 1,2 etc.)
*
Do you have IPC International Classification? If Yes, mention Class :
Sports achievements at State / National / International levels (past 3 years only):
Name of Para Sport
Achievements/Place
Years
Specify Performance (Time/ Distance/ Points/ Weight etc.)
Add More
State/ National/ International
Achievements Detail
--Select--
State
National
International
--Select--
2014
2015
2016
2017
Bank Details
Bank Account No:
*
Name of Bank:
*
Branch Name:
*
IFS Code:
*
Attachments to attach
Birth Certificate:
*
Aadhaar Card:
*
PAN Card(if any) :
IPC License copy, if any :
Photo Upload (Passport Size):
*
Full size coloured photo:
*
Sport Merit/Participation Certificates:
*
Passport (first and last pages) :
Marksheet of previous class/examination passed:
*
Bank Passbook (first page and last transaction page):
*
Proof of Address (not required if Aadhaar or Passport copies submitted) :
Disability Certificate, along with supporting medical documents and prescriptions, if any :
Signature:
*
Date:
*
Place of Form submission:
*
For technical support enquries: 8827279559