Disability application form is filled by an individual in order to get registered as disabled in the records of the government. This will help him to get the benefits prescribed for disable individuals. for more application forms
Sample disability application form
Social Security Number: _____________________________
Full Name: __________________________________________
Permanent Address: ____________________________________________________
Present Address: _______________________________________________________
Contact No.: ____________________________________
Marital Status: _____________________
Date from when you are having disability: ____________________
The cause of the disability is: Accident / Disease / Other, Please mention _____________
Are you employed? Yes / No.
Name of the organization: ______________________________________
Total duration of employment (in years): ________________
Monthly Salary: __________________________
Are you presently undergoing any treatment for your disability? Yes / No.
Date when your treatment started: _____________________________
Name of the medical practitioner: _____________________________
Medicines you take: ________________________________________
Total duration of your treatment: ______________________________
Are you presently receiving any monetary benefits on account of your disability?
Yes / No.
Total amount received (per month): _________________