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RF1- Registration Slip : New Client
DBF Care Center Registry Framework
Date of Registration:
New Client Registration Number (CRN):
OR New Monitoring Client Number (MCN):
Full Name (with Prefix Mr/Ms/Master/Dr):
Date of Birth:
Age:
Gender:
Male
Female
Others
📍 Complete Contact & Address Bounds
Full Address with city, state and Pin Code:
City / Tehsil:
State:
Pin Code:
Email Address:
Phone Number (1. Client):
Phone Number (2. Caregiver):
Phone Number (3. Emergency):
Category Group:
General
SC
ST
OBC
Any other
🪪 Identity Verification Records
Client Aadhaar Card Number:
Caregiver Aadhaar Card Name:
Caregiver Aadhaar Card Number:
UDID Certificate Holder?
No
Yes
UDID Number (If Available):
Disability Diagnosis as per UDID:
💰 Socio-Economic Classification (ADIP Scheme parameters)
Client Income / Pension (Monthly):
Upto 22500
30000
above 30000
Family Income (Monthly):
Upto 22500
30000
above 30000
Education Status Tier:
Not Literate
Below 10th Std
Below 12th Std
Below Graduation
vocational or Diploma
Graduation
Occupation Status Tier:
Not employed
Employed
Retired
Source of Referral:
📝 Administrative Audit Settlement
Registration Fees receipt no.:
Signature of registration staff:
💾 Process Registry Form & Initialize Client File