* marked fields are compulsory
Athlete Name *
Father Name *
Licence Fees: Rs.
Mode of Payment
-Online GatewayDemand DraftBank ChequeCash with Bank
Fees Receipt Reference No.
Date of Payment
Payment Receipt *
Your Photo *
Date of Birth *
Gender
MaleFemale
Mother Name
Marital
SingleMarried
Phone No.
Alt Phone No.
Address Permanent
Postal Pincode
Address Communication
Email
ID Card #/ Aadhar/ Voter ID/ DL *
Identity Card Upload *
Education
Occupation
Employer
Office Address
Passport No.
Passport Expiry Date
Passport Place of Issue
Physical
-PhysicalVisualDwarfCerebral-palsyIntellectual
Disability Certificate *
Blood Group
-AB+A+B+O+O-B-A-AB-
Height in Cms.
Weight in Kgs.
Wheelchair?
NoYes
Bank Account Number
Bank A/c. Holder Name
Bank Name
Bank Branch
Bank IFSC
Para Sports :
AthleticsSwimmingShootingPower lifting
ParaSports +
ArcheryBadmintonBasketball (WC)BocciaFootballFencingGoalballJudoRacing (WC)Para-cyclingPara-TriathlonRugbySitting VolleyballTable TennisTennis (WC)
IPC SDMS Licence No.
IPC Licence Card
School Name
First / Personal Coach
National Coach
National Certificate / Accreditation
Athletics Track Class
-T11T12T13T20T32T33T34T35T36T37T38T40T41T42T43T44T45T46T47T51T52T53T54
Athletics Track Status
ConfirmReviewNew
Athletics Field Class
Athletics Field Status
Swimming Class
-S1 SB1S2 SB1S3 SB2S4 SB3S5 SB4S6 SB5S7 SB6S8 SB7S9 SB8S10 SB9S/SB11S/SB12S/SB13
Swimming Class Status
Classifier Name
Classifier Designation
Classified @ Place & Country
Classification Date
Classifier Remarks
State Level: #. Performance, Event, Place, Year
National Level: #. Performance, Event, Place, Year
International: #. Performance, Event, Place, Year
Achievements: Awards, Place & Year
Undertaking *
The Paralympic committee of Punjab (PSAP) was founded by Sukhmanpreet Singh Sidhu Talwandi (Sippy Sidhu) on April 28, 2006, to develop the Paralympic sports in Punjab and to impart training to the disabled.
Address : #891 3B2 Mohali Call : +91-7200000004
