Particulars of Outstanding Work in the creation of Barrier-Free Environment for persons with disabilities for National Award (Annexure-H)
| 1 | Name in English (in BLOCK Capital letters) and Hindi | |
| 2 | Address of the agency along with telephone & fax number, if any. | |
| 3 | Web-site / E-mail address, if any | |
| 4 | Nature of the agency | |
| 5 | Particulars of access facilities provided | |
| 6 | Number of the people benefited annually category-wise. | |
| 7 | Comment on the replicability of the facilities given. | |
| 8 | Whether toilets have been modified, doors are modified keeping in view the needs of disabled and ramps are provided in the building. | |
| 9 | Whether facilities for visually and hearing handicapped are provided at work site and protective devices are used for their physical safeguard. Give full details |
Signature of the applicant with date
Signature of the recommending authority with date
