Full Name (required)
E-mail (required)
Phone(WhatsApp number if possible) (required)
Birth Date (required)
Disability Type
(required)
Amputee
Hearing Impaired
Locomoter Disability
Mental Illness
Visually Impaired
Multiple Disabilities
Explain how Disability Limits your Functioning (required)
Guardian/Representative/Organization Name
Partner Organization
(required)
APH: Belgaum
BPA: Ahmedabad
SNEH : Nagda
SYSS: Basti
Raso: Amritsar
NAB-Goa
GASVS: Chhindwara
NAB : Maharashtra
Devnar School for the Blind
Care Educational Trust: Lucknow
Deva International: Varanasi
Dextroware Devices: Chennai
VYO: Rajkot
Shri Unique Viklang Charitable Trust, Rajkot
Neomotion: Chennai
VIPO : Vadodara
Indent
Bharat Vikas : Patna
Bethany Society: Meghalaya
Trestle Labs
NFBM : Pune
Jodhpur Chapter
Pune Chapter
We Hear
Signable Communications
Rotary Club - Geetanjali Kolkata
Oneceptual Technologies
SHG Technologies
Creativiti Council
Torchit: Ahmedabad
NAB, Bharuch
Siddh Divyang Foundation, Pune
Sathiyameh Jayam Charitable trust - Chennai
Sabarmati Samruddhi Seva Sangh, Gandhinagar
Sahayatha Healthcare
Flexmotiv Technologies pvt. Ltd.
Paralympic Sports Association Kolhapur, Maharashtra
Office of the Chief Education Officer, Leh Ladakh
NAB - Nashik, Maharashtra
34 Assam Rifles Srinagar
Vision Wallet
Nav Bharat Jagriti Kendra : Patna Branch
Sunbots Innovation
Shri Navchetan Andhjan Mandal Divyang Vidhya Vihar, Bhuj
Kalyanam Karoti Mathura
Orbit Research
Country
(required)
Select Country
State (required)
Select State
City (required)
Select City
District
Select District
Heavily Subsidized
Flexmo Premium Elbow Crutch
CiCare
Hearing Aid- We hear (Age below 14)
Hearing Aid For Microtia
Smarton Smartglasses (Age 14 and above)
Flexmo Premium Underarm Crutch
Flexmo silent walker
CP Walker
Signable- ISL Interpreter Service (Any age)
Kibo App (1 Year Subscription)
Kibo App (3 Year Subscription)
Mouseware (Wearable head device)
Kibo XS device for visually-impaired (Age 14 and above)
Sahayatha 100
Sahayatha 200
Orbit Braille Reader(Any age 20 Cell)
Jyoti AI Glasses
Orbit Reader 200
Callipers / Braces
Heavily Subsidized ( Prosthetic / Orthotics )
AK Prostheses
BK Prostheses
Air Splint
Cervical Collar
Dennis Brown Splint
Knee Cap
Knee Cap with Hinge
O. A. Brace
L.S. Belt
Molded ACL Caliper without shoes
Molded ACL Caliper with shoes
Partially Subsidized
Neofly (customized wheelchair)
Combo (Neofly+Neobolt)
Electric Tricycle
VGO Wheelchair Attachment
Vision Wallet
Govt ID Number(UDID/Aadhar Card/Pan Card/Voter ID Card) (required)
Primary Use of Assistive Device
(required)
Education
Employment / Self Employment
Safety / Mobility
Communication
Explain the Usage Purpose in Detail
(required)
Tell us about you and your family?
(required)
Family income per year
(required)
Less Than Rs 1.5 LAC
Rs 1.5 LAC To Rs 3 LAC
Rs 3 LAC To Rs 5 LAC
Above Rs 5 LAC
Delivery Center
(required)
BPA - Ahmedabad
GATORBHAI HIMMATLAL PATEL (BIDAJ) ORTHOPAEDIC & GENERAL HOSPITAL
LIONESS KARNAVATI HOSTEL FOR BLIND WOMEN & BPA GUEST HOUSE
KUTCH COMPREHENSIVE REHABILITATION CENTRE (KCRC)
MSM-NAAZ SAMMILIT PATH SHALA & RESIDENTIAL CENTRE
SHRI R.M. PARIKH RESOURCE CENTRE (SUMERU CENTRE) PALDI
KASHIBHAI LALITABEN BHADRABEN & JAGDISHBHAI PATEL “SAMARPAN SANKUL
SAVINAY CENTRE FOR INCLUSIVE EDUCATION - BAVLA
KHUSHIYO NU SARNAMU DEESA
DR. JIT MEHTA BALSHALA TRUST
PRAYAS DAY CARE CENTRE JODHPUR, RAJASHTHAN
BLIND PEOPLE’S ASSOCIATION NADIAD BRANCH
Ashirvad Viklang Trust
Shri Unique Viklang Charitable Trust, Rajkot
NAB-Goa
New VIP Road, Vadodara
New Delhi
Shikshit yuva sewa saimiti (SYSS)
Care Educational Trust (Lucknow)
Deva International Society (Varanasi)
GASVS (Chhindwara)
Bharat Vikas(Patna)
Dextroware Devices, Chennai
NFBM, Pune
NAB : Maharashtra
Raso: Amritsar
Varanasi, UP
Varanasi, UP
Jabalpur, MP
Hyderabad, Telangana
Sneh (Nagda, MP)
APH (Belgaum, Karnataka)
Haridwar, Uttarakhand
Jodhpur Chapter
Pune Chapter
RC Geetanjali Kolkata
Bethany Society, Meghalaya
We Hear
Siddh Divyang Foundation, Pune
Home Delivery
Download Kibo App
Oneceptual Technologies
Signable Communications
SHG Technologies
Creativiti Council
Torchit
NAB, Bharuch
Sathiyameh Jayam Charitable trust - Chennai
Sabarmati Samruddhi Seva Sangh, Gandhinagar
Sahayatha Healthcare
Flexmotiv Technologies pvt. Ltd.
Paralympic Sports Association Kolhapur, Maharashtra
Office of the Chief Education Officer, Leh Ladakh
NAB - Nashik, Maharashtra
Gandarbal (Kangan 34 Assam Rifles)
H VISION INDIA PRIVATE LIMITED
Nav Bharat Jagriti Kendra : Patna Branch
Sunbots Innovation
Shri Navchetan Andhjan Mandal Divyang Vidhya Vihar, Bhuj
Kalyanam Karoti Mathura
Orbit Research
Delivery Address