| District Name | Anantapur |
| Mandal Name | Roddam |
| Panchayat Name | BOKKASAMPALLE |
| VO Name | SHRI BAILAANJANEYASWAMI |
| Application Number | 11334 |
| Policy Holder Name | Harija Gopal |
| Father / Husband Name | Anjinappa |
| Gender | Male |
| Age | 41 |
| Caste | SC |
| Nominee Name | Adhilakshmi |
| Nominee Age | 30 |
| Nominee Gender | Female |
| RationCard | yap12530014a0210 |
| StreeNo | LGB Nagar |
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