| District Name | Srikakulam |
| Mandal Name | Ranastalam |
| Panchayat Name | DERASAM |
| VO Name | Sri Rama |
| Application Number | 134 |
| Policy Holder Name | Krishna Chaitanya Meesala |
| Father / Husband Name | Mukhundanaidu |
| Gender | Male |
| Age | 28 |
| Caste | BC |
| Nominee Name | Susheela |
| Nominee Age | 42 |
| Nominee Gender | Female |
| RationCard | wap010705800071 |
| StreeNo | Derasam |