| District Name | Visakhapatnam |
| Mandal Name | Golugonda |
| Panchayat Name | Patha mallempeta |
| VO Name | HUKUMPETA GRAMAPEDALAIKYASANGAM |
| Application Number | 13968 |
| Policy Holder Name | JAKARYA DULLA |
| Father / Husband Name | PIDIYYA |
| Gender | Male |
| Age | 43 |
| Caste | SC |
| Nominee Name | ELIJABETH |
| Nominee Age | 39 |
| Nominee Gender | Female |
| RationCard | YAP031501300222 |
| StreeNo | HUKKUMPETA |