| District Name | Prakasam |
| Mandal Name | Dornala |
| Panchayat Name | GANTAVARI PALLI |
| VO Name | KOTHURUPEDALAGRAMIKYASANGAM |
| Application Number | 15542 |
| Policy Holder Name | Singa Kejiya |
| Father / Husband Name | Ankalaiah |
| Gender | Female |
| Age | 20 |
| Caste | SC |
| Nominee Name | Ankalaiah |
| Nominee Age | 21 |
| Nominee Gender | Male |
| RationCard | wap080700800010 |
| StreeNo | kothuru |