| District Name | S.P.S Nellore |
| Mandal Name | Varikuntapadu |
| Panchayat Name | MOHAMMADAPURAM |
| VO Name | gollapalle |
| Application Number | 17120 |
| Policy Holder Name | DEVARAKUNDA CHANDRAKALA |
| Father / Husband Name | CHENNAKISTAIAH |
| Gender | Female |
| Age | 28 |
| Caste | SC |
| Nominee Name | VENKATALAKSHMAMMA |
| Nominee Age | 45 |
| Nominee Gender | Female |
| RationCard | WAP090201100333 |
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