| District Name | Prakasam |
| Mandal Name | Dornala |
| Panchayat Name | PEDDA DORNALA |
| VO Name | MOTHERTERISSAGRAMIKYASANGAM |
| Application Number | 19265 |
| Policy Holder Name | Bandaru Madhavilatha |
| Father / Husband Name | venkateswarlu |
| Gender | Female |
| Age | 34 |
| Caste | BC |
| Nominee Name | swarajyam |
| Nominee Age | 60 |
| Nominee Gender | Female |
| RationCard | wap0807016a0211 |