| District Name | Krishna |
| Mandal Name | Gudivada |
| Panchayat Name | MALLAIPALEM |
| VO Name | KOTTAMALLAIPALEM |
| Application Number | 22176 |
| Policy Holder Name | Mattala Tulasi |
| Father / Husband Name | CHINNA |
| Gender | Female |
| Age | 20 |
| Caste | SC |
| Nominee Name | NAVEEN KUMAR |
| Nominee Age | 20 |
| Nominee Gender | Male |
| RationCard | YAP064202200552 |
| StreeNo | cHOWYAPALLI |
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