| District Name | Srikakulam |
| Mandal Name | Regidiamadalavalasa |
| Panchayat Name | KANDISA |
| VO Name | Nirmala Wmacvs |
| Application Number | 22368 |
| Policy Holder Name | SAMBANA RAMA |
| Father / Husband Name | VENKATARAMANA |
| Gender | Female |
| Age | 24 |
| Caste | BC |
| Nominee Name | VENKATARAMANA |
| Nominee Age | 27 |
| Nominee Gender | Female |
| RationCard | WAP0103053A0034 |
| StreeNo | peddaveedi |
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