| District Name | Srikakulam |
| Mandal Name | Seethampeta |
| Panchayat Name | KODISA |
| VO Name | KUMMARIGANDI VO |
| Application Number | 28552 |
| Policy Holder Name | SIMMAYYA SAVARA |
| Father / Husband Name | BAPANNA |
| Gender | Male |
| Age | 43 |
| Caste | ST |
| Nominee Name | SUNEETHA |
| Nominee Age | 26 |
| Nominee Gender | Female |
| RationCard | YAP011331100314 |
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