| District Name | Visakhapatnam |
| Mandal Name | Araku Valley |
| Panchayat Name | Kothabhalluguda |
| VO Name | Gattaraguda |
| Application Number | 3956 |
| Policy Holder Name | Samardi Arjun |
| Father / Husband Name | Dombu |
| Gender | Male |
| Age | 33 |
| Caste | ST |
| Nominee Name | Chandramma |
| Nominee Age | 27 |
| Nominee Gender | Female |
| RationCard | wap030518900119 |
| StreeNo | Gatharaguda |
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