| District Name | Visakhapatnam |
| Mandal Name | Araku Valley |
| Panchayat Name | Baski |
| VO Name | Kontraiguda |
| Application Number | 4057 |
| Policy Holder Name | PANGI JAGADEESH |
| Father / Husband Name | CHOTHUR |
| Gender | Male |
| Age | 26 |
| Caste | ST |
| Nominee Name | GURUBUDDI |
| Nominee Age | 26 |
| Nominee Gender | Female |
| RationCard | WAP0305188A0305 |
| StreeNo | BASKI |
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