| District Name | Srikakulam |
| Mandal Name | Burja |
| Panchayat Name | CHEEDIVALASA |
| VO Name | CHEEDIVALASA |
| Application Number | 545 |
| Policy Holder Name | Illipilli Kalavati |
| Father / Husband Name | Venkataramana |
| Gender | Female |
| Age | 29 |
| Caste | BC |
| Nominee Name | Venkataramana |
| Nominee Age | 37 |
| Nominee Gender | Male |
| RationCard | Wap011102100139 |
| StreeNo | Mainveedi |
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