ffiBH ef ;M^

erd SSF $og0

'-,._:...,;.tr$; $*qg *5t.6ta$ , . ',, ,.
ar.C&otu

InO

5a$;:ecr *5r,*$ 6dr3oo ao*.

tt& S$

,se;,01-'.ce;igss

*.ry.*fudrLlq+,

;aE @ ta*@

.:.

3'SdS

Boq.d> '
a-o$d.a.$ (s6l EoaCb

lB[Fe5s

,*l*utsd.:dry
csoon,.

10.Fsa *t(:;r$J.

{Ii*.+*,tr4[r,Sf
j

Sa2uqd-'-1, a \

zco&B>eSU:Ddr(V-tLl)t
SS

S SS*$ Aear***erQofry cfrc.gg,Sf* zf;s$oenl$).

r,Po-*otof
:'..',..

)'*srs -#gss*,
26A'e9&
Iy
tdo.)

'97ot(?t$gfk*res

$od{S# Sods$ro :
ffo $od{$od # $oao6o:
da:

.t {}ffi[l]tlflll,Yf

iP;*rrlsrvr'

OR.r-.**,U;*"t"rUGli"Sl':*iAtrnakur

6S o5$Sr, $s

6:6ea$ur

dX5$oc'21darerd

$arp6)

os66rdeo6Soosffi
o#ili;[t ;I

J'*ira'*rrr sl*aktrr

ion ofevery birth and death wittt

s.6eoafui! 17(1) Bg&o$e6:.

21 days

_--:-i\a-:>:".;'->

,G:l-.:-'-

.J*-.

in2l

days

Ration Card Details

Peraonal- DetailE

Ration Card

No

Office

nAPl-333o27ofiy'

Card Status rn^ctive

of Head of Da6i Danamma

FamilY(in Loca1

Bandi AtEEkur

ShoP No L333027

./

Name

Name

Head of Family

Fe4lffi

Language)

Mother's Name --

Motherrs Name(in Local

Language

Father's

Father's

Name(in Local
Language

Name

Pre8ent AddreEs

Bandi'Atmakur
sandi Atmakur, Bandi
Atmakur {V}

Landmarkllocality/Colony 8.119,

House No-/House Name 8.119

Vr

Mandal Name Bandi Atmakur

jlage/'l'own Bandi Atmakur

District

Name

state

KufBool

Name ANDHRA PRADESH

50 000 0

Landmark,/Locality/Colony

Name

Bandi

Atmakur

Bandi

Mandal Name Kurnool

VillagelTown Bandi Atmakur

District

8.1"19,

Bandi Atmakur,
.*tmakur (v)

State

Kurnool

Name

.Andhra Pradeah

PrN s00000

Profes8ional
Occupation r,ABoUR/Cool-i/Porxer/:llar.d'

Detail-s
Total Annual fncome 15000

eart Puller
GaE Connection DetaiLs

Gas Company Name

Gas Connection Statlus

Gas Agency

Page Na.7

Consumer Number

Name

Card T)?e

BPL

\6) -* ^,-d
comffi+nator

"

sv

"":"p,2;i#;Z;Zizi,J',7*""132i":f

DRDA{/ELUGU, Jnsrdi Atmakur

11f],X'i!'"n"'""17'2"

Famil"Y Meuiber Details

l{o

inelud
ing Itead of
rasrily)

Dasi

Name (

Gender

Age (YrB)

Date of
Bilth (DD/!,EI

llother'

Father'E

DaBi
KarnarEra

Da6i Barna

wi Lh

Applicant

so

-NA-

NA

Barna Basu

2A

.NA-

NA

NA

58

-NA-

NA

NA

MALE

))

-NA-

NA

NA

MAtE

-NA-

NA

NA

MALE

Danatrlma
2

Relatsior

Name

Name

/yYwt
l.EMAI,E

gp6use Narre

gELF

DAUGHTER IN
I,AW

;:q,\ u3

HUSBAND

BaEu
4

Daei

soN

Karnakar
5

Dasi

GXAND SON

Krupakar

Co
DRDAIVELUCU'

Page No-2

/dinator^
rlB,nrli Atnrakur

DeveloPed by
Food and Supply DePE' Syieefr Design
Report Geflerated by ltyderbad
Na:ianaT Intoz&atica Centre'
.

v";..,

,*4q.\r

ffi

a''7^iJ.\
13{7ITT

.iar.6r

6oo5 / Enrollment No.: 2021120312107847

ro
eeEF,isJ&

o
N
@

- a.-ffr.r
> C)<-J

DASHI DANAMMA
HNO.8-119/1 S C COLONY
BANDI ATMAKURU
Bandi Atmakur
Bandi Atmakur

N Kurnool

o
o
o
(,

Andhra Pradesh 518523

sf ill

fftililil]

Iilt

IIilililtIfillfl

lll

M1438633326FT

5: eery6 bo:r:J / Your Aadhaar No. :

3583 6518 6120

ssqr.6

- $ArSrJ$ *nSrL,

-""ffi ';.ffi&;:;""""'-'><'
ffi

'rtc6remi'eisn6trtii'oreo

reffi*1'sis4.
,_ _

._3599__qfl_g *612,0

erqi"6

*9ffi"

$A:rSrJS Xr5rb

t_

LITE IN$URANCE CSRFSRATIOH OF IHSIA

P&GS Unit., Divisional Office, Secretariat Road,
Hyder*bad- 5S0 063 Tel: t4S-33{20?S8: Fax : O4&232123S5
email:bo qsorKal icindia.gom

FORM OF RECEIPT FOR THE RETURN OF CAPITAL UNDER

THE MASTER POLICY NO.

,LIC
ANNUITY NO

We, the authorized signatories of $ERP \-\t"\ 3

. .being the proposers and
.Sv-. *AiA\.nn-qk-u?hotders of the above mentioned master policy, do hereby
acknowledge receipt from the Life lnsurance Corporation of
India, of the $um of rupees
being the total return of the capital in respect of Late
Smt.

T>qS', , Jrq

rvlqtuvr

rw\q

ln witness where of these presents are subscribed by

melus at
day of

0rr this
Retum of Capital

Total

2B_
fts. 3?sX1 :

AG'1S

Rs.

English Knowing l4litness:

Signature:
Full name:
Occupation:
Address:

DRDA/li[i-I"!9,;
"o*F*Tfu#n**-ror,
[Jr,:r!! Atmakur

.- !t*

Signature of
authorized Official
cf SERP with seal

l-

r-----_--a+;;t

r***rr fut;**+ ,*

":*

*J*;,,H-fi;lffifffikg*4"*f

*a*,i,i,

f;:f,flr
5.i;;#eroj,.'
$ji"ii':$

30f++
:.

c*6sraif,fpg*Uu
,:':.-i.*t:.,1

arn#o
t

ql{lt66'

*u*r* j

*g *oaEi),

-t

fi;r:-.irr!;:.4*:ft q

fl b tuj{$} (aTos,

f*

rrur.X*,

q*]4*.

66rdqt
1;$oc$o"
+rffi"ffiffi
:affiUi#m,g*;"mrus
STBFtra

r4$s\o5, $ od$;5r:
lic$rr

:L*--.{