LEGAL LIABILITY CERTIFICATE

Received sum of Rs. 2,00,000/- (Rupees Two Lakhs only) from the Divisional
Engineer/Operation/Srikakulam towards Exgratia under compassionate grounds
for the accident occurred on 11.03.2016 at around 20.30 Hrs at Budagatlapalem
Village,Etcherla Mandalam. 1 No. Fatal accident occurred to Smt. SURADA
DANAMMA W/o YARAKAYYA on 11.03.2016 at about 20:30 Hrs vide sanction
Memo.No.CGM/O&CS/EPDCL/VSP/LMC/Acc-SKL/D.No.124/18, dt. 24.02.2018.
 I submit that I and my Family members have not approached any Court on
the fatal accident occurred to 1 No. Fatal accident occurred to Smt. SURADA
DANAMMA W/o YARAKAYYA, aged 40 years, Budagatlapalem Village,Etcherla
Mandal, Srikakulam District on 11.03.2016 at about 20:30 Hrs.
I have received Rs. 2,00,000/- (Rupees Two Lakhs only ) for full and final
settlement of claims against the A.P.E.P.D.C.L.

Signature

Witnesses:

1)

2)
 CERTIFICATE

Certified that SURADA DANAMMA Wife of YARAKAYYA, and my family

members have received a sum of Rs. 2,00,000/- (Rupees Two Lakhs only) from the
Divisional Engineer/Operation/APEPDCL, Srikakulam 1.No. Fatal accident vide
sanction Memo. No. CGM/O&CS/EPDCL/VSP/LMC/Acc-SKL/D.No.124/18, dt.
24.02.2018.towards ex-gratia under compassionage grounds for the accident
occurred on 11.03.2016 at about 20:30 Hrs at Budagatlapalem Village, Etcherla
Mandalam, Srikakulam District for full and final settlement of claims against in the
APEPDCL.
Sl.No. Name of the Family Relation Age Signatures
Mebers
01. Surada Yarakayya Husband 55
02. Surada Appanna Son 20
03 Surada Maisen Son 16
04 Rayithi Kameswari Daughter 26
05 AmaraLakshmi Daughter 25

Signature.
 CERTIFICATE OF NO COURT CASE CLAIMED

Certified that SURADA DANAMMA W/o SURADA YARAKAYYA and my

family members leave not claimed any Court cases on the Electrical fatal accident
occurred 11.03.2016 at 20:30 Hrs at Budagatlapalem Village, Etcherla Mandalam,
Srikakulam District and there is no Court cases pending with the above subject
matter the following family members.

Sl.No. Name of the Family Relation Age Signatures

Mebers
01. Surada Yarakayya Husband 55
02. Surada Appanna Son 20
03 Surada Maisen Son 16
04 Rayithi Kameswari Daughter 26
05 AmaraLakshmi Daughter 25

Signature.