YSR Navasakam

Social audit Survey format for Fee Reimbursement

Village/Ward Secretariat Name: Village/Ward Secretariat Code:

Village/Ward Volunteer Details :

Name Mobile No. Volunteer Code Nomenclature & Ward No

District: West Godavari Mandal: PENTAPADU GP/Village: PENTAPADU

Family Head Details:

Family Head Name:AMBATI HARI BABU Caste:Kapu

Ration Card No.WAP052700200127 Family Income :

Address :D.No.3/136-1A,NH 16 PRATHIPADU,PENTAPADU,PENTAPADU,West Godavari, Pincode:534146

Student Details in the Family:

Sl Student Name Aadhaar/ Age/ College Course/

No Mobile Gender Course Year

1 AMBATI DURGA 260019071855/ 20/ M swarnandhra college of BTECH (ECE)/3

RAMA KRISHNA 9398973736 engineeringtechnology swrn a2,West
Godavari

Bank Account Details of Mother (Required) *:

Mother Name:AMBATI DHANA LAKSHMI

Mother Bank Account Number: IFSC Code:

Details For Validation:

Details Of Family Member if Govt. Employee/Pensioner: Details Of Family Member Paying Income Tax:

Details of Details Agree/Disagree

Four Wheeler Owned by family Member: A Dhana Lakshmi, AP37DC3023, Maruti

Suzuki India Ltd

Land Holding By the Family:

Property(Commercial/Residential)
in urban Area

FOUR-WHEELER
Personal Vehicle still in the name of
applicant / family members.
Taxi vehicle still in the name of applicant /
family members
Vehicle was in the name of the applicant /
family member but sold to other person now
updated in the database.
Vehicle never belong to applicant and
database updated to applicant / family
members.
Please Family Land Holding
tick
The extents of land details are correct.
The land details have been updated and
the total extent of the land is more than
10.00 Ac. Wet (or) 25 Ac. Dry or both
together 25 Ac.
The land details have been updated and
the total extent of the land is less than
10.00 Ac. Wet (or) 25 Ac. Dry or both
together 25 Ac.
Do not own any land on applicant and
family member's.
Please Municipal Property details Please
tick tick
Applicant having property less than 1500
Sq.ft. with assessment no.-----------
Applicant having property more than 1500
Sq.ft. with assessment no.-------------
Ancestral property . The Applicant is legal
heir and would get less than 1500 Sq.Ft. if
mutated / sub divided
Ancestral property . The Applicant is legal
heir and would get more than 1500 Sq.Ft. if
mutated / sub divided

The above mentioned details are correct and certified by me

Signature of the Student/Parent

The above mentioned details are examined as per the standard procedures of social welfare department on Jagananna Vidya deevena and
Jagananna Vasathi Deevena schemes.

Signature of the volunteer