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Ration
Card
Details
Peraonal-
DetailE
Ration
Card
No
Card
Status
Name
of
Head
of
FamilY(in
Loca1
Language)
Motherrs
Name(in
Local
Language )
Father's
Name(in
Local
Language
)
nAPl-333o27ofiy'
rn^ctive ./
Da6i
Danamma
Fe4lffi
Office
Name
ShoP
No
Head
of
Family
Bandi
AtEEkur
L333027
Mother's
Name --
Father's
Name
Pre8ent
AddreEs
House
No-/House
Name
8.119
Landmarkllocality/Colony
8.119,
Bandi'Atmakur
Vr
jlage/'l'own
District
Name
Bandi
Atmakur
KufBool
50
000
0
sandi
Atmakur,
Bandi
Atmakur
{V}
Mandal
Name
Bandi
Atmakur
state
Name
ANDHRA
PRADESH
Landmark,/Locality/Colony
8.1"19,
Bandi
Atmakur
Bandi
Atmakur,
Bandi
.*tmakur
(v)
VillagelTown
Bandi
Atmakur
District
Name
Kurnool
Mandal
Name
Kurnool
State
Name
.Andhra
Pradeah
PrN
s00000
Profes8ional
Detail-s
Occupation
r,ABoUR/Cool-i/Porxer/:llar.d'
Total
Annual
fncome
15000
eart
Puller
GaE
Connection
DetaiLs
:
Gas
Connection
Statlus
Gas
Agency
Name
Gas
Company
Name
Consumer
Number
Card
T)?e
BPL
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DRDA{/ELUGU,
Jnsrdi
Atmakur
Page
Na.7
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7/23/2019 d.danamma Claim
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Famil"Y
Meuiber
Details
Date
of
Bilth
(DD/ ,EI
/yYwt
llother'
a
Name
Father'E
Name
gp6use
Narre
Relatsior
wi
Lh
Applicant
{o
Name
(
inelud
ing
Itead
of
rasrily)
Gender
Age
(YrB)
Barna
Basu
gELF
1
Dasi
Danatrlma
l.EMAI,E
so
-NA-
NA
NA
NA
DAUGHTER
IN
I,AW
2
DaBi
KarnarEra
;:q,\
u3
2A
.NA-
-NA-
NA
NA
HUSBAND
3
Da6i
Barna
BaEu
MALE
58
NA
NA
NA
soN
4
Daei
Karnakar
MAtE
))
-NA-
GXAND
SON
5
Dasi
Krupakar
MALE
I
-NA-
NA
/dinator^
Co
rlB,nrli
Atnrakur
DRDAIVELUCU'
Report
Geflerated
by
ltyderbad
Food
and
Supply
DePE'
Syieefr
Design
DeveloPed
by
.
Na:ianaT
Intoz&atica
Centre'
age
No-2
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7/23/2019 d.danamma Claim
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FORM
OF RECEIPT
FOR
THE
RETURN
OF
CAPITAL
UNDER
THE
MASTER
POLICY
NO.
ANNUITY
NO ,LIC
We,
the
authorized signatories
of
$ERP
\-\t"\
3
.Sv-.
*AiA\.nn-qk-u?-
.
.being
the
proposers
and
hotders
of
the
above mentioned
master
policy,
do
hereby
acknowledge
receipt from
the
Life
lnsurance Corporation
of
India,
of the $um
of rupees
being the
total
return
of
the
capital
in
respect
of
Late
Smt.
T>qS',
,
Jrq
rvlqtuvr
rw\q
ln
witness
where of these
presents
are
subscribed
by
melus at
0rr
this
day
of
2B_
LITE
IN$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
i
fts.
3?sX1
:
AG'1S
l-
etum
of
Capital
Total
English
Knowing
l4litness:
Signature:
Full
name:
Occupation:
Address:
"o*F*Tfu#n**-ror,
RDA/li[i-I" 9,;
[Jr,:r Atmakur
Signature
of
authorized
Official
cf
SERP
with
seal
Rs.
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7/23/2019 d.danamma Claim
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