SKS Survey Number:MB0121974/002

Household Verification Format Door No:7-163,LATUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband SAKRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KETHAVA Husband Female Nil DAILY 842042555346
TH WAGES
PANDU(50) LABOUR/N
il
2 KETHAVA Wife Female Nil DAILY
TH WAGES
THULASI(4 LABOUR/N
0) il
3 KETHAVA Son Male Nil OTHERS(P 790120320285
TH ROVIDE
PREMKUA DETAILS)/
MR(27) Nil
4 KETHAVA Son Male Nil Nil/Nil 271679802837
TH
BALU(20)
5 KETHAVA Daughter in Female Nil HOUSE
TH Law WIFE/Nil
SWATHI(23
)
6 KETHAVA Grand Son Male Nil Nil/Nil
TH SAI
CHANUKY
A(3)
7 KETHAVA Grand Son Male Nil Nil/Nil
TH
BABU(0)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:4.48/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0127926/000

Household Verification Format Door No:13-60,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband SUNNI Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil AGRICULT
SHANKAR( URE
39) LABOUR
/Nil
2 SAKRI(35) Wife Female Nil Nil/Nil
3 GOPAL(29) Son Male Nil Nil/Nil
4 Son Male Nil Nil/Nil
RAMULU(3
3)PWD: Y &
Sadaran
No:1418939
014011301
5 Son Male Nil Nil/Nil
BHARATH(
21)
6 Daughter Female Nil Nil/Nil
NEELAMM
A(24)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:3.12/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0127928/000

Household Verification Format Door No:13-61,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BALU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VADLAVA Self Female Nil Nil/Nil
TH
KAMALA(1
6)
2 VADLAVA Son Male Nil Nil/Nil
TH
SRINU(13)
3 VADLAVA Son Male Nil AGRICULT 364286777868
TH URE
PULYA(59) LABOUR
/Nil
4 VADLAVA Son Male Nil Nil/Nil
TH
HANMANT
HU(17)
5 VADLAVA Son Male Nil Nil/Nil
TH
GANESH(5)
6 VADLAVA Son Male Nil AGRICULT 522887207987
TH URE
MANGLI(69 LABOUR
) /Nil
7 VADLAVA Daughter Female Nil Nil/Nil
TH
LALLI(27)
8 VADLAVA Brother in Female Nil Nil/Nil
TH Law
RAMANI(4
4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:5/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0127929/000

Household Verification Format Door No:13-61/1,LATTUPALE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BALU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VASSA(38) Self Male Nil AGRICULT 251282038554
URE
LABOUR
/Nil
2 Wife Female Nil AGRICULT 960767512737
CHANDI(33 URE
) LABOUR
/Nil
3 Son Male Nil Nil/Nil
ESHWAR(5
)
4 PAVAN(4) Son Male Nil Nil/Nil
5 Son Male Nil AGRICULT
RAJESH(24) URE
LABOUR
/Nil
6 Son Male Nil AGRICULT
SURESH(25 URE
) LABOUR
/Nil
7 ARUNA(7) Daughter Female Nil Nil/Nil
8 ANITHA(6) Daughter Female Nil Nil/Nil
9 Daughter Female Nil Nil/Nil
SHIVAMM
A(23)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0127933/001

Household Verification Format Door No:13-65,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband MOTHLA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil 638513412748
NARVYA(3
1)
2 CHITTI(29) Wife Female Nil Nil/Nil
3 Son Male Nil Nil/Nil
ARAVINDU
(7)
4 Daughter Female Nil Nil/Nil
THULASI(1
0)
5 MANJU(5) Daughter Female Nil Nil/Nil
6 Daughter Female Nil Nil/Nil
NANDINI(3
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0127937/001

Household Verification Format Door No:13-63/1,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband VALLYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ODDI(56) Self Female Nil Nil/Nil 526681871381

2 Son in Law Female Nil Nil/Nil

GALAGEET
HA(15)
3 Grand Female Nil Nil/Nil
MANGEEL Daughter
U(18)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:1/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0131920/000

Household Verification Format Door No:4-92,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband MASHAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUMMAK Self Male Nil Nil/Nil 921827641111
ONDA
NADIYAPP
A(60)
2 GUMMAK Wife Female Nil Nil/Nil 823258661706
ONDA
LAXMAM
MA(52)
3 GUMMAK Son Male Nil Nil/Nil
ONDA
MANEYAN
M(34)
4 GUMMAK Daughter in Female Nil Nil/Nil
ONDA Law
RENUKA(2
5)
5 GUMMAK Father in Male Nil Nil/Nil
ONDA Law
RAKESH(8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:2.42/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217727/000

Household Verification Format Door No:12-26,TANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband GOVINDARAJ Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VADDY Self Male Nil Nil/Nil
RAMESH(2
5)
2 VADDY Wife Female Nil Nil/Nil
SOYMA(20)
3 VADDY Son Male Nil Nil/Nil
KARTEEK(
5)
4 VADDY Daughter Female Nil Nil/Nil
SURAKHA(
2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217731/000

Household Verification Format Door No:1101,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband KESHYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil AGRICULT 686804245665
HR URE
NARYA(43) LABOUR
/Nil
2 RAMAVAT Wife Female Nil AGRICULT 677721957713
HR URE
MUTHYAL LABOUR
U(30) /Nil
3 RAMAVAT Daughter Female Nil Nil/Nil 638261145046
HR
NEELAMM
A(7)
4 RAMAVAT Daughter Female Nil Nil/Nil 966688249052
HR
ANITHA(12
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.32 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217732/000

Household Verification Format Door No:1102,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband KESHYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil AGRICULT 643733292563
HR URE
PANDU(41) LABOUR
/Nil
2 RAMAVAT Wife Female Nil AGRICULT 326679398362
HR URE
KAMLI(40) LABOUR
/Nil
3 RAMAVAT Son Male Nil Nil/Nil 444300216981
HR
RAJU(11)
4 RAMAVAT Son Male Nil Nil/Nil 279602919816
HR
SRINU(15)
5 RAMAVAT Daughter Female Nil Nil/Nil
HR
PRIYA(1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.08 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217733/000

Household Verification Format Door No:1103,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband KASINA Gas YES/HP/632556
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil AGRICULT 831050426501
HM URE
BADHYA(5 LABOUR
0)PWD: Y & /Nil
Sadaran No:
Nil
2 MUDAVAT Wife Female Nil AGRICULT 612973483583
HM URE
MARONI(4 LABOUR
8) /Nil
3 MUDAVAT Son Male Nil DRIVERS/N 769151516325
HM il
SRINU(20)
4 MUDAVAT Son Male Nil STUDENT/ 627931751321
HM Nil
SHANKAR(
20)
5 MUDAVAT Son Male Nil DRIVERS/N 227588067099
HM il
RAJU(28)
6 MUDAVAT Daughter in Female Nil AGRICULT 630241680870
HM Law URE
VIJAYAM LABOUR
MA(18) /Nil
7 MUDAVAT Daughter in Female Nil AGRICULT 720655296657
HM Law URE
NEELA(25) LABOUR
/Nil
8 MUDAVAT Grand Female Nil Nil/Nil 977510711010
HM Daughter
SWAPNA(4
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:5.12 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217734/000

Household Verification Format Door No:1104,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband KASINA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil Nil/Nil 798784122290
HM
SHANKAR(
45)
2 MUDAVAT Wife Female Nil Nil/Nil 798822185983
HM
ANTHYALI
(35)
3 MUDAVAT Son Male Nil Nil/Nil 886753645814
HM
BABU(9)
4 MUDAVAT Son Male Nil Nil/Nil 807519491470
HM
SATISH(7)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.25 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217735/000

Household Verification Format Door No:1105,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband LACHYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil AGRICULT 682463381451
HM URE
JAMPYA(40 LABOUR
) /Nil
2 MUDAVAT Wife Female Nil AGRICULT 942534995047
HM URE
ANJAMMA LABOUR
(36) /Nil
3 MUDAVAT Son Male Nil Nil/Nil 726450455165
HM
SANTOSH(
17)
4 MUDAVAT Son Male Nil Nil/Nil 610912141844
HM
RAMBABU
(11)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217736/000

Household Verification Format Door No:1106,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband LACHYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil AGRICULT 455039673180
HM URE
PANDU(37) LABOUR
/Nil
2 MUDAVAT Wife Female Nil AGRICULT 301900245937
HM URE
SOMLI(25) LABOUR
/Nil
3 MUDAVAT Son Male Nil Nil/Nil 986632671228
HM
RAMACHA
NDHAR(12)
4 MUDAVAT Son Male Nil Nil/Nil
HM
SRIKANTH
(10)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217737/000

Household Verification Format Door No:1107,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband LACHYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil DRIVERS/N 544357454302
HM il
BHASHYA(
36)
2 MUDAVAT Wife Female Nil AGRICULT 288959762254
HM URE
NARAMMA LABOUR
(30) /Nil
3 MUDAVAT Son Male Nil Nil/Nil 442744701199
HM
RAJESH(6)
4 MUDAVAT Son Male Nil Nil/Nil 969443277682
HM
RAMCHAR
AN(5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217738/000

Household Verification Format Door No:1108,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband LACHYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDUVAT Self Male Nil AGRICULT 789291821854
HM URE
MAANYA(4 LABOUR
0) /Nil
2 MUDUVAT Wife Female Nil AGRICULT 233199239269
HM URE
SOMLI(38)P LABOUR
WD: Y & /Nil
Sadaran No:
Nil
3 MUDUVAT Son Male Nil Nil/Nil 510081163472
HM
JAGAN(13)
4 MUDUVAT Son Male Nil Nil/Nil
HM
SRIKANTH
(8)
5 MUDUVAT Daughter Female Nil Nil/Nil 906027889704
HM
BHARATHI
(15)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217739/000

Household Verification Format Door No:1109,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband LACHYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil AGRICULT 734709317925
HM URE
HANMYA(4 LABOUR
6) /Nil
2 MUDAVAT Wife Female Nil AGRICULT 426775744727
HM URE
THARI(41) LABOUR
/Nil
3 MUDAVAT Son Male Nil STUDENT/ 792367630323
HM Nil
RAJKUMA
R(22)
4 MUDAVAT Son Male Nil STUDENT/ 546787004050
HM Nil
DEVYA(17)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217740/000

Household Verification Format Door No:1110,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband JAGUVA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ISLAVATH Self Male Nil AGRICULT 408239306815
I URE
RAMULU(6 LABOUR
5) /Nil
2 ISLAVATH Wife Female Nil AGRICULT 561633837488
I URE
CHANDHI( LABOUR
60)PWD: Y /Nil
& Sadaran
No: Nil
3 ISLAVATH Son Male Nil AGRICULT 464020088290
I URE
BASHA(26) LABOUR
/Nil
4 ISLAVATH Son Male Nil AGRICULT 465172874919
I URE
KAALYA(4 LABOUR
0)PWD: Y & /Nil
Sadaran No:
Nil
5 ISLAVATH Daughter in Female Nil DAILY 891482221582
I Law WAGES
MUTHYAL LABOUR/N
U(36) il
6 ISLAVATH Daughter in Female Nil Nil/Nil 587712542641
I Law
SHANTHI(2
5)
7 ISLAVATH Grand Son Male Nil AGRICULT 590374309238
I SHIVA(13) URE
LABOUR
/Nil
8 ISLAVATH Grand Son Male Nil Nil/Nil 697635654551
I
JEEVAN(6)
9 ISLAVATH Grand Son Male Nil Nil/Nil
I
KUMAR(2)
10 ISLAVATH Grand Son Male Nil Nil/Nil 892709871152
I SRINU(15)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:
Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217741/000

Household Verification Format Door No:1111,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband TEEKYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ISLAVATH Self Male Nil AGRICULT 654176272235
I URE
SHANKAR( LABOUR
40)PWD: Y /Nil
& Sadaran
No: Nil
2 ISLAVATH Wife Female Nil AGRICULT 593336450429
I URE
LAXHMI(30 LABOUR
) /Nil
3 ISLAVATH Son Male Nil STUDENT/ 763462094521
I Nil
UMESH(17)
4 ISLAVATH Son Male Nil STUDENT/ 745973905641
I Nil
MAHESH(1
9)
5 ISLAVATH Daughter Female Nil STUDENT/ 670448304710
I Nil
CHITTI(13)
6 ISLAVATH Mother Female Nil AGRICULT 429261551094
I SAALI(70) URE
LABOUR
/Nil
7 ISLAVATH Father Male Nil AGRICULT 363165323130
I URE
TEEKYA(76 LABOUR
) /Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.72 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217742/000

Household Verification Format Door No:1112,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband TEEKYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ISLAVATH Self Female Nil AGRICULT 874688978687
I URE
HARJYA(39 LABOUR
) /Nil
2 ISLAVATH Wife Female Nil AGRICULT 206473411689
I URE
JAMRU(35) LABOUR
/Nil
3 ISLAVATH Daughter Female Nil Nil/Nil 860436840860
I
NEELA(14)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.72 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217743/000

Household Verification Format Door No:1113,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband JAGUNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ISLA VATH Self Male Nil AGRICULT 752150179746
I URE
CHANDHY LABOUR
A(60) /Nil
2 ISLA VATH Wife Female Nil AGRICULT 461218947909
I URE
GOORI(55) LABOUR
/Nil
3 ISLA VATH Son Female Nil DRIVERS/N 858674825587
I il
BHASKAR(
23)
4 ISLA VATH Son Female Nil AGRICULT 499511244997
I GOPI(15) URE
LABOUR
/Nil
5 ISLA VATH Daughter in Male Nil AGRICULT 830239607652
I Law URE
JAYASRI(2 LABOUR
0) /Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:6.52 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217744/000

Household Verification Format Door No:1114,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband JAGUNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ISLA VATH Self Male Nil AGRICULT 469290590076
I URE
THUNTYA( LABOUR
70) /Nil
2 ISLA VATH Son Male Nil DRIVERS/N 204987348894
I RAJU(34) il

3 ISLA VATH Daughter in Female Nil AGRICULT 753574306747

I Law URE
HASLIBAI( LABOUR
28) /Nil
4 ISLA VATH Grand Son Male Nil Nil/Nil 229006887389
I NITHIN(7)

5 ISLA VATH Grand Son Male Nil Nil/Nil

I SRINU(8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:6.52 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217745/000

Household Verification Format Door No:1114,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband THUNTYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ISLAVATH Self Male Nil AGRICULT 894682218742
I URE
BADHRU(4 LABOUR
0) /Nil
2 ISLAVATH Wife Female Nil AGRICULT 210666999681
I URE
HANMIBAI LABOUR
(38) /Nil
3 ISLAVATH Son Male Nil Nil/Nil 507978399315
I
RAVINDHA
R(12)
4 ISLAVATH Son Male Nil Nil/Nil 889657678938
I
MAHESH(1
3)PWD: Y &
Sadaran No:
Nil
5 ISLAVATH Daughter Female Nil Nil/Nil 817285620422
I
SHARADH
A(15)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217746/000

Household Verification Format Door No:1114,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband THONTYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ISLAVATH Self Male Nil AGRICULT 958956820658
I URE
SHANKAR( LABOUR
35) /Nil
2 ISLAVATH Wife Female Nil AGRICULT 752903540911
I URE
KAMALAM LABOUR
MA(30) /Nil
3 ISLAVATH Son Male Nil Nil/Nil 913900861952
K
KARTHIK(4
)
4 ISLAVATH Daughter Female Nil Nil/Nil
K
AKHILA(7)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217747/000

Household Verification Format Door No:1115,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband TEEKYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ISLAVATH Self Male Nil AGRICULT 705839674490
I URE
HANMYA(5 LABOUR
0) /Nil
2 ISLAVATH Wife Female Nil AGRICULT 613072859341
I URE
SUVALI(47) LABOUR
/Nil
3 ISLAVATH Son Male Nil Nil/Nil 202833300586
I SRINU(25)

4 ISLAVATH Son Male Nil Nil/Nil 862123713631

I
KRISHNAP
RASADH(2
0)
5 ISLAVATH Daughter in Female Nil Nil/Nil
I Law
SHANTHI(2
0)
6 ISLAVATH Mother in Female Nil Nil/Nil 639337078263
I Law
MUTHYALI
(70)
7 ISLAVATH Grand Son Male Nil Nil/Nil
I
VINAYAK(
10)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217748/000

Household Verification Format Door No:1116,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband CHANDHU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil AGRICULT 267578240622
HR URE
RAMULU(7 LABOUR
0)PWD: Y & /Nil
Sadaran No:
Nil
2 RAMAVAT Wife Female Nil AGRICULT 396781638261
HR URE
RUKKALI(6 LABOUR
0) /Nil
3 RAMAVAT Son Male Nil DRIVERS/N 841423625954
HR il
SRINU(28)
4 RAMAVAT Daughter in Female Nil AGRICULT 228620852287
HR Law URE
MANNI(24) LABOUR
/Nil
5 RAMAVAT Grand Son Male Nil Nil/Nil 888204070366
HR
BALU(8)
6 RAMAVAT Grand Female Nil Nil/Nil 313796697978
HR Daughter
NANDHINI(
6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.48 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217749/000

Household Verification Format Door No:1117,LATPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil AGRICULT 534694765018
HR URE
SARIYA(40 LABOUR
) /Nil
2 RAMAVAT Husband Female Nil AGRICULT 718090537762
HR URE
MARONI(3 LABOUR
5) /Nil
3 RAMAVAT Son Male Nil STUDENT/ 629988727070
HR Nil
SHIVAKU
MAR(11)
4 RAMAVAT Son Male Nil STUDENT/ 213272197287
HR Nil
NANDHAN
KUMAR(8)
5 RAMAVAT Daughter Female Nil STUDENT/ 820466797212
HR Nil
SAROJA(14
)
6 RAMAVAT Daughter Female Nil STUDENT/ 826861144665
HR Nil
HARITHA(1
2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.48 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217750/000

Household Verification Format Door No:1118,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband POOLYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Female Nil AGRICULT 859334051520
HR URE
PATNI(60) LABOUR
/Nil
2 RAMAVAT Son Male Nil AGRICULT 295143046007
HR URE
LAXHMAN LABOUR
(45) /Nil
3 RAMAVAT Son Male Nil AGRICULT 294983361690
HR URE
PEERU(28) LABOUR
/Nil
4 RAMAVAT Daughter in Female Nil AGRICULT 430077193377
HR Law URE
LAXHMI(26 LABOUR
) /Nil
5 RAMAVAT Daughter in Female Nil AGRICULT 862127549448
HR Law URE
ANJI(35) LABOUR
/Nil
6 RAMAVAT Grand Son Male Nil Nil/Nil 765510294910
HR
RAKESH(6)
7 RAMAVAT Grand Son Male Nil Nil/Nil 781362462710
HR
CHARAN(4
)
8 RAMAVAT Grand Son Male Nil Nil/Nil 816996765665
HR
RAVI(16)
9 RAMAVAT Grand Son Male Nil Nil/Nil 524935636182
HR
SANTOSH(
12)
10 RAMAVAT Grand Female Nil Nil/Nil 294321802514
HR Daughter
MANJULA(
10)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:5.55 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:
Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217751/000

Household Verification Format Door No:1119,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BADHRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil Nil/Nil 929133644203
HR
CHINNA
POOLYA(6
4)
2 RAMAVAT Wife Female Nil Nil/Nil 360612240467
HR
MANEMM
A(57)
3 RAMAVAT Son Male Nil Nil/Nil 613873840449
HR
SRINU(32)
4 RAMAVAT Daughter in Female Nil Nil/Nil 264416803622
HR Law
BUJJI(28)
5 RAMAVAT Grand Son Male Nil Nil/Nil 813743328986
HR
CHINTU(6)
6 RAMAVAT Grand Son Male Nil Nil/Nil 939258039755
HR
ANIL(5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.25 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217752/000

Household Verification Format Door No:1120,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BADHRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil AGRICULT 234547188705
HR URE
THAVURU( LABOUR
50) /Nil
2 RAMAVAT Wife Female Nil AGRICULT 589511587604
HR URE
BHAMINI(4 LABOUR
6) /Nil
3 RAMAVAT Son Male Nil DRIVERS/N 839435300890
HR il
SRISHAILA
M(12)
4 RAMAVAT Daughter Female Nil DRIVERS/N 561718185631
HR il
SANDHYA(
8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217753/000

Household Verification Format Door No:1121,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband POOLYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil Nil/Nil 625767266075
HR
GEEMYA(3
5)
2 RAMAVAT Wife Female Nil Nil/Nil 677671043779
HR
SUVALI(31)
3 RAMAVAT Son Male Nil Nil/Nil 773518453898
HR
JAGAN(7)
4 RAMAVAT Son Male Nil Nil/Nil 634401205717
HR
SHIVA(10)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.25 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217754/000

Household Verification Format Door No:1122,MIRYA THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband POOLYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil AGRICULT 993029787181
HR URE
SHANKAR( LABOUR
29) /Nil
2 RAMAVAT Wife Female Nil AGRICULT 395486948024
HR URE
SEETHAM LABOUR
MA(26) /Nil
3 RAMAVAT Son Male Nil STUDENT/ 534534030548
HR Nil
GANESH(1
0)
4 RAMAVAT Son Male Nil STUDENT/ 308573372759
HR Nil
PAVAN(7)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.25 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217755/000

Household Verification Format Door No:1123,MIRYA THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband LAXHMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VADDERA Self Female Nil OTHERS(P
V ROVIDE
NARSIMHA DETAILS)/
(46) Nil
2 VADDERA Wife Female Nil OTHERS(P
V ROVIDE
JYOTHI(41) DETAILS)/
Nil
3 VADDERA Son Male Nil OTHERS(P
V ROVIDE
MAREPPA( DETAILS)/
16) Nil
4 VADDERA Son Male Nil OTHERS(P
V ROVIDE
SRINU(14) DETAILS)/
Nil
5 VADDERA Daughter Female Nil Nil/Nil
V
PRAMILA(1
0)
6 VADDERA Daughter Female Nil Nil/Nil
V
KAVITHA(
12)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) YES

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217756/000

Household Verification Format Door No:1124,MIRYA THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband VENKATESH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VADDE V Self Female Nil Nil/Nil
CHANDHR
AMMA(42)
2 VADDE V Husband Male Nil Nil/Nil
VENKATES
H(50)
3 VADDE V Son Male Nil Nil/Nil
MALLESH(
11)
4 VADDE V Son Male Nil Nil/Nil
RAVI(22)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) YES

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217757/000

Household Verification Format Door No:1125,MIRYA THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband MUNNEPPA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VADDE V Self Male Nil AGRICULT
VIJAY(26)P URE
WD: Y & LABOUR
Sadaran No: /Nil
Nil
2 VADDE V Wife Female Nil AGRICULT
LAXHMI(20 URE
) LABOUR
/Nil
3 VADDE V Brother Male Nil Nil/Nil
SRINU(27)P
WD: Y &
Sadaran No:
Nil
4 VADDE V Sister Female Nil Nil/Nil
SUNITHA(8
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) YES

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217800/000

Household Verification Format Door No:12-79/1,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband PARSHA Gas YES/HP/652078
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ROUTHLA Self Male Nil Central Govt 598111376020
VATH Employee/Ni
KRUSHNA l
PRASAD(38
)
2 ROUTHLA Wife Female Nil Nil/Nil 780755507674
VATH
SHANTHI(3
4)
3 ROUTHLA Son Male Nil Nil/Nil 260983684683
VATH
DINESHKA
RTHIK(9)
4 ROUTHLA Daughter Female Nil Nil/Nil 976917986556
VATH
SINDHU(14
)
5 ROUTHLA Daughter Female Nil Nil/Nil 475380742308
VATH
SRUTHI(16)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:1.98 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217821/000

Household Verification Format Door No:12-89,CHINNA PEER THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband JEELU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil OWN 792113220231
H AGRICULT
SAREYA(44 URE
) /Nil
2 MUDAVAT Wife Male Nil OWN 714815116212
H AGRICULT
MANNY(34 URE
) /Nil
3 MUDAVAT Son Male Nil OWN
H AGRICULT
RAMESH(1 URE
9) /Nil
4 MUDAVAT Son Male Nil STUDENT/ 363774089723
H Nil
GANESH(1
2)
5 MUDAVAT Daughter in Female Nil Nil/Nil
H Law
SAROJA(18
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.08 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217822/000

Household Verification Format Door No:12-89/1,CHINNA PEER THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband JEELU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Wife Female Nil OWN 669086522161
H RAJE(38) AGRICULT
URE
/Nil
2 MUDAVAT Wife Female Nil OWN
H AGRICULT
SATHYA(4 URE
3)PWD: Y & /Nil
Sadaran No:
Nil
3 MUDAVAT Son Male Nil STUDENT/ 822504420778
H Nil
RAJESH(12)
4 MUDAVAT Daughter Female Nil DAILY 713205520865
H WAGES
NEELA(16) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.08 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217823/000

Household Verification Format Door No:12-90,CHINNA PEER THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband JAMPALIAH Gas YES/Indane/635714
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MYDAVAT Self Male Nil OWN 561335056205
H AGRICULT
MANU(35) URE
/Nil
2 MYDAVAT Wife Female Nil OWN 962367457636
H AGRICULT
SHANTHA( URE
28) /Nil
3 MYDAVAT Son Male Nil STUDENT/ 201102850249
H SHIDU(7) Nil

4 MYDAVAT Daughter Female Nil STUDENT/ 243600338492

H Nil
SWATHI(8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:5.02 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217824/000

Household Verification Format Door No:12-91,CHINNA PEER THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband MARONI Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil DRIVERS/N 484438889119
H il
KRISHAN(2
5)
2 MUDAVAT Wife Female Nil DAILY 953416191464
H WAGES
SHANTHA( LABOUR/N
23) il
3 MUDAVAT Wife Female Nil DAILY 615272123635
H WAGES
MARONI(4 LABOUR/N
8) il
4 MUDAVAT Son Male Nil STUDENT/ 277950322350
H Nil
MUKESH(5
)
5 MUDAVAT Son Female Nil DAILY 601805283247
H WAGES
LALITHA(8 LABOUR/N
) il
6 MUDAVAT Sister in Law Male Nil STUDENT/ 652709108301
H Nil
PAVAN(8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.58 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217825/000

Household Verification Format Door No:12-92,CHINNA PEER THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband LAXMI Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDHAVA Self Male Nil OWN 746857382822
TH AGRICULT
BHADIAH( URE
25) /Nil
2 MUDHAVA Wife Female Nil DRIVERS/N 524379361960
TH il
CHITTE(20)
3 MUDHAVA Son Male Nil Nil/Nil
TH
DHELIP(1)
4 MUDHAVA Daughter Female Nil Nil/Nil
TH
MOGHITH
A(2)
5 MUDHAVA Mother Female Nil DAILY 815362245218
TH WAGES
LAXMI(43) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:5.05 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217826/000

Household Verification Format Door No:12-92/1,CHINNA PEER THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband JAMPALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDHAVA Self Male Nil DAILY
TH WAGES
PANDHU(3 LABOUR/N
5) il
2 MUDHAVA Wife Female Nil DAILY 591108975999
TH WAGES
RAJE(23) LABOUR/N
il
3 MUDHAVA Wife Female Nil DAILY
TH WAGES
ANJAMMA LABOUR/N
(25) il
4 MUDHAVA Son Male Nil Nil/Nil 955745215873
TH
RAMBABU
(4)
5 MUDHAVA Son Male Nil Nil/Nil
TH
SAIKUMAR
(1)
6 MUDHAVA Daughter Female Nil STUDENT/ 414329311260
TH Nil
GETHA(7)
7 MUDHAVA Daughter Female Nil Nil/Nil
TH
INDHU(3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217827/000

Household Verification Format Door No:12-93,CHINNA PEER THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband PEKLLA Gas YES/Indane/631901
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Female Nil OWN 877033007403
H AGRICULT
LALLI(66) URE
/Nil
2 MUDAVAT Son Female Nil OWN 401124167116
H AGRICULT
BUJJE(30) URE
/Nil
3 MUDAVAT Son Male Nil OWN 667719551194
H AGRICULT
JAGER(33) URE
/Nil
4 MUDAVAT Grand Son Male Nil STUDENT/ 584934122181
H Nil
THARUN(7)
5 MUDAVAT Grand Son Male Nil STUDENT/ 870477500470
H Nil
VIJAIKUM
AR(11)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:12.62 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217828/000

Household Verification Format Door No:12-94,CHINNA PEER THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband JEILL Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil Nil/Nil
H
GOPAL(39)
2 MUDAVAT Wife Female Nil Nil/Nil
H
BUJJE(28)
3 MUDAVAT Son Male Nil Nil/Nil
H SIDHU(1)
4 MUDAVAT Son Male Nil Nil/Nil
H
CHANTI(5)
5 MUDAVAT Mother Female Nil Nil/Nil
H
SAKRE(68)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217829/000

Household Verification Format Door No:12-95,CHINNA PEER THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BHALIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SABHAVA Wife Female Nil DO 547063558434
TH NOTHING/
SAKRE(54) Nil
2 SABHAVA Son Male Nil DAILY 969272923251
TH WAGES
GANESH(2 LABOUR/N
9) il
3 SABHAVA Daughter in Female Nil DAILY 831622121880
TH Law WAGES
SUNITHA(3 LABOUR/N
1) il
4 SABHAVA Father in Male Nil DO 454770558777
TH Law NOTHING/
SUKRA(75) Nil
5 SABHAVA Grand Son Male Nil STUDENT/ 823135004074
TH Nil
HARSHA(5)
6 SABHAVA Grand Son Male Nil Nil/Nil
TH
PARAS(3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217830/000

Household Verification Format Door No:12-96,CHINNA PEER THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband SUKRA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SUBHAVA Self Male Nil DAILY 744562215211
TH WAGES
MOHAN(31 LABOUR/N
) il
2 SUBHAVA Husband Female Nil DAILY 757842616349
TH WAGES
ANITHA(32 LABOUR/N
) il
3 SUBHAVA Son Male Nil Nil/Nil 672418090940
TH
AVANESH(
11)
4 SUBHAVA Son Male Nil Nil/Nil 359856082460
TH
SUJAL(9)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217831/000

Household Verification Format Door No:12-97,CHINNA PEER THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband VACIAH Gas YES/HP/635715
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil OWN 206695670573
H AGRICULT
ALLIAH(58 URE
) /Nil
2 MUDAVAT Wife Female Nil OWN
H JEEJA(48) AGRICULT
URE
/Nil
3 MUDAVAT Son Male Nil DAILY 606729540074
H WAGES
HUNIIAH(3 LABOUR/N
7) il
4 MUDAVAT Daughter Male Nil OWN 338293503150
H RAJU(16) AGRICULT
URE
/Nil
5 MUDAVAT Daughter in Female Nil DAILY 690370103050
H Law WAGES
SHANTHI(3 LABOUR/N
5) il
6 MUDAVAT Grand Son Male Nil Nil/Nil 613544469326
H
CHARAN(4
)
7 MUDAVAT Grand Female Nil STUDENT/ 308892944316
H Daughter Nil
SANGETH
A(9)
8 MUDAVAT Grand Female Nil STUDENT/ 681864492448
H Daughter Nil
LAVANYA(
7)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.45 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217832/000

Household Verification Format Door No:12-98,CHINNA PEER THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil Nil/Nil
H
SRINU(28)
2 MUDAVAT Wife Female Nil AGRICULT 489073083827
H URE
MASURU(2 LABOUR
7) /Nil
3 MUDAVAT Son Male Nil Nil/Nil
H SHIVA(4)
4 MUDAVAT Son Male Nil Nil/Nil
H
PAVAN(7)
5 MUDAVAT Son Male Nil Nil/Nil
H
SANTHOSH
(12)
6 MUDAVAT Son Male Nil Nil/Nil
H
SANDEEP(2
)
7 MUDAVAT Daughter Female Nil Nil/Nil
H
NIKETHA(5
)
8 MUDAVAT Daughter Female Nil Nil/Nil
H
NANDHINI(
4)
9 MUDAVAT Daughter Female Nil Nil/Nil
H
SHARDHA(
8)
10 MUDAVAT Daughter Female Nil Nil/Nil
H
PADHMA(1
0)
11 MUDAVAT Brother Male Nil Nil/Nil
H RAVI(26)
12 MUDAVAT Sister in Law Female Nil Nil/Nil
H
LAXMI(33)
13 MUDAVAT Sister in Law Female Nil Nil/Nil
H
NALLI(24)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.42 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL
Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217833/000

Household Verification Format Door No:12-99,CHINNA PEER THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband VACHIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil OWN 733874899881
H AGRICULT
HEERIAH(4 URE
8) /Nil
2 MUDAVAT Wife Female Nil OWN 272493793179
H AGRICULT
THULASE( URE
40) /Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.42 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217834/000

Household Verification Format Door No:12-100,CHINNA PEER THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband DHASARIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVTH Husband Male Nil DRIVERS/N 723558167231
HANMANT il
H(1)
2 MUDAVTH Wife Female Nil DAILY 321154266503
LAXMI(27) WAGES
LABOUR/N
il
3 MUDAVTH Son Male Nil STUDENT/ 893812892558
SAI(4) Nil

4 MUDAVTH Son Male Nil STUDENT/ 723571014198

SHIVA(6) Nil

5 MUDAVTH Son Male Nil STUDENT/ 344212014732

SURESH(7) Nil

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217835/000

Household Verification Format Door No:13-1,CHINNA PEER THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband VACHIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Wife Female Nil OWN 581245746812
H AGRICULT
JAMRE(43) URE
/Nil
2 MUDAVAT Daughter Female Nil MILCH 704490819341
H ANIMALS/
VIJYA(20) Nil
3 MUDAVAT Daughter Female Nil MILCH 610339138983
H ANIMALS/
NEELA(15) Nil
4 MUDAVAT Father in Male Nil OWN 586087121061
H Law AGRICULT
DHASARIA URE
H(48) /Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.45 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217836/000

Household Verification Format Door No:13-2,TCHINNA PEER THHANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband THAUUR Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Female Nil DAILY 484899145909
H WAGES
LAXMI(48) LABOUR/N
il
2 MUDAVAT Son Male Nil DAILY 238756164495
H HARI(40) WAGES
LABOUR/N
il
3 MUDAVAT Daughter in Female Nil DAILY 875913724077
H Law WAGES
JAMUNNA( LABOUR/N
35) il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.35 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217837/000

Household Verification Format Door No:13-3,CHINNA PEER THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband GYIAH Gas YES/HP/631735
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VADYAVA Self Male Nil OWN 765205823318
TH AGRICULT
KOTYAIAH URE
(53) /Nil
2 VADYAVA Wife Female Nil OWN 896873198931
TH AGRICULT
LAXMI(48) URE
/Nil
3 VADYAVA Son Male Nil DAILY 524945856760
TH WAGES
MUNIDHA LABOUR/N
R(21) il
4 VADYAVA Daughter in Female Nil HOUSE
TH Law WIFE/Nil
NELLA(19)
5 VADYAVA Mother Female Nil DO 611946542856
TH NOTHING/
SUKREE(78 Nil
)
6 VADYAVA Grand Son Male Nil OTHERS(P
TH ROVIDE
VARUN(1) DETAILS)/
Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:5.45 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217838/000

Household Verification Format Door No:13-4,CHINNA PEER THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband KOTYAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VADYAVA Self Male Nil DAILY 272674354507
TH WAGES
HANMANT LABOUR/N
H(33) il
2 VADYAVA Wife Female Nil DAILY 410443186438
TH WAGES
KAMALA(2 LABOUR/N
7) il
3 VADYAVA Son Male Nil Nil/Nil 791384659382
TH
SANDEEP(7
)
4 VADYAVA Son Male Nil Nil/Nil 273453386125
TH
SANJU(6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217839/000

Household Verification Format Door No:13-5,CHINNA PEER THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband THAURR Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VADYAIH Self Female Nil DAILY 645471440911
PEEKLLI(5 WAGES
3) LABOUR/N
il
2 VADYAIH Son Male Nil STUDENT/ 373936337662
ANADH(18) Nil

3 VADYAIH Son Male Nil DAILY 369405764380

KERAN(19) WAGES
LABOUR/N
il
4 VADYAIH Daughter in Female Nil HOUSE
PREYANK Law WIFE/Nil
A(18)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:5.85 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217840/000

Household Verification Format Door No:13-6,CHINNA PEER THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband SHENKAR Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VADYAVA Self Male Nil Nil/Nil 580316203226
TH
SRINU(38)
2 VADYAVA Wife Female Nil Nil/Nil 742416282362
TH
VIJAYLAX
MI(33)
3 VADYAVA Son Male Nil Nil/Nil 863143504092
TH
PAVAN(16)
4 VADYAVA Daughter Female Nil Nil/Nil 846017182409
TH
DHEVYA(1
3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217841/000

Household Verification Format Door No:13-7,CHINNA PEER THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband MOUGYIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VADYAVA Self Male Nil Nil/Nil
TH
BHASKAE(
31)
2 VADYAVA Wife Female Nil Nil/Nil 294535842991
TH
MANYAM
MA(33)
3 VADYAVA Son Male Nil Nil/Nil 935937356685
TH
SURESH(7)
4 VADYAVA Daughter Female Nil Nil/Nil 883139347463
TH
NANDHAB
OY(4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217842/000

Household Verification Format Door No:13-8,CHINNA PEER THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband KEESHYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VADYAVA Self Male Nil MIGRATED 771423413239
TH LABOUR/N
VAGYIAH( il
59)
2 VADYAVA Wife Female Nil DAILY 851296274841
TH WAGES
MUTHYAL( LABOUR/N
53) il
3 VADYAVA Son Male Nil DAILY 224103387031
TH WAGES
RAJKUMA LABOUR/N
R(18) il
4 VADYAVA Daughter in Female Nil HOUSE 731613770888
TH Law WIFE/Nil
SUNETHA(
20)
5 VADYAVA Grand Son Male Nil Nil/Nil
TH
SOUN(1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.92 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217843/000

Household Verification Format Door No:13-9,CHINNA PEER THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband GYAMYIA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VADYAVA Self Male Nil OWN 734222935219
THY AGRICULT
HANMANT URE
H(46) /Nil
2 VADYAVA Wife Female Nil OWN 858829002529
THY AGRICULT
RAJAMMA( URE
43) /Nil
3 VADYAVA Son Male Nil Nil/Nil 996254322065
THY
RAMESH(2
2)
4 VADYAVA Son Male Nil DAILY
THY WAGES
SRINU(27) LABOUR/N
il
5 VADYAVA Daughter Female Nil Nil/Nil 518742426402
THY
SHANTHI(1
3)
6 VADYAVA Daughter in Female Nil HOUSE
THY Law WIFE/Nil
SUNITHA(2
5)
7 VADYAVA Grand Son Male Nil Nil/Nil
THY
VIJAYKUM
AR(1)
8 VADYAVA Grand Son Male Nil Nil/Nil
THY
GANESH(3)
9 VADYAVA Grand Female Nil STUDENT/ 299425454208
THY Daughter Nil
SHERESHA
(6)
10 VADYAVA Grand Female Nil STUDENT/ 454267450071
THY Daughter Nil
ANUSHA(7)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:
Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217844/000

Household Verification Format Door No:13-10,CHINNA PEER THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband PEEKLLA Gas YES/Others/38294693
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 vadyavath Self Male Nil DRIVERS/N 213301476744
PEERYAIH( il
34)
2 vadyavath Wife Female Nil DAILY 724682392185
KAMLLI(30 WAGES
) LABOUR/N
il
3 vadyavath Son Male Nil STUDENT/
SAIKUMAR Nil
(10)
4 vadyavath Son Male Nil STUDENT/
SANTHOSH Nil
(12)
5 vadyavath Daughter Female Nil STUDENT/
SHIVANEL Nil
LA(7)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217845/000

Household Verification Format Door No:13-11,CHINNA PEER THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband SHENKAR Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VADYAVA Self Male Nil DRIVERS/N 545857522824
TH il
JOHNNY(37
)
2 VADYAVA Wife Female Nil HOUSE
TH WIFE/Nil
GOURAMM
A(34)
3 VADYAVA Son Male Nil Nil/Nil
TH
SHIVAKU
MAR(15)
4 VADYAVA Daughter Female Nil Nil/Nil
TH
ANUSHA(1
1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217846/000

Household Verification Format Door No:12-94,CHINNA PEER THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband JELLU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil OWN 966986860101
H AGRICULT
GOPAL(39) URE
/Nil
2 MUDAVAT Wife Female Nil Nil/Nil 883365098368
H
BUJJE(28)
3 MUDAVAT Son Male Nil Nil/Nil 460477818831
H
CHANTE(5)
4 MUDAVAT Son Male Nil Nil/Nil
H SIDHU(1)
5 MUDAVAT Mother Female Nil Nil/Nil 988838544636
H
SAKRE(68)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.05 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217881/000

Household Verification Format Door No:11-01,KATRAVATH THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband SURYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KATRAVA Self Male Nil Nil/Nil
TH K
HANMANT
HU(31)
2 KATRAVA Wife Female Nil Nil/Nil
TH K
JUMANI(28
)
3 KATRAVA Son Male Nil Nil/Nil
TH K
CHINTI(6)
4 KATRAVA Daughter Female Nil Nil/Nil
TH K
SHANTHI(8
)
5 KATRAVA Daughter Female Nil Nil/Nil
TH K
SHIREESH
A(11)
6 KATRAVA Daughter Female Nil Nil/Nil
TH K
GEETHA(4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217882/000

Household Verification Format Door No:11-1,katravath thanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband bikya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 katravath k Self Male Nil AGRICULT 514361073499
surya(51) URE
LABOUR
/Nil
2 katravath k Wife Female Nil AGRICULT 307881157270
manya(45) URE
LABOUR
/Nil
3 katravath k Son Male Nil STUDENT/ 985357540918
udaykiran(21 Nil
)
4 katravath k Son Male Nil STUDENT/ 743459880452
srinu(18) Nil

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:1/DRY:3.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217883/000

Household Verification Format Door No:11-2,katravath thanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband kamya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 katravath k Self Male Nil DRIVERS/N
krishna(28) il
2 katravath k Wife Female Nil HOUSE 812677456409
bhumika(22) WIFE/Nil

3 katravath k Daughter Female Nil DO

mounika(1) NOTHING/
Nil
4 katravath k Mother Female Nil AGRICULT 309082354984
laxmi(55) URE
LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217884/000

Household Verification Format Door No:7-58,KATRAVATH THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband KAMYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KATRAVA Self Male Nil DRIVERS/N 747411269632
TH K il
SHANKAR(
29)
2 KATRAVA Wife Female Nil HOUSE 497631625794
TH K WIFE/Nil
SALI(25)
3 KATRAVA Son Male Nil Nil/Nil 738608514746
TH K
MALLIKAR
JUN(6)PWD
:Y&
Sadaran No:
Nil
4 KATRAVA Daughter Female Nil Nil/Nil 800749753292
TH K
RANI(4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217885/000

Household Verification Format Door No:7-58,KATRAVATH THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband KAMYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KATRAVA Self Male Nil DRIVERS/N 411756922058
TH K il
RAMULU(4
0)
2 KATRAVA Wife Female Nil HOUSE 810113673830
TH K WIFE/Nil
KAMBLI(35
)
3 KATRAVA Son Male Nil STUDENT/ 667915899426
TH K Nil
CHANDU(1
9)
4 KATRAVA Son Male Nil STUDENT/ 679199013208
TH K Nil
LAXMAN(1
2)
5 KATRAVA Son Male Nil STUDENT/ 471531141464
TH K Nil
RAMULU(1
4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217886/000

Household Verification Format Door No:11-05,KATRAVATH THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband PULYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KATRAVA Self Female Nil DAILY 643878062988
TH K WAGES
DEVLI(38)P LABOUR/N
WD: Y & il
Sadaran
No:1418939
0140113066
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0217887/000

Household Verification Format Door No:11-07,KATRAVATH THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband GOPAL Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KATRAVA Self Female Nil DAILY 593717649086
TH K WAGES
GORI(37) LABOUR/N
il
2 KATRAVA Son Male Nil DRIVERS/N 857815200282
TH K il
RAMESH(1
5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0.88 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217888/000

Household Verification Format Door No:11-06,KATRAVATH THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband CHATRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KATRAVA Self Male Nil AGRICULT 815401131428
TH K URE
LAXMAN(4 LABOUR
2) /Nil
2 KATRAVA Wife Female Nil DAILY 270765402064
TH K WAGES
JAMINI(37) LABOUR/N
il
3 KATRAVA Son Male Nil STUDENT/ 380094722746
TH K Nil
PARUSHAR
AMULU(16)
4 KATRAVA Son Male Nil STUDENT/ 986417737397
TH K Nil
PAVAN
KALYAN(9
)
5 KATRAVA Son Male Nil STUDENT/ 647851617550
TH K Nil
MANU(19)
6 KATRAVA Daughter Female Nil MILCH 634935273071
TH K ANIMALS/
RENUKA(1 Nil
3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.25 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217889/000

Household Verification Format Door No:11-09,KATRAVATH THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KATRAVA Self Male Nil DRIVERS/N 922895922494
TH K il
RAMULU(4
2)
2 KATRAVA Wife Female Nil DAILY 217088074908
TH K WAGES
SAKRI(37) LABOUR/N
il
3 KATRAVA Son Male Nil DRIVERS/N 970396778224
TH K il
SRINU(28)
4 KATRAVA Daughter in Female Nil DAILY 899302276288
TH K Law WAGES
SHANTHI(2 LABOUR/N
4) il
5 KATRAVA Grand Female Nil STUDENT/ 451656876092
TH K Daughter Nil
HARITHA(3
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0.88 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217890/000

Household Verification Format Door No:11-05,KATRAVATH THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband CHATRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KATRAVA Self Male Nil DRIVERS/N 437754983008
TH K il
THAVURU(
37)
2 KATRAVA Wife Female Nil HOUSE 651863317661
TH K WIFE/Nil
DEVI(34)
3 KATRAVA Son Male Nil STUDENT/ 508573301151
TH K Nil
RAJU(12)
4 KATRAVA Daughter Female Nil STUDENT/ 321676663236
TH K Nil
ANITHA(9)
5 KATRAVA Daughter Female Nil DO 743781664459
TH K NOTHING/
SABITHA(1 Nil
)
6 KATRAVA Daughter Female Nil STUDENT/ 777388138095
TH K Nil
AMRUTHA
(5)
7 KATRAVA Daughter Female Nil STUDENT/
TH K Nil
ASHWITHA
(3)
8 KATRAVA Mother Female Nil DO
TH K NOTHING/
PIKLI(75) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0.88 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217891/000

Household Verification Format Door No:11-08,KATRAVATH THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband CHATRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KATRAVA Self Male Nil AGRICULT 637385358244
TH K URE
HANMYA(5 LABOUR
2) /Nil
2 KATRAVA Wife Female Nil DAILY 869666477755
TH K WAGES
MANGILI(4 LABOUR/N
8) il
3 KATRAVA Son Male Nil DRIVERS/N 251537656420
TH K il
KALYA(30)
4 KATRAVA Daughter in Female Nil DAILY 574580317151
TH k Law WAGES
hasli(27) LABOUR/N
il
5 KATRAVA Grand Son Male Nil STUDENT/ 253792322043
TH k Nil
ramlal(9)
6 KATRAVA Grand Son Male Nil STUDENT/ 611288455273
TH k Nil
pulya(13)
7 KATRAVA Grand Female Nil MILCH 253792322043
TH k Daughter ANIMALS/
shamku(12) Nil
8 KATRAVA Grand Female Nil STUDENT/ 502823941199
TH Daughter Nil
kanilima(8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0.88 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217911/000

Household Verification Format Door No:1349,phulsinghtanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband ISLAVATH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ISLAVATH Self Male Nil AGRICULT 949206369922
DEVLI(54) URE
LABOUR
/Nil
2 ISLAVATH Son Male Nil AGRICULT
JAAN(30) URE
LABOUR
/Nil
3 ISLAVATH Son Male Nil AGRICULT
SRINU(28) URE
LABOUR
/Nil
4 ISLAVATH Son Male Nil AGRICULT
DEVU(33) URE
LABOUR
/Nil
5 ISLAVATH Son Male Nil AGRICULT
VENKATES URE
H(35) LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:7.48/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217912/000

Household Verification Format Door No:1350,PHOOLSINGHTANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband SAKRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ISLAVATH Self Female Nil AGRICULT
HOONI(64) URE
LABOUR
/Nil
2 ISLAVATH Son Male Nil Nil/Nil
RAJU(18)
3 ISLAVATH Son Male Nil AGRICULT
SHANKAR( URE
30) LABOUR
/Nil
4 ISLAVATH Daughter in Female Nil Nil/Nil
BUJJI(24) Law
5 ISLAVATH Grand Son Male Nil Nil/Nil
ARAVIND(
4)
6 ISLAVATH Grand Son Male Nil Nil/Nil
GOPAL(6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:5.3/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217913/000

Household Verification Format Door No:1351,PHOOLSINGH TANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ISLAVATH Self Female Nil AGRICULT
BADDI(40) URE
LABOUR
/Nil
2 ISLAVATH Son Male Nil Nil/Nil
RAJU(25)
3 ISLAVATH Son Male Nil Nil/Nil
PAVAN(18)
4 ISLAVATH Sister in Law Female Nil Nil/Nil
LAXMI(34)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:3.8/DRY:1.85 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217914/000

Household Verification Format Door No:1351,PHOOLSINGH TANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BALU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ISLAVATH Husband Male Nil AGRICULT
RAJU(68) URE
LABOUR
/Nil
2 ISLAVATH Wife Female Nil AGRICULT
LAXMI(60) URE
LABOUR
/Nil
3 ISLAVATH Son Female Nil Nil/Nil
RAHUL(15)
4 ISLAVATH Son Male Nil Nil/Nil
KRISHNA(2
4)
5 ISLAVATH Son Male Nil AGRICULT
NARESH(16 URE
) LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217915/000

Household Verification Format Door No:1352,PHOOLSINGH TANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband ALIYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ISLAVATH Self Male Nil AGRICULT
JHILYA(44) URE
LABOUR
/Nil
2 ISLAVATH Wife Female Nil Nil/Nil
DEVI(32)
3 ISLAVATH Son Male Nil Nil/Nil
TIRUPATHI
(12)
4 ISLAVATH Son Male Nil Nil/Nil
RAMBABU
(7)
5 ISLAVATH Mother Female Nil Nil/Nil
SUKKI(76)
6 ISLAVATH Sister in Law Female Nil Nil/Nil
CHANDI(34
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:4.98/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217916/000

Household Verification Format Door No:0,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband ALYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ISLAVATH Self Female Nil AGRICULT
SHALI(33) URE
LABOUR
/Nil
2 ISLAVATH Wife Female Nil AGRICULT
GILI(40) URE
LABOUR
/Nil
3 ISLAVATH Son Male Nil AGRICULT
LAXMAN(2 URE
2) LABOUR
/Nil
4 ISLAVATH Son Male Nil AGRICULT 327494457104
SUKI(45) URE
LABOUR
/Nil
5 ISLAVATH Son Male Nil AGRICULT
SUKYA(54) URE
LABOUR
/Nil
6 ISLAVATH Son Male Nil AGRICULT
SHIVA(26) URE
LABOUR
/Nil
7 ISLAVATH Grand Son Male Nil Nil/Nil
CHINNA(12
)
8 ISLAVATH Grand Son Male Nil Nil/Nil
RAVI(16)
9 ISLAVATH Grand Son Male Nil Nil/Nil
THARUN(1
2)
10 ISLAVATH Grand Female Nil Nil/Nil
GANESH(1 Daughter
4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:4.95/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217917/000

Household Verification Format Door No:13-53,LATTUPALLY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BASHA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ISLVATH Self Female Nil AGRICULT 478929064499
DEVI(42) URE
LABOUR
/Nil
2 ISLVATH Son Male Nil Nil/Nil 926248361419
MOHAN(17
)
3 ISLVATH Son Male Nil Nil/Nil
SRINU(12)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:2.5/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217918/000

Household Verification Format Door No:13-54,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband POOLSINGH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ISLVATH Son Male Nil Nil/Nil 981493099010
NANAK(6)

2 ISLVATH Daughter in Female Nil Nil/Nil 271628963817

NAMITHA( Law
8)
3 ISLVATH Daughter in Female Nil Nil/Nil 932062594645
BUJJI(33) Law

4 ISLVATH Father in Male Nil AGRICULT 762890196136

GOPAL(38) Law URE
LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:2.08/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217919/000

Household Verification Format Door No:13-51/1,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband SUKYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ISLAVATH Self Male Nil Nil/Nil
RAVI(25)
2 ISLAVATH Son Male Nil Nil/Nil 234954808518
SIDDU(3)

3 ISLAVATH Daughter Female Nil Nil/Nil

SNEHA(2)
4 ISLAVATH Daughter Female Nil Nil/Nil
SHARADA(
22)
5 ISLAVATH Daughter Female Nil Nil/Nil
NIHARIKA(
5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217920/000

Household Verification Format Door No:13-55,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SACRI(57) Wife Female Nil AGRICULT 989025366368
URE
LABOUR
/Nil
2 Son Male Nil Nil/Nil
LOBHYA(2)
3 CHINNA(5) Son Male Nil Nil/Nil
4 Son Male Nil Nil/Nil
CHANDRU(
20)
5 PFER(19) Son Male Nil Nil/Nil
6 Daughter Female Nil BEGGERS/
ANJI(28)PW Nil
D: Y &
Sadaran
No:109
7 RAJU(20) Grand Son Male Nil Nil/Nil
8 Grand Female Nil Nil/Nil
MANJULA( Daughter
3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:2/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217921/000

Household Verification Format Door No:0,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband KASHINA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil 640001010258
BHADYA(6
9)
2 Son Male Nil Nil/Nil
NARESH(17
)
3 Son Male Nil Nil/Nil 284904095044
HANMANT
H(38)
4 SHAILU(7) Daughter Female Nil Nil/Nil
5 Daughter Female Nil Nil/Nil
CHAVALI(3
6)
6 Daughter Female Nil Nil/Nil
ANUSHA(1
0)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:2.12/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217924/000

Household Verification Format Door No:13-58,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband PARUSHA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KETHAVA Self Male Nil Nil/Nil 246969314684
TH
RAMULU(3
8)
2 KETHAVA Son Male Nil Nil/Nil 435153298227
TH
MOHAN(5)
3 KETHAVA Daughter Female Nil Nil/Nil 781476292892
TH
SHIREESH
A(12)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:2.5/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217925/000

Household Verification Format Door No:13-59,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband DEVJI Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil AGRICULT 467007014958
BASKAR(3 URE
3) LABOUR
/Nil
2 LAXMI(30) Wife Female Nil Nil/Nil 558967825009

3 Son Male Nil Nil/Nil

NAGESH(5)
4 PAPNI(5) Daughter Female Nil Nil/Nil
5 Daughter Female Nil Nil/Nil 786100474373
SUJATHA(1
6)
6 Daughter Female Nil Nil/Nil
SWAPNA(4
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:1.05/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217930/000

Household Verification Format Door No:13-62,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband MOTHYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VADTAVA Self Male Nil Nil/Nil 384108085323
TH
LAXMAN(4
9)
2 VADTAVA Wife Female Nil AGRICULT 417074169681
TH URE
CHINNAM LABOUR
MA(43) /Nil
3 VADTAVA Son Male Nil Nil/Nil
TH
GOPAL(14)
4 VADTAVA Son Male Nil Nil/Nil
TH
SATOSH(12
)
5 VADTAVA Daughter Female Nil AGRICULT 381110400346
TH URE
JYOTHI(16) LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217931/000

Household Verification Format Door No:13-62,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil AGRICULT 840447844736
DEVYA(32) URE
LABOUR
/Nil
2 ODI(30) Wife Female Nil AGRICULT 724878816610
URE
LABOUR
/Nil
3 Son Male Nil Nil/Nil 518460844828
SANDIP(10)

4 SAI(7) Son Male Nil Nil/Nil 880090235182

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217932/000

Household Verification Format Door No:13-62,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband MOTTU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Female Nil AGRICULT 704535411856
RABLILI(68 URE
) LABOUR
/Nil
2 BABU(6) Son Male Nil Nil/Nil
3 Son Male Nil Nil/Nil 775850540768
KRISHNA(2
8)
4 THIAE(22) Daughter Female Nil Nil/Nil 596653704187

5 AKILA(5) Daughter Female Nil Nil/Nil

6 Daughter Female Nil Nil/Nil
ALEKHYA(
2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:3.92/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217934/000

Household Verification Format Door No:13-63,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband VALYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil 462106125059
HANMANT
HU(32)
2 LALI(27) Wife Female Nil Nil/Nil 785815232873

3 HARISH(8) Son Male Nil Nil/Nil

4 Son Male Nil Nil/Nil
RAMESH(4)
5 Daughter Female Nil Nil/Nil
BHARATHI
(6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217935/000

Household Verification Format Door No:13-63,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband VALYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 S Self Male Nil AGRICULT 538846830458
SHANKAR( URE
29) LABOUR
/Nil
2 S Wife Female Nil AGRICULT 984428803159
MOTHI(26) URE
LABOUR
/Nil
3 S Son Male Nil Nil/Nil
SRISHILA
M(4)
4 S Son Male Nil Nil/Nil 206691001045
SURENDA
R(7)
5 S Daughter Female Nil Nil/Nil
SUJATHA(5
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:5.9/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217936/000

Household Verification Format Door No:13-63/2,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband VALYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil AGRICULT 424237637553
CHANDRU( URE
32) LABOUR
/Nil
2 Wife Female Nil AGRICULT
CHANDI(27 URE
) LABOUR
/Nil
3 Son Male Nil Nil/Nil
MOHAN(11
)
4 VIJITHA(9) Daughter Female Nil Nil/Nil
5 Daughter Female Nil Nil/Nil
SUJITHA(3)
6 SAROJA(6) Daughter Female Nil Nil/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:1.5/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217941/000

Household Verification Format Door No:1301,chidusgudathanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband hanma Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ratlavath Self Male Nil AGRICULT 881916297437
shankar(38) URE
LABOUR
/Nil
2 ratlavath Wife Female Nil AGRICULT 717858258885
bujji(28) URE
LABOUR
/Nil
3 ratlavath Son Male Nil STUDENT/ 459931514144
kissan(13) Nil

4 ratlavath Daughter Female Nil STUDENT/ 572760943417

sangitha(9) Nil

5 ratlavath Daughter Female Nil STUDENT/ 774821263291

shirisha(7) Nil

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217942/000

Household Verification Format Door No:1302,chadugaddapallythanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband chandra Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ratlavath Self Male Nil AGRICULT 945148550735
piru(48) URE
LABOUR
/Nil
2 ratlavath Wife Female Nil AGRICULT 383126782878
mutlaya(43) URE
LABOUR
/Nil
3 ratlavath Son Male Nil STUDENT/ 709160742282
ravindar(15) Nil

4 ratlavath Son Male Nil STUDENT/ 297548420724

ravi(22) Nil

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.32 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217943/000

Household Verification Format Door No:12-05,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband ramulu Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ratvalath Self Male Nil AGRICULT 498863301417
manya(48) URE
LABOUR
/Nil
2 ratvalath Wife Female Nil AGRICULT 515732399830
laxmi(38) URE
LABOUR
/Nil
3 ratvalath Son Male Nil STUDENT/ 334624459562
raju(18) Nil

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.8 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217944/000

Household Verification Format Door No:12-3,barsugaddathanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband ramulu Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ratlavath Self Male Nil AGRICULT 315934564829
hamya(48) URE
LABOUR
/Nil
2 ratlavath Wife Female Nil AGRICULT 294162115494
anju(38) URE
LABOUR
/Nil
3 ratlavath Son Male Nil STUDENT/ 641093135845
mohan(5) Nil

4 ratlavath Daughter Female Nil STUDENT/ 578982525756

mounaka(7) Nil

5 ratlavath Daughter Female Nil DAILY 733312747348

manjula(18) WAGES
LABOUR/N
il
6 ratlavath Daughter Female Nil DAILY 904415635789
saroja(15) WAGES
LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.8 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217945/000

Household Verification Format Door No:12-4,boursgandlathanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband dhipla Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ratlavath Self Female Nil DAILY 930177202619
naji(40) WAGES
LABOUR/N
il
2 ratlavath Son Male Nil Nil/Nil 948335595265
pravennayak
(16)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.3 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217946/000

Household Verification Format Door No:12-3,barsugandlathanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband manya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ratlavath Self Male Nil AGRICULT 963906416102
pandu(27) URE
LABOUR
/Nil
2 ratlavath Wife Female Nil AGRICULT 353858162191
lalli(23) URE
LABOUR
/Nil
3 ratlavath Son Male Nil STUDENT/
jagan(2) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217947/000

Household Verification Format Door No:12-16,barsugandlathanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband ramulu Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ratlavath Self Male Nil AGRICULT 283621606051
kalya(53) URE
LABOUR
/Nil
2 ratlavath Wife Female Nil AGRICULT 561166542243
raju(41) URE
LABOUR
/Nil
3 ratlavath Son Male Nil AGRICULT 718520375964
ramesh(23) URE
LABOUR
/Nil
4 ratlavath Son Male Nil STUDENT/ 443231804323
srinu(13) Nil

5 ratlavath Daughter in Female Nil STUDENT/ 800761404795

sunitha(15) Law Nil

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.28 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217948/000

Household Verification Format Door No:122-8,barsugaddla

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband sakru Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ratlavath Self Female Nil DRIVERS/N 318030338089
tarasing(36) il

2 ratlavath Wife Female Nil DAILY 902945033837

jarru(31) WAGES
LABOUR/N
il
3 ratlavath Son Male Nil STUDENT/
aravind(4) Nil
4 ratlavath Son Male Nil STUDENT/ 344880946667
goupal(9) Nil

5 ratlavath Daughter Female Nil STUDENT/

swathi(7) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217950/000

Household Verification Format Door No:1310,boursgaddathanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband danjya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ratlavath Self Male Nil OWN 992694743884
sukru(45) AGRICULT
URE
/Nil
2 ratlavath Wife Female Nil DAILY
manemma(4 WAGES
7) LABOUR/N
il
3 ratlavath Son Male Nil DAILY 298843041302
hanmanthu(2 WAGES
5) LABOUR/N
il
4 ratlavath Daughter in Female Nil DAILY
chitti(25) Law WAGES
LABOUR/N
il
5 ratlavath Grand Son Male Nil STUDENT/ 404149315790
chanti(4) Nil

6 ratlavath Grand Female Nil STUDENT/

JAYAMMA Daughter Nil
(0)
7 ratlavath Grand Female Nil STUDENT/
anjilli(3) Daughter Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217951/000

Household Verification Format Door No:13-90,BOURSGADDATHANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband DANJAYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLAVA Self Male Nil OWN 830928478910
TH AGRICULT
CHINATAR URE
U(52) /Nil
2 RATLAVA Wife Female Nil OWN 626614619750
TH AGRICULT
BUDDI(48) URE
/Nil
3 RATLAVA Son Male Nil DAILY 819893287414
TH WAGES
HANMANT LABOUR/N
HU(45) il
4 RATLAVA Daughter in Female Nil DAILY 757861978320
TH RAJI(32) Law WAGES
LABOUR/N
il
5 RATLAVA Grand Son Male Nil STUDENT/
TH Nil
RAMCHAR
AN(4)
6 RATLAVA Grand Son Male Nil STUDENT/ 909771025487
TH Nil
THIRUPAT
HI(7)
7 RATLAVA Grand Female Nil STUDENT/ 795534296301
TH Daughter Nil
PADMA(7)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.18 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217952/000

Household Verification Format Door No:13-91,BOURSGANDLATHANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband DANJYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLAVA Self Male Nil DAILY 876548272740
TH WAGES
LACHYA(4 LABOUR/N
4) il
2 RATLAVA Wife Female Nil DAILY 520146015317
TH WAGES
CHINAKA LABOUR/N
MLI(36) il
3 RATLAVA Wife Female Nil DAILY 451190514970
TH WAGES
KAMLLI(40 LABOUR/N
) il
4 RATLAVA Son Male Nil STUDENT/ 248573316183
TH Nil
CHANDAR(
3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.18 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217953/000

Household Verification Format Door No:1313,BOURSGADDATHANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband DAJYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLAVA Self Male Nil DAILY 807207316443
TH WAGES
PEDDATA LABOUR/N
VURU(58) il
2 RATLAVA Wife Female Nil DAILY 996881649690
TH WAGES
DEVILLI(54 LABOUR/N
) il
3 RATLAVA Wife Female Nil DAILY 910690027150
TH WAGES
JAMIRI(35) LABOUR/N
il
4 RATLAVA Daughter Female Nil STUDENT/ 299796114673
TH Nil
SARITHA(2
)
5 RATLAVA Daughter Female Nil STUDENT/ 851737901531
TH Nil
AMITHA(8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.18 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217954/000

Household Verification Format Door No:13-91/2,BARSUGADDLATHANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband DAJYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLAVA Self Male Nil AGRICULT 774942280400
TH URE
BADYA(58) LABOUR
/Nil
2 RATLAVA Wife Female Nil DAILY 403776850232
TH WAGES
BHAMANI( LABOUR/N
55) il
3 RATLAVA Son Male Nil DAILY 660091267743
TH WAGES
MANU(28) LABOUR/N
il
4 RATLAVA Daughter in Female Nil STUDENT/ 637437371890
TH Law Nil
RANI(24)
5 RATLAVA Grand Son Male Nil STUDENT/
TH Nil
THARUN(4)
6 RATLAVA Grand Son Male Nil STUDENT/
TH Nil
NAGARAJ
U(4)
7 RATLAVA Grand Female Nil DAILY 665055536692
TH Daughter WAGES
SINDU(7) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217955/000

Household Verification Format Door No:13-92,BOURSGADDATHANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BADYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLAVA Self Male Nil DAILY 652324153327
TH WAGES
CHANDU(5 LABOUR/N
9) il
2 RATLAVA Wife Female Nil DAILY 907644682645
TH WAGES
CHAVILI(5 LABOUR/N
5) il
3 RATLAVA Son Male Nil STUDENT/
TH Nil
NITHIN(9)
4 RATLAVA Son Male Nil AGRICULT 503373914860
TH URE
THIRUPAT LABOUR
HI(15) /Nil
5 RATLAVA Son Male Nil AGRICULT
TH URE
NARESH(10 LABOUR
) /Nil
6 RATLAVA Son Male Nil STUDENT/ 332367843072
TH Nil
SRINU(14)
7 RATLAVA Son Male Nil STUDENT/ 212303246676
TH Nil
MAHESH(1
2)
8 RATLAVA Brother Male Nil AGRICULT
TH URE
REDYA(48) LABOUR
/Nil
9 RATLAVA Sister in Law Female Nil AGRICULT 469859586591
TH URE
SUVALLI(4 LABOUR
0) /Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217956/000

Household Verification Format Door No:13-93,BARSUGADDATHANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband GOULLA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLAVA Self Male Nil AGRICULT 956707358071
TH URE
DIPLLA(48) LABOUR
/Nil
2 RATLAVA Wife Female Nil DAILY 430310333870
TH WAGES
LAXMI(32) LABOUR/N
il
3 RATLAVA Daughter Female Nil STUDENT/ 211692863602
TH Nil
CHITTI(15)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.58 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217957/000

Household Verification Format Door No:13-93,BOURSGUDDATHANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband GOULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLAVA Self Male Nil DAILY 266957420556
TH WAGES
DEVOUJI(5 LABOUR/N
6) il
2 RATLAVA Wife Female Nil DAILY 267935129517
TH WAGES
SHITA(48) LABOUR/N
il
3 RATLAVA Son Male Nil STUDENT/
TH Nil
RAMESH(1
8)
4 RATLAVA Daughter Female Nil STUDENT/
TH Nil
ANUSHA(4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0.8 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217958/000

Household Verification Format Door No:13-94,BOURSGADDATHANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband REDYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLAVA Self Female BEEDI Nil/Nil 323260892110
TH WORKERS
LAXMI(58)
2 RATLAVA Son Male Nil STUDENT/ 955324226941
TH Nil
RAJU(20)
3 RATLAVA Son Male Nil DAILY 628031610791
TH WAGES
GOVINDA( LABOUR/N
22) il
4 RATLAVA Daughter in Female Nil STUDENT/ 817200447408
TH Law Nil
ANITHA(18
)
5 RATLAVA Mother Female Nil STUDENT/ 917613220991
TH Nil
VALI(55)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0.85 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217959/000

Household Verification Format Door No:13-95,BOURSGADDATHANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband GOULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLAVA Self Male Nil OTHERS(P 400239546341
TH ROVIDE
GOUD(40) DETAILS)/
Nil
2 RATLAVA Wife Female Nil DAILY 301323692015
TH WAGES
CHANDI(24 LABOUR/N
) il
3 RATLAVA Son Male Nil STUDENT/ 625538086961
TH Nil
SURESH(11
)
4 RATLAVA Son Male Nil STUDENT/ 902305237612
TH Nil
RAMESH(1
2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0.8 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217960/000

Household Verification Format Door No:13-96,BOURGUDDAPALLY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLAVA Self Male Nil AGRICULT 215828871209
TH URE
HANMYA(5 LABOUR
0) /Nil
2 RATLAVA Wife Female Nil AGRICULT 807618065212
TH URE
JANK(46) LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.42 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217961/000

Household Verification Format Door No:13-97,BOURSGADDATHANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband CHANDRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLAVA Self Male Nil DAILY 388262121636
TH WAGES
LACHYA(5 LABOUR/N
5) il
2 RATLAVA Wife Female Nil DAILY 530230600996
TH WAGES
CHANDI(54 LABOUR/N
) il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217962/000

Household Verification Format Door No:13-98,BOURSGUDDATHANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband CHANDRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLAVA Self Male Nil AGRICULT 493847729111
TH URE
MATRU(35) LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0217963/000

Household Verification Format Door No:13-98/1,BOURSGUDDATHANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband CHANDRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLAVA Self Male Nil AGRICULT 291777111368
TH URE
GOUPAL(5 LABOUR
5) /Nil
2 RATLAVA Wife Female Nil DAILY
TH WAGES
SUNITHA(5 LABOUR/N
0) il
3 RATLAVA Son Male Nil STUDENT/
TH Nil
SHIVA(1)
4 RATLAVA Son Male Nil STUDENT/
TH Nil
GOVIND(16
)
5 RATLAVA Son Male Nil DAILY 262319889657
TH WAGES
RAVINDAR LABOUR/N
(18) il
6 RATLAVA Daughter Female Nil STUDENT/
TH Nil
ANITHA(4)
7 RATLAVA Mother Female Nil DAILY 518978775814
TH WAGES
SOUNI(65) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.45 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217964/000

Household Verification Format Door No:13-99,BOURGADDATHANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BIKYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLAVA Self Male Nil DAILY 381898408218
TH WAGES
BADYA(55) LABOUR/N
il
2 RATLAVA Wife Female Nil DAILY 241434238947
TH WAGES
SOUNI(50) LABOUR/N
il
3 RATLAVA Son Male Nil DAILY 219680977690
TH WAGES
SEVYA(33) LABOUR/N
il
4 RATLAVA Son Male Nil STUDENT/
TH Nil
SRINU(15)
5 RATLAVA Daughter in Female Nil DAILY
TH Law WAGES
KAVITHA( LABOUR/N
32) il
6 RATLAVA Daughter in Female Nil STUDENT/
TH RAJI(16) Law Nil
7 RATLAVA Grand Son Male Nil STUDENT/
TH Nil
LAXMAN(9
)
8 RATLAVA Grand Son Male Nil DAILY
TH WAGES
RAMESH(3) LABOUR/N
il
9 RATLAVA Grand Female Nil STUDENT/
TH Daughter Nil
BHAGYA(2
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.9 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217965/000

Household Verification Format Door No:13-100,BOUDSGADDATHANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband PARSHIYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLAVIT Wife Female Nil AGRICULT 777477905760
H URE
MUTYALI( LABOUR
45) /Nil
2 RATLAVIT Son Male Nil DO 244350560939
H NOTHING/
SRINU(42) Nil
3 RATLAVIT Daughter in Female Nil STUDENT/
H Law Nil
LAXMI(25)
4 RATLAVIT Daughter in Female Nil STUDENT/
H Law Nil
CHITTI(20)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217974/000

Household Verification Format Door No:14-4,BARUSUGADDA THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband SOMLA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATHLVA Self Male Nil DRIVERS/N 993427774728
TH il
LOKYA(39)
2 RATHLVA Wife Female Nil HOUSE 761757283090
TH WIFE/Nil
SHANTHI(3
4)
3 RATHLVA Son Male Nil DAILY 201906973044
TH WAGES
GANESH(1 LABOUR/N
7) il
4 RATHLVA Daughter Female Nil STUDENT/ 204983044247
TH Nil
JAYA(14)
5 RATHLVA Daughter Female Nil STUDENT/ 581958563232
TH Nil
CHITTI(12)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217975/000

Household Verification Format Door No:14/4/1,BARUSUGADDA THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband SOMLA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATHLAV Self Male Nil Nil/Nil 896069658541
ATH
SHANKER(
29)
2 RATHLAV Wife Female Nil Nil/Nil 585578457476
ATH
JAMUNA(2
4)
3 RATHLAV Son Male Nil Nil/Nil
ATH
NIKIL(2)
4 RATHLAV Daughter Female Nil Nil/Nil 917056871441
ATH
MOUNIKA(
5)
5 RATHLAV Mother Female Nil DO 785655118160
ATH NOTHING/
JAMKA(64) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.55 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed YES
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217976/000

Household Verification Format Door No:14-5,BARUSUGADDA THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BADRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLAVA Self Female Nil DO 954143786395
TH NOTHING/
LALI(68) Nil
2 RATLAVA Son Male Nil DAILY 605250665367
TH WAGES
PUNYA(33) LABOUR/N
il
3 RATLAVA Daughter Female Nil AGRICULT
TH URE
TAARI(36) LABOUR
/Nil
4 RATLAVA Daughter in Female Nil DAILY 229762734590
TH Law WAGES
RAMAGI(3 LABOUR/N
0) il
5 RATLAVA Grand Son Male Nil STUDENT/ 827814220710
TH Nil
CHANTI(8)
6 RATLAVA Grand Female Nil STUDENT/
TH Daughter Nil
SYLAJA(9)
7 RATLAVA Grand Female Nil STUDENT/ 424911086367
TH Daughter Nil
SAIGEETA(
12)
8 RATLAVA Grand Female Nil STUDENT/ 926852387339
TH Daughter Nil
NANDINI(7
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.32 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217977/000

Household Verification Format Door No:14-5,BARUSUGADDA THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BADRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLAVA Self Male Nil DRIVERS/N 964478111004
TH il
SRINU(33)
2 RATLAVA Wife Female Nil DAILY 826680942612
TH WAGES
LAXMI(30) LABOUR/N
il
3 RATLAVA Son Male Nil STUDENT/ 337490089773
TH Nil
BHASKAR(
7)
4 RATLAVA Daughter Female Nil STUDENT/ 795266639385
TH Nil
ANUSHA(6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.32 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217978/000

Household Verification Format Door No:0,BARUSUGADDA THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband LACHYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil DO 532832333422
H NOTHING/
MANYA(68 Nil
)
2 MUDAVAT Son Male Nil MILCH 823131862870
H ANIMALS/
GOVINDU( Nil
28)
3 MUDAVAT Daughter in Female Nil HOUSE 676455346664
H Law WIFE/Nil
LAXMI(25)
4 MUDAVAT Grand Son Male Nil STUDENT/ 237159116542
H Nil
SANTHOSH
(6)
5 MUDAVAT Grand Son Male Nil Nil/Nil
H
ARAVINDU
(113)
6 MUDAVAT Grand Female Nil Nil/Nil 710708113846
H Daughter
GOUTAHM
I(5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.95 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217979/000

Household Verification Format Door No:14-7,BARUSUGADDA THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BADRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLAVA Self Male Nil DAILY 646453616193
TH WAGES
SOMLA(39) LABOUR/N
il
2 RATLAVA Son Male Nil STUDENT/ 649757434625
TH Nil
HARILAL(1
5)
3 RATLAVA Daughter Female Nil STUDENT/
TH Nil
SHIVALEE
LA(11)
4 RATLAVA Daughter Female Nil STUDENT/ 241251220964
TH Nil
MAHADEV
I(8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217980/000

Household Verification Format Door No:14-8,BARUSUGADDA THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband MANYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil AGRICULT 851344284665
H RAJU(31) URE
LABOUR
/Nil
2 MUDAVAT Wife Female Nil AGRICULT 819883081636
H URE
VIJAYA(28) LABOUR
/Nil
3 MUDAVAT Son Male Nil Nil/Nil 832230699378
H
TARUN(4)
4 MUDAVAT Daughter Female Nil Nil/Nil 767855923101
H
BINDHU(5)
5 MUDAVAT Daughter Female Nil Nil/Nil 205191395932
H
SWAPNA(8
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217981/000

Household Verification Format Door No:14-8/1,BARSUGADDA THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband MANYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil DAILY 351020094616
H WAGES
MAAMA(33 LABOUR/N
) il
2 MUDAVAT Wife Female Nil DAILY 303456479769
H BUJJI(29) WAGES
LABOUR/N
il
3 MUDAVAT Son Male Nil STUDENT/ 674835742766
H Nil
SIDDHU(6)
4 MUDAVAT Son Male Nil STUDENT/ 786210727049
H Nil
NITHIN(8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.15 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217982/000

Household Verification Format Door No:14-9,BARSUGADDA THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband CHATRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLVAT Self Male Nil DAILY 598316628417
H WAGES
MANGYA(3 LABOUR/N
6) il
2 RATLVAT Wife Female Nil DAILY 316358387504
H DEVI(33) WAGES
LABOUR/N
il
3 RATLVAT Son Male Nil STUDENT/ 702643804993
H Nil
PRABHAV
ATH(15)
4 RATLVAT Son Male Nil STUDENT/ 230199024104
H SHIVA Nil
KUMAR(12
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217983/000

Household Verification Format Door No:14/9/1,BARSUGADDA THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband CHATRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLAVT Self Male Nil OWN 787058142769
H AGRICULT
SAKRU(52) URE
/Nil
2 RATLAVT Wife Female Nil OWN 707569925276
H AGRICULT
TULASI(38) URE
/Nil
3 RATLAVT Son Male Nil STUDENT/ 452234371912
H Nil
NAVEEN(4)
4 RATLAVT Daughter Female Nil STUDENT/ 715618251242
H Nil
JAYANTHI(
15)
5 RATLAVT Daughter Female Nil STUDENT/ 882001572324
H Nil
SHUSHILA(
10)
6 RATLAVT Daughter Female Nil Nil/Nil 894411297907
H
KAVITHA(
18)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0.99 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217985/000

Household Verification Format Door No:14-10,BARSUGADDA THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband LACHHA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLVAT Self Female Nil DO 655728516575
H NOTHING/
DARSHI(58 Nil
)
2 RATLVAT Son Male Nil DRIVERS/N 517424602379
H il
SAVEYA(3
2)
3 RATLVAT Son Male Nil DO 253838313451
H NOTHING/
GOPAL(21) Nil
4 RATLVAT Daughter in Female Nil DAILY 489183727546
H Law WAGES
CHITIIBAB LABOUR/N
U(23) il
5 RATLVAT Grand Son Female Nil STUDENT/ 729849914215
H UDAY(8) Nil

6 RATLVAT Grand Son Male Nil STUDENT/ 867466283381

H Nil
NITHIN(8)
7 RATLVAT Grand Female Nil STUDENT/ 793350911298
H Daughter Nil
LAVANYA(
6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.32 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217986/000

Household Verification Format Door No:14-11,BARSUGADDA THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband DENYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLVAT Self Female Nil DO 801989676120
HR NOTHING/
LAALI(55) Nil
2 RATLVAT Husband Male Nil Nil/Nil 576603609077
H
DEVYA(68)
3 RATLVAT Son Male Nil MIGRATED 908110015662
HR LABOUR/N
SHANKER( il
32)
4 RATLVAT Daughter in Female Nil MIGRATED 699613364528
HR Law LABOUR/N
ANJI(26) il
5 RATLVAT Grand Son Female Nil Nil/Nil 340080268833
H DIVYA(6)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:33.15 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217987/000

Household Verification Format Door No:14-11/1,BARSUGADDA THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband R DEVNAY Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATKVAT Self Male Nil MIGRATED 740960082238
H LABOUR/N
HANAIAH( il
53)
2 RATKVAT Son Male Nil STUDENT/ 476715316800
H SHIVA Nil
KUMAR(19
)
3 RATKVAT Son Male Nil STUDENT/ 640925304108
H Nil
KRISHANA
(18)
4 RATKVAT Daughter Female Nil DO 392405850508
H NOTHING/
KRISHANA Nil
(14)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217988/000

Household Verification Format Door No:14-12,BARSUGADDA THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband CHANDRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BADDAVA Self Female Nil AGRICULT 619882857931
TH URE
LAXMI(38) LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0217990/000

Household Verification Format Door No:0,BARASUGADDA LAXMI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLVAT Self Female Nil MIGRATED 261775160311
H LABOUR/N
SEETA(40) il
2 RATLVAT Son Male Nil SMALL
H RAJU(17) BUSINESS
/Nil
3 RATLVAT Daughter Female Nil DO 571935336902
H NOTHING/
LAXMI(15) Nil
4 RATLVAT Daughter Female Nil MIGRATED 435521483675
H VIJJU(22) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217991/000

Household Verification Format Door No:14-14,BARASUGADDA LAXMI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband HANMYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLVAT Self Male Nil MIGRATED 576948840250
H LABOUR/N
JEENTAYA il
(48)
2 RATLVAT Wife Female Nil MIGRATED 330198770379
H LABOUR/N
KEELI(33) il
3 RATLVAT Son Male Nil STUDENT/ 458863111547
H Nil
ANJANEYU
LU(10)
4 RATLVAT Son Male Nil STUDENT/ 427981527328
H Nil
SRINU(14)
5 RATLVAT Daughter Female Nil STUDENT/ 450642891746
H Nil
LALITHA(1
2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217992/000

Household Verification Format Door No:14-15,BARASUGADDA LAXMI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband GANGYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLAVA Self Male Nil AGRICULT 782795522958
TH URE
GOPAL(60) LABOUR
/Nil
2 RATLAVA Wife Female Nil AGRICULT 860831766649
TH URE
LAXMI(55) LABOUR
/Nil
3 RATLAVA Son Male Nil DRIVERS/N 470604530162
TH il
RAMESH(2
2)
4 RATLAVA Son Male Nil Nil/Nil 209170426044
TH
SWOMYA(
20)
5 RATLAVA Daughter in Female Nil HOUSE 319984721729
TH Law WIFE/Nil
MANEMM
A(21)
6 RATLAVA Grand Son Male Nil DRIVERS/N
TH il
SRSHANTH
(0)
7 RATLAVA Grand Son Male Nil Nil/Nil 340646749751
TH
REBAL(1)
8 RATLAVA Grand Female Nil STUDENT/ 819100723766
TH Daughter Nil
MALLIKA(
4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0.68 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217993/000

Household Verification Format Door No:14-15,BARASUGADDA LAXMI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband GOPAL Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLAVA Self Male Nil Nil/Nil 204277561411
TH
GOVINDU(
28)
2 RATLAVA Wife Female Nil Nil/Nil 484315618293
TH
HEMA(24)
3 RATLAVA Son Male Nil Nil/Nil
TH
BUNNY(4)
4 RATLAVA Daughter Female Nil Nil/Nil 444304870542
TH
DIVYA(2)
5 RATLAVA Daughter Female Nil Nil/Nil 874826217549
TH
VISHANVI(
6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217994/000

Household Verification Format Door No:14-15/1,BARASUGADDA LAXMI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband GANGYA Gas YES/HP/637539
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLVAT Self Male Nil DO 772431858624
H NOTHING/
HARSINGH Nil
(60)
2 RATLVAT Wife Female Nil State Govt 256734848699
H Project
RATHI(55) Employee
/Nil
3 RATLVAT Son Male Nil OWN 681951760699
H AGRICULT
KISTA(35) URE
/Nil
4 RATLVAT Son Male Nil MIGRATED 462507577750
H LABOUR/N
MAANU(33 il
)
5 RATLVAT Son Male Nil STUDENT/ 718835513799
H RAJU(23) Nil

6 RATLVAT Daughter in Female Nil OWN 287413757756

H Law AGRICULT
SEETA(33) URE
/Nil
7 RATLVAT Daughter in Female Nil MIGRATED 926463615806
H Law LABOUR/N
JYOTHI(30) il
8 RATLVAT Grand Son Male Nil STUDENT/
H Nil
THIRUPAT
HI(1)
9 RATLVAT Grand Female Nil STUDENT/ 231717365665
H Daughter Nil
VANISRI(5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.92 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217995/000

Household Verification Format Door No:14-16,BARASUGADDA LAXMI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband HARSINGH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLVAT Self Male Nil MIGRATED
H LABOUR/N
BHASHYA( il
39)
2 RATLVAT Wife Female Nil MIGRATED 971671576068
H RAJI(37) LABOUR/N
il
3 RATLVAT Son Male Nil STUDENT/ 882096761049
H Nil
NARESH(20
)
4 RATLVAT Son Male Nil STUDENT/ 760822431364
H Nil
SRINADH(5
)
5 RATLVAT Son Male Nil STUDENT/ 969428333237
H Nil
SRIKANTH
(13)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217996/000

Household Verification Format Door No:14-17,BARASUGADDA LAXMI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BHIKYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLAVA Self Female Nil MIGRATED 516472472109
TH LABOUR/N
MASRI(39) il
2 RATLAVA Son Male Nil DRIVERS/N 962586967240
TH il
RAVI(22)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.02 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217997/000

Household Verification Format Door No:14-18,BARASUGADDA LAXMI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband SAJYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLAVA Self Male Nil LEASE 508614509537
TH AGRICULT
CHINNYA( URE /Nil
62)
2 RATLAVA Wife Female Nil LEASE 796493508938
TH AGRICULT
VEERAMM URE /Nil
A(47)
3 RATLAVA Son Male Nil DO 916377991441
TH NOTHING/
SOWMYA( Nil
26)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.78 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0217999/000

Household Verification Format Door No:14-19,BARASUGADDA LAXMI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BHEEKYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLAVA Self Female Nil DO 487774990558
TH DEVI(4) NOTHING/
Nil
2 RATLAVA Son Male Nil MIGRATED 983610911964
TH LABOUR/N
SANTHOSH il
(16)
3 RATLAVA Son Male Nil DRIVERS/N 210453049606
TH il
RAVI(19)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.05 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219501/000

Household Verification Format Door No:4-93,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband PAPANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ANAMONI Self Male Nil Nil/Nil 593664735130
A
BUCHANN
A(58)
2 ANAMONI Wife Female Nil Nil/Nil 230514560966
NAGAMM
A(53)
3 ANAMONI Son Male Nil AGRICULT 902224111313
RAMULU(3 URE
3) LABOUR
/Nil
4 ANAMONI Son Male Nil AGRICULT 654853917810
BAL URE
RAJU(30) LABOUR
/Nil
5 ANAMONI Daughter in Female Nil AGRICULT 775670660002
GANGAM Law URE
MA(23) LABOUR
/Nil
6 ANAMONI Daughter in Female Nil AGRICULT 981452411711
BHAGYAM Law URE
MA(28) LABOUR
/Nil
7 ANAMONI Grand Son Male Nil Nil/Nil 675073047067
SHANKAR(
7)
8 ANAMONI Grand Son Male Nil Nil/Nil 482181721971
PAVAN(8)

9 ANAMONI Grand Female Nil Nil/Nil

GOUTHAM Daughter
I(0)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.42 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219502/000

Household Verification Format Door No:4-92,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband PAPANNA Gas YES/HP/634860
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ANAMONI Self Male Nil AGRICULT 866077733848
A URE
LAKSHMAI LABOUR
AH(39) /Nil
2 ANAMONI Wife Female Nil AGRICULT 297962385301
LAKSHMI( URE
35) LABOUR
/Nil
3 ANAMONI Son Male Nil Nil/Nil 402555637987
SHIVAKU
MAR(17)
4 ANAMONI Son Male Nil Nil/Nil 554882111115
RAMESH(1
3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.45 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219503/000

Household Verification Format Door No:4-91,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SAYANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ANAMONI Self Male Nil AGRICULT 437336034839
VENKATAI URE
AH(54) LABOUR
/Nil
2 ANAMONI Wife Female Nil AGRICULT 243615609539
NAGAMM URE
A(51) LABOUR
/Nil
3 ANAMONI Son Male Nil Nil/Nil 950878482282
SHARATH
KUMAR(2)
4 ANAMONI Son Male Nil AGRICULT 408628534054
THIRUPAT URE
AIAH(25) LABOUR
/Nil
5 ANAMONI Son Male Nil AGRICULT 823880604860
SHIVAIAH( URE
20) LABOUR
/Nil
6 ANAMONI Daughter in Female Nil AGRICULT 606882549392
SANDHYA( Law URE
22) LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.62 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219504/000

Household Verification Format Door No:5-47,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SRINIVASULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KINNER Self Female Nil AGRICULT 832077676859
KINNERA URE
PUSHPAM LABOUR
MA(48) /Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0219505/000

Household Verification Format Door No:5-45,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARASIMHA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 UDUTHAL Self Male Nil AGRICULT 921405102582
A URE
SRISHILA LABOUR
M(33) /Nil
2 UDUTHAL Wife Female Nil AGRICULT 258969814240
A URE
BHEEMAM LABOUR
MA(31) /Nil
3 UDUTHAL Son Male Nil Nil/Nil
A
MAHESH(2
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.95 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219507/000

Household Verification Format Door No:5-46,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SAYANNA Gas YES/HP/626162
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KINNERA Self Male Nil Nil/Nil 487522698677
LAKSHMIP
ATHI(63)
2 KINNERA Husband Female Nil Nil/Nil 808238070330
SANJAMM
A(53)
3 KINNERA Son Male Nil PRESENTL 933176384779
BALARAJU Y
(28) WORKING
BARBOUR/
Nil
4 KINNERA Son Male Nil Nil/Nil 631486934307
RAVI(27)

5 KINNERA Daughter in Female Nil Nil/Nil 790184238993

MADHAVI( Law
24)
6 KINNERA Grand Son Male Nil Nil/Nil
CHARAN(0
)
7 KINNERA Grand Female Nil Nil/Nil 247286183070
SMATY(3) Daughter

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219508/000

Household Verification Format Door No:5-43,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHANDARIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BATTINI Self Male Nil AGRICULT 934415982652
RAMULU(3 URE
6) LABOUR
/Nil
2 BATTINI Wife Female Nil AGRICULT 726861839052
LAKSHMI( URE
28) LABOUR
/Nil
3 BATTINI Son Male Nil Nil/Nil 764773431441
ANJANEYU
LU(9)
4 BATTINI Son Male Nil Nil/Nil 375071206601
MALLESH(
7)
5 BATTINI Mother Female Nil Nil/Nil 654809825932
SAYAMMA
(63)
6 BATTINI Father Male Nil Nil/Nil 638091240474
CHANDRAI
AH(68)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:10.15 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219509/000

Household Verification Format Door No:5-42,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHANDRAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BODIMEED Self Male Nil Nil/Nil 419049437571
I
MANYAM(
35)
2 BODIMEED Wife Female Nil Nil/Nil 824247118977
I
NEELAMM
A(31)
3 BODIMEED Daughter Female Nil Nil/Nil 592151172542
I
SHIREESH
A(12)
4 BODIMEED Daughter Female Nil Nil/Nil 788370720724
I
CHITTI(10)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219510/000

Household Verification Format Door No:5-40,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SAYANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ATHINARA Self Male Nil AGRICULT 523159698584
PU URE
KASHANN LABOUR
A(75) /Nil
2 ATHINARA Wife Female Nil Nil/Nil 538594121339
PU
CHENNAM
MA(64)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:13.18 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219511/000

Household Verification Format Door No:5-41,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KASHANNA Gas YES/HP/635556
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ATHINARA Self Male Nil AGRICULT 612146386838
PU URE
GOPAL(30) LABOUR
/Nil
2 ATHINARA Wife Female Nil AGRICULT 829749565537
PU URE
SHANKAR LABOUR
AMMA(28) /Nil
3 ATHINARA Son Male Nil Nil/Nil 957376842662
PU
KHJADASU
(12)
4 ATHINARA Daughter Female Nil Nil/Nil 810907783942
PU
GOURAMM
A(9)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0.55/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219512/000

Household Verification Format Door No:99,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHENNAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ANIMONI Self Female Nil AGRICULT 594236631471
THIRUPAT URE
HAMMA(41 LABOUR
) /Nil
2 ANIMONI Son Male Nil AGRICULT 387744603584
KUMAR(23 URE
) LABOUR
/Nil
3 ANIMONI Daughter Female Nil Nil/Nil 279944696213
RENUKA(8)

4 ANIMONI Daughter Female Nil Nil/Nil 487580335807

NANDINI(1
2)
5 ANIMONI Daughter in Female Nil AGRICULT 932521168586
BHAGYA(1 Law URE
3) LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.02 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219513/000

Household Verification Format Door No:5-33,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 AMEMONI Self Male Nil AGRICULT 272398629986
BALAIAH(5 URE
1) LABOUR
/Nil
2 AMEMONI Wife Female Nil AGRICULT 383638796776
SHANTHA URE
MMA(41) LABOUR
/Nil
3 AMEMONI Son Male Nil DRIVERS/N 399988661268
GOPAL(25) il

4 AMEMONI Son Male Nil OTHERS(P 779290675253

THIRUPAT ROVIDE
HAIAH(28) DETAILS)/
Nil
5 AMEMONI Daughter in Female Nil Nil/Nil 344979462167
RADHIKA( Law
21)
6 AMEMONI Grand Son Male Nil Nil/Nil
JAYANTH(
0)
7 AMEMONI Grand Son Male Nil Nil/Nil 832101549470
PRANAV(2)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.04 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219514/000

Household Verification Format Door No:7-38,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NADIPANNA Gas YES/HP/637886
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ANEMONI Self Male Nil Nil/Nil 305036064229
LAKSHMAI
AH(48)
2 ANEMONI Wife Female Nil Nil/Nil 586128439014
LALITHAM
A(43)
3 ANEMONI Son Male Nil Nil/Nil 410884358672
CHITTEMM
A(24)
4 ANEMONI Son Male Nil Nil/Nil 553932971779
NARESH(27
)
5 ANEMONI Son Male Nil Nil/Nil 695132568812
YADAIAH(
26)
6 ANEMONI Daughter in Female Nil Nil/Nil 783404822558
SARASWA Law
THI(24)
7 ANEMONI Grand Son Male Nil Nil/Nil 876224178531
CHANDRA
SHEKAR(5)
8 ANEMONI Grand Son Male Nil Nil/Nil
JASWHAN
TH(3)
9 ANEMONI Grand Female Nil Nil/Nil 790115018809
SHIVANI(6) Daughter

10 ANEMONI Grand Female Nil Nil/Nil

SRUTHI(2) Daughter
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:9.24 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219515/000

Household Verification Format Door No:5-36,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMASWAMY Gas YES/HP/639033
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ANEMONI Self Female Nil AGRICULT 658387559796
SURYA URE
NAGAMM LABOUR
A(58) /Nil
2 ANEMONI Son Male Nil AGRICULT 988494116521
THIRUPAT URE
HAIAH(38) LABOUR
PWD: Y & /Nil
Sadaran No:
Nil
3 ANEMONI Son Male Nil AGRICULT 365821399878
MAHESH(2 URE
3) LABOUR
/Nil
4 ANEMONI Daughter in Female Nil AGRICULT 726143209232
SUNITHA(2 Law URE
8) LABOUR
/Nil
5 ANEMONI Daughter in Female Nil AGRICULT 978095287360
JYOTHI(20) Law URE
LABOUR
/Nil
6 ANEMONI Grand Son Male Nil Nil/Nil 870794790368
BHARATH(
5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:5.1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219516/000

Household Verification Format Door No:5-35,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARAYANA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ANAMONI Self Female Nil Nil/Nil
ANASUYA
MMA(63)
2 ANAMONI Son Male Nil Nil/Nil 638293748806
LAKSHMAI
AH(33)
3 ANAMONI Son Male Nil AGRICULT 829111791776
VENKATAI URE
AH(46) LABOUR
/Nil
4 ANAMONI Daughter in Female Nil AGRICULT 620018723117
THIRUPAT Law URE
HAMMA(43 LABOUR
) /Nil
5 ANAMONI Daughter in Female Nil Nil/Nil 371424145088
SHARADA( Law
28)
6 ANAMONI Grand Son Male Nil Nil/Nil 283996453522
NGARAJU(
15)
7 ANAMONI Grand Son Male Nil Nil/Nil 842804248903
HEMANTH(
5)
8 ANAMONI Grand Female Nil Nil/Nil 691838756695
MYTHRI(8) Daughter

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.86 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219517/000

Household Verification Format Door No:99,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARAYANA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ANEMONI Self Male Nil AGRICULT 890804062200
RMULU(40) URE
LABOUR
/Nil
2 ANEMONI Wife Female Nil AGRICULT 710846122839
BHAGYAM URE
MA(37) LABOUR
/Nil
3 ANEMONI Son Male Nil Nil/Nil 734020058570
SRINATH(1
5)
4 ANEMONI Son Male Nil Nil/Nil 372554740607
SRIKANTH
(17)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.48 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219518/000

Household Verification Format Door No:99,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RANGANNA Gas YES/HP/638659
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM Self Male Nil AGRICULT 700754952648
RAMULU(5 URE
8)PWD: Y & LABOUR
Sadaran /Nil
No:99
2 JANGAM Wife Female Nil AGRICULT 342440489809
SAYAMMA URE
(61) LABOUR
/Nil
3 JANGAM Son Male Nil AGRICULT 819888559346
SRISHYLA URE
M(39) LABOUR
/Nil
4 JANGAM Son Male Nil OTHERS(P 555821336280
SRINIVAS( ROVIDE
33) DETAILS)/
Nil
5 JANGAM Daughter in Female Nil AGRICULT 932564380456
LAKSHMI( Law URE
28) LABOUR
/Nil
6 JANGAM Daughter in Female Nil AGRICULT 854289232843
ESWARAM Law URE
MA(29) LABOUR
/Nil
7 JANGAM Grand Son Male Nil Nil/Nil 727102154922
DINESH(4)

8 JANGAM Grand Son Male Nil Nil/Nil 339460109922

GANESH(6)

9 JANGAM Grand Female Nil Nil/Nil 734550503474

DIVYA(8) Daughter

10 JANGAM Grand Female Nil Nil/Nil

MOUNIKA( Daughter
1)
11 JANGAM Grand Female Nil Nil/Nil 899942306539
SANDHYA( Daughter
10)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.48 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:
Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219519/000

Household Verification Format Door No:99,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband VENKATAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUNDEMO Self Male Nil AGRICULT 667219673545
NI URE
BUCHAIAH LABOUR
(35) /Nil
2 GUNDEMO Wife Female Nil AGRICULT 329318499207
NI URE
ALIVELA(3 LABOUR
1) /Nil
3 GUNDEMO Son Male Nil Nil/Nil
NI
VENKATA
SWAMY(0)
4 GUNDEMO Daughter Female Nil Nil/Nil 469942855204
NI
NANDINI(6
)
5 GUNDEMO Daughter Female Nil Nil/Nil
NI
BHAVITHA
(1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.32 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219520/000

Household Verification Format Door No:5-65,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARSIMHAH Gas YES/HP/617336
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KYANSANI Self Male Nil Nil/State 512447957794
THIRUPAT Govt
HAIAH(66) Pension
2 KYANSANI Wife Female Nil Nil/Nil 949728560359
NARSIMHU
LU(76)
3 KYANSANI Son Male Nil OTHERS(P 360947367954
SRINIVAS( ROVIDE
43) DETAILS)/
Nil
4 KYANSANI Daughter in Female Nil AGRICULT 525607812694
YADAMM Law URE
A(36) LABOUR
/Nil
5 KYANSANI Grand Son Male Nil Nil/Nil 715636981704
NARESH(19
)
6 KYANSANI Grand Female Nil Nil/Nil 993454469454
MANISHA( Daughter
14)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:5.9 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219521/000

Household Verification Format Door No:5-69,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARAYANA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MANGALI Self Female Nil DAILY 494223426005
PRAMEEL WAGES
A(46) LABOUR/St
ate Govt
Pension
2 MANGALI Son Male Nil Nil/Nil
LINGAM(25
)
3 MANGALI Son Male Nil Nil/Nil 491831938475
SHIVA(20)

4 MANGALI Daughter in Female Nil Nil/Nil 759862440479

BHARGAVI Law
(21)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.05 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219522/000

Household Verification Format Door No:5-64,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARSIMHULU Gas YES/HP/628769
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KHYASANI Self Male Nil AGRICULT 236977042995
BATHARA URE
M(65) LABOUR
/Nil
2 KHYASANI Wife Female Nil AGRICULT 840338676155
ANJANAM URE
MA(56) LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219523/000

Household Verification Format Door No:5-62,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALASWAMY Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KHYASANI Self Female Nil AGRICULT 408484344367
VENKATA URE
MMA(58) LABOUR
/State Govt
Pension
2 KHYASANI Son Male Nil DAILY
RAJU(28)P WAGES
WD: Y & LABOUR/N
Sadaran No: il
Nil
3 KHYASANI Daughter Female Nil Nil/Nil 534496566943
NAGALAK
SHMI(21)
4 KHYASANI Daughter in Female Nil Nil/Nil
INDIRA(24) Law
5 KHYASANI Grand Son Male Nil Nil/Nil
BHASKAR(
73)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219524/000

Household Verification Format Door No:5-62/1,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHINNA Gas YES/HP/636491
Name BALASWAMY Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUNTI Self Female Nil AGRICULT 947513584906
SATHYAM URE
MA(48) LABOUR
/Nil
2 GUNTI Husband Male Nil AGRICULT 419274490761
BALASWA URE
MY(43) LABOUR
/Nil
3 GUNTI Son Male Nil DAILY 460428252109
VENKATES WAGES
H(28) LABOUR/N
il
4 GUNTI Son Male Nil DAILY 673514090216
SRINIVASU WAGES
LU(22) LABOUR/N
il
5 GUNTI Daughter in Female Nil Nil/Nil 725128703491
LALIYHA(2 Law
3)
6 GUNTI Daughter in Female Nil DAILY 428011076331
KRUSHNA Law WAGES
VENI(23) LABOUR/N
il
7 GUNTI Grand Female Nil Nil/Nil
EEKSHITH Daughter
A(1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:1/DRY:2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219525/000

Household Verification Format Door No:99,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband DHANNAJI Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KATIKE Self Male Nil OTHERS(P 964216534239
BALAJI(35) ROVIDE
DETAILS)/
Nil
2 KATIKE Wife Female Nil DAILY 712680809999
VIJAYALA WAGES
KSHMI(29) LABOUR/N
il
3 KATIKE Son Male Nil Nil/Nil 638321274916
OM
KHAR(12)
4 KATIKE Daughter in Female Nil Nil/Nil 741899259903
BHUVANE Law
SWARI(10)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219526/000

Household Verification Format Door No:5-60,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SWAMY Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NEREDI Self Male Nil DRIVERS/N 403588559465
MADHU(33 il
)
2 NEREDI Wife Female Nil DAILY 326381517094
NIRANJAN WAGES
AMMA(33) LABOUR/N
il
3 NEREDI Son Male Nil Nil/Nil 590997059950
BHARATH(
10)
4 NEREDI Son Male Nil Nil/Nil 379291397063
SRINIVASU
LU(3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:3.08 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219527/000

Household Verification Format Door No:5-58,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHANDROJI Gas YES/HP/617471
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PANTHUL Self Male Nil OTHERS(P 423548013512
A ROVIDE
GIYAJI(39) DETAILS)/
Nil
2 PANTHUL Wife Female Nil OTHERS(P 954570766996
A ROVIDE
MANJULA( DETAILS)/
31) Nil
3 PANTHUL Daughter Female Nil Nil/Nil 775874532028
A
BHUMIKA(
13)
4 PANTHUL Daughter Female Nil Nil/Nil 684356475140
A
MOUNIKA(
15)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.62 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219531/000

Household Verification Format Door No:5-58,MAIN BAZAR

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BUDDOJI Gas YES/HP/617576
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KARNEKO Self Male Nil SMALL 989123047861
TA K BUSINESS
RAMOJI(45 /Nil
)
2 KARNEKO Wife Female Nil HOUSE 720123843203
TA K WIFE/Nil
NAGUBAI(
38)
3 KARNEKO Son Male Nil DO 420104091600
TA K NOTHING/
NAGARAJ Nil
U(18)
4 KARNEKO Son Male Nil SMALL 803134663736
TA K BUSINESS
SHIVASHA /Nil
NKAR(13)
5 KARNEKO Daughter Female Nil STUDENT/
TA K Nil
SARITHAB
AI(16)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219532/000

Household Verification Format Door No:5-57,MAIN BAZAR

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BUCHHANNA Gas YES/HP/617327
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KINNERA Self Male Nil PRESENTL 789802698826
K Y
CHANDRA WORKING
SHEKAR(28 BARBOUR/
) Nil
2 KINNERA Wife Female Nil STUDENT/ 517129431740
K Nil
LAVANYA(
17)
3 KINNERA Mother Female Nil DO 512683134859
K NOTHING/
JANGAMM Nil
A(80)
4 KINNERA Non Female Nil BEGGERS/ 530211978614
K Relatives Nil
ERAMMA(4
1)PWD: Y &
Sadaran No:
Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:1.05/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219533/000

Household Verification Format Door No:5-54,MAIN BAZAR

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas YES/HP/615391
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KINNERA Self Male Nil PRESENTL 605451146980
K Y
PENTAIAH( WORKING
58) BARBOUR/
Nil
2 KINNERA Wife Female Nil HOUSE 322070446472
K WIFE/Nil
ESHWARA
MMA(53)
3 KINNERA Son Male Nil PRESENTL 717851411430
K Y
BAIRAJ(34) WORKING
BARBOUR/
Nil
4 KINNERA Daughter in Female Nil HOUSE 683512381393
K Law WIFE/Nil
MANJULA(
28)
5 KINNERA Grand Son Male Nil STUDENT/
K Nil
KARTHIK(7
)
6 KINNERA Grand Female Nil STUDENT/ 493093856755
K Daughter Nil
BARGHAVI
(5)
7 KINNERA Grand Female Nil STUDENT/ 252669259596
K Daughter Nil
TEJESHWI
NI(9)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:2.42/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219535/000

Household Verification Format Door No:5-49,MAIN BAZAR

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAME Self Female Nil DO 574785096819
EDI G NOTHING/
BALAMMA Nil
(58)
2 GADDAME Son Male Nil DAILY 910074603781
EDI G WAGES
RAMULU(3 LABOUR/N
3) il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219536/000

Household Verification Format Door No:5-48,MAIN BAZAR

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas YES/HP/615386
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAME Self Male Nil Nil/Nil 413714942032
EDI G
SRINIVASU
LU(43)
2 GADDAME Wife Female Nil Nil/Nil 779080133911
EDI G
LAXMI(38)
3 GADDAME Son Male Nil Nil/Nil 697320652742
EDI G
BALARAJU
(13)
4 GADDAME Son Male Nil Nil/Nil 567129114575
EDI G
SRINIVASU
LU(7)
5 GADDAME Daughter Female Nil Nil/Nil 721831096586
EDI G
MAHADEV
I(8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219537/000

Household Verification Format Door No:5-75,SC COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband MAHABOOB ALI Gas YES/HP/617335
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAHAMM Self Male Nil Nil/Nil 234016883401
AD MD
SALAM(63)
PWD: Y &
Sadaran No:
Nil
2 MAHAMM Wife Female Nil Nil/Nil 904313844738
AD MD
KHAJA
ji(53)
3 MAHAMM Son Male Nil Nil/Nil 311165467452
AD MD
KHALEEL(
25)
4 MAHAMM Son Male Nil Nil/Nil 983968109896
AD md
jahangir(27)
5 MAHAMM Son Male Nil Nil/Nil 441427876346
AD MD
KHADEER(
20)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.75 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed YES
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219538/000

Household Verification Format Door No:5-51,SC COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BUDDOJI Gas YES/HP/617482
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KARNEKO Self Male Nil DO 959183105757
TA K NOTHING/
KRUSHNAJ Nil
I(58)PWD:
Y & Sadaran
No: Nil
2 KARNEKO Wife Female Nil DAILY 247306396203
TA K WAGES
SUVARNA( LABOUR/N
52) il
3 KARNEKO Son Male Nil DAILY 391525524309
TA K WAGES
ANJANEYU LABOUR/N
LU(26) il
4 KARNEKO Daughter in Male Nil HOUSE 436755304036
TA K Law WIFE/Nil
MOUNIKA(
20)
5 KARNEKO Grand Male Nil Nil/Nil
TA K Daughter
SRIGAYAT
HRI(0)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219540/000

Household Verification Format Door No:5-79,SC COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BAPUJI Gas YES/HP/637450
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PANTHUL Self Male Nil Nil/Nil 738224914731
AP
BAJIRAO(5
6)
2 PANTHUL Wife Female Nil Nil/Nil 805682960865
AP
RADHABAI
(50)
3 PANTHUL Son Male Nil Nil/Nil 767621851354
AP
SRIHARI(34
)
4 PANTHUL Daughter Female Nil Nil/Nil 350016581406
AP
SHIVAJYO
THI(22)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.32 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219542/000

Household Verification Format Door No:5050/1,main bazar

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SADAPPA Gas YES/HP/6797
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 DEVARAS Self Male Nil Nil/Nil 930760692010
HETTY D
VENKATES
HWARLU(3
6)
2 DEVARAS Wife Female Nil Nil/Nil 482087420188
HETTY D
GIRIJA(25)
3 DEVARAS Daughter Female Nil Nil/Nil
HETTY D
SANGEETH
A(1)
4 DEVARAS Daughter Female Nil Nil/Nil
HETTY D
VISHISHTA
(5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0.88 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219543/000

Household Verification Format Door No:5050,SC COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband LINGAPPA Gas YES/HP/607757
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 EDULA A Self Male Nil Nil/Nil 721317591200
VEERABA
DRAIAH(50
)
2 EDULA A Wife Female Nil Nil/Nil 558801940985
SHARADH
A(40)
3 EDULA A Son Male Nil Nil/Nil 804361661287
VIJAY
KUMAR(19
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0.82 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219544/000

Household Verification Format Door No:5-87,MAIN BAZAR

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband PASHA Gas YES/HP/617476
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAHAMM Self Female Nil DO 889813595023
AD NOTHING/
GOUSIYA Nil
BEGUM(43)
2 MAHAMM Son Male Nil DO 544257735838
AD M NOTHING/
MAHABOO Nil
B(19)
3 MAHAMM Daughter Female Nil Nil/Nil 296388927297
AD
RESHMA(1
2)
4 MAHAMM Mother Female Nil Nil/Nil 891782788477
AD GORI
B(67)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219545/000

Household Verification Format Door No:5-90,SC COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband SRINIVASULU Gas YES/HP/628268
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KOTTHA K Self Male Nil Nil/Nil 528578438709
RAMESH(4
7)
2 KOTTHA K Wife Female Nil Nil/Nil 320720206607
SHOBARA
NI(42)
3 KOTTHA K Daughter Female Nil Nil/Nil 610804885883
SRILAXMI(
15)
4 KOTTHA K Daughter Female Nil Nil/Nil 590056586868
SRAVYA(1
8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:0.38 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219546/000

Household Verification Format Door No:5-89,SC COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALESAB Gas YES/HP/610142
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAHAMM Self Male Nil Nil/Nil
AD MD
MAHAMO
OD(51)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0219547/000

Household Verification Format Door No:5-89,SC COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALESAB Gas YES/HP/610142
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAHAMM Self Male Nil State 240365487150
AD MD GovtEmploy
MAHAMO ee/Nil
OD(51)
2 MAHAMM Wife Female Nil Nil/Nil 853130462138
AD MD
RIHEMNIS
HA(41)
3 MAHAMM Son Male Nil Nil/Nil 799557847473
AD MD
AHAMMA
D
MANSOOR(
24)
4 MAHAMM Son Male Nil Nil/Nil 464643528969
AD MD
ZAHED(19)
5 MAHAMM Son Male Nil Nil/Nil 892106304658
AD MD
JAHANGIR(
29)
6 MAHAMM Daughter Female Nil Nil/Nil 974774498390
AD MD
ZAREENA
BEGUM(22)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219548/000

Household Verification Format Door No:6-109,SC COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband ANJANEYULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KUMMARI Self Female Nil Nil/Nil
K
NARAYAN
AMMA(62)
2 KUMMARI Non Female Nil Nil/Nil
K Relatives
SHANTHA
MMA(70)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219549/000

Household Verification Format Door No:6-110,SC COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband ABDUL KHADEER Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAHAMM Self Female Nil Nil/Nil 361132177798
AD MD
GOUSIYA
BEGUM(37)
2 MAHAMM Son Male Nil Nil/Nil 569225188994
AD MD
CHAN
PASHA(21)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219550/000

Household Verification Format Door No:6-110/1,SC COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband MOULANA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAHAMM Self Male Nil Nil/Nil 747888159590
AD MD
AZAM(59)
2 MAHAMM Wife Female Nil Nil/Nil 450569501184
AD MD
ALIYA(47)
3 MAHAMM Daughter Female Nil Nil/Nil 676043928183
AD MD
SHIREESH
A(9)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219551/000

Household Verification Format Door No:6-110/2,SC COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband KOKYA Gas YES/HP/640087
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil Nil/Nil 592243790238
HR
BADRU(45)
2 RAMAVAT Wife Female Nil Nil/Nil 324741983937
HR
NARI(38)
3 RAMAVAT Son Male Nil Nil/Nil 830079492743
HR
RAJU(20)
4 RAMAVAT Son Male Nil Nil/Nil 369849562138
HR
KISHAN(16
)
5 RAMAVAT Son Male Nil Nil/Nil 376600346508
HR
SURESH(14
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219552/000

Household Verification Format Door No:6-110/3,BHADYA THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband PAPIREDDY Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MIREPALL Self Male Nil Nil/Nil 430705673301
YM
MANNEMR
EDDY(47)
2 MIREPALL Wife Female Nil Nil/Nil 224266996671
YM
SHYAMAL
AMMA(40)
3 MIREPALL Son Male Nil Nil/Nil 245304120411
YM
SHIVAKU
MAR
REDDY(19)
4 MIREPALL Son Male Nil Nil/Nil 216548787176
YM
GANGADH
AR
REDDY(23)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.38 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219553/001

Household Verification Format Door No:6-111,SC COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband CHANDRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil Nil/Nil 781140875147
HM
SOMULU(3
8)
2 MUDAVAT Wife Female Nil Nil/Nil 763616630583
HM
CHITTI(34)
3 MUDAVAT Son Male Nil Nil/Nil 532479345220
HM
BADRINAT
H(14)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.25 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219553/002

Household Verification Format Door No:5-52,MAIN BAZAR

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband LAXMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KINNERA Self Male Nil PRESENTL 305992212157
K Y
KRUSHNAI WORKING
AH(42) BARBOUR/
Nil
2 KINNERA Wife Female Nil DAILY 357572406169
K WAGES
LAXMAM LABOUR/N
MA(35) il
3 KINNERA Son Male Nil STUDENT/ 214875269395
K ANIL Nil
KUMAR(15
)
4 KINNERA Son Male Nil STUDENT/ 424335953410
K AKHIL(6) Nil

5 KINNERA Daughter Female Nil STUDENT/ 622663578328

K Nil
SWATHI(14
)
6 KINNERA Daughter Female Nil STUDENT/ 785871387820
K Nil
SOUJANYA
(13)
7 KINNERA Daughter Female Nil STUDENT/ 883543695222
K Nil
PRAVALIK
A(5)
8 KINNERA Brother Male Nil PRESENTL 563611926306
K Y
SHEKAR(33 WORKING
) BARBOUR/
Nil
9 KINNERA Sister in Law Female Nil DAILY 599138901249
K WAGES
MANJULA( LABOUR/N
27) il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219554/000

Household Verification Format Door No:6-111/1,SC COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband ANJANEYULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KAKOJU K Self Male Nil Nil/Nil 710796707146
PANDURA
NGASWAM
Y(39)
2 KAKOJU K Wife Female Nil Nil/Nil 288737976374
BAVANAS
RI(26)
3 KAKOJU K Son Male Nil Nil/Nil 203978196384
BRHAMMA
TEJA(3)
4 KAKOJU K Daughter Female Nil Nil/Nil 742285403464
SHANUKH
ASRI(5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219555/000

Household Verification Format Door No:6-111/1,ST COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband ANJANEYULU Gas YES/HP/634072
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KAKOJU K Self Male Nil Nil/Nil 930378773863
VENKATES
H(30)
2 KAKOJU K Wife Female Nil Nil/Nil 368233878157
RENUKAS
RI(26)
3 KAKOJU k Son Male Nil Nil/Nil
jayathejesh(0
)
4 KAKOJU k Daughter Female Nil Nil/Nil 209417173984
avanthika(3)

5 KAKOJU k Mother Female Nil Nil/Nil 294406389798

sugunamma(
55)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219556/000

Household Verification Format Door No:6-112,ST COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband HARIYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil Nil/Nil 391603635858
HR
GOPAL(43)
2 RAMAVAT Wife Female Nil Nil/Nil 255895217054
HR
MUTHYALI
(33)
3 RAMAVAT Son Female Nil Nil/Nil 871877648613
HR
BHASKAR(
28)PWD: Y
& Sadaran
No: Nil
4 RAMAVAT Son Male Nil Nil/Nil 972129866054
HR
MOHAN(15
)
5 RAMAVAT Daughter Female Nil Nil/Nil 598601306200
HR
ARUNA(13)
6 RAMAVAT Daughter in Female Nil Nil/Nil 350766431606
HR Law
SARADI(21
)
7 RAMAVAT Grand Female Nil Nil/Nil
HR Daughter
SRAVANI(1
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.82 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219557/000

Household Verification Format Door No:6-113,ST COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband HARIYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil Nil/Nil 732092934259
HR
MANU(38)
2 RAMAVAT Wife Female Nil Nil/Nil 254003137711
HR
MANNEM
MA(33)
3 RAMAVAT Son Male Nil Nil/Nil 851514555933
HR
VENKATES
H(11)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219558/000

Household Verification Format Door No:6-114,ST COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband HARYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil Nil/Nil 785976346689
HR
JAHANGIR(
31)
2 RAMAVAT Wife Female Nil Nil/Nil 797638291536
HR
LAXMI(28)
3 RAMAVAT Son Male Nil Nil/Nil 663544622343
HR
SRIKANTH
(6)
4 RAMAVAT Son Male Nil Nil/Nil 335127791319
HR
THIRUPAT
HI(7)
5 RAMAVAT Mother Female Nil Nil/Nil 252320304274
H R JAI(58)

6 RAMAVAT Father Male Nil Nil/Nil 666749213929

HR
HARYA(68)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0.82 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219561/000

Household Verification Format Door No:7-1,vuragadda pally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband ramulu Gas YES/HP/617458
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 jangam Self Male Nil OWN 743540925357
venkataih(44 AGRICULT
) URE
/Nil
2 jangam Wife Female Nil OWN 609648346431
ramulamma( AGRICULT
33) URE
/Nil
3 jangam Son Male Nil Nil/Nil 548675442790
SUDEER
KUMAR(18
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:2/DRY:1.48 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219562/000

Household Verification Format Door No:7-2,vuragadda pally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BAPUJI Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MULTHUM Self Male Nil OTHER 86444219973
KARI SKILLED
MALLIKAR WORKERS/
JUN(61) Nil
2 MULTHUM Husband Female Nil HOUSE 779312261036
KARI WIFE/Nil
LAKSHMI(
55)
3 MULTHUM Son Male Nil OTHER 972285840792
KARI SKILLED
CHAKRAV WORKERS/
ARTHI(26) Nil
4 MULTHUM Daughter in Female Nil HOUSE
KARI Law WIFE/Nil
HARITHA(1
9)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219563/000

Household Verification Format Door No:7-2/1,vuragadda pally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband VUDDALU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VEMULA V Self Male Nil DAILY 768344536576
THIRUPAT WAGES
HIAH(59) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0219564/000

Household Verification Format Door No:7-4,vuragadda pally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KRISHNAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JAMPULA Self Female Nil DAILY 370582228372
BHARATHI WAGES
(38) LABOUR/N
il
2 JAMPULA Husband Male Nil PRESENTL 202364185522
KRISHNAI Y
AH(43) WORKING
BARBOUR/
Nil
3 JAMPULA Son Male Nil Nil/Nil 673189085957
VUDEY
KUMAR(14
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219565/000

Household Verification Format Door No:7-5,vuragadda pally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband LAKSHMAIAH Gas YES/HP/617578
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JAGAM Self Male Nil AGRICULT
KARENNA( URE
65) LABOUR
/Nil
2 JAGAM Wife Female Nil DAILY
NAGAMM WAGES
A(49) LABOUR/N
il
3 JAGAM Son Male Nil Nil/Nil 956103016724
SHEKAR(13
)
4 JAGAM Daughter Female Nil Nil/Nil
MADHAVI(
19)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219566/000

Household Verification Format Door No:7-6,vuragadda pally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMCHANDRAIAH Gas YES/HP/627366
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM Self Male Nil AGRICULT 211825318414
VENKATAI URE
H(45) LABOUR
/Nil
2 JANGAM Wife Female Nil DAILY 517993496959
INDIRAMM WAGES
A(34) LABOUR/N
il
3 JANGAM Son Male Nil DAILY 680550774057
SHIVAIAH( WAGES
22) LABOUR/N
il
4 JANGAM Son Male Nil DAILY 300639160723
SRINU(22) WAGES
LABOUR/N
il
5 JANGAM Daughter in Female Nil DAILY 979280826015
RAJITHA(1 Law WAGES
9) LABOUR/N
il
6 JANGAM Daughter in Female Nil DAILY
LALITHA(1 Law WAGES
8) LABOUR/N
il
7 JANGAM Grand Son Male Nil DAILY 977896982930
RAMCHAR WAGES
AN(3)PWD: LABOUR/N
Y & Sadaran il
No: Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:1.78/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219567/000

Household Verification Format Door No:7-6/1,vuragadda pally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BHAGAVANTHU Gas YES/HP/617314
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BEESAM Self Male Nil AGRICULT 529636287240
VENKATAI URE
H(50) LABOUR
/Nil
2 BEESAM Wife Female Nil DAILY
LAKSHMA WAGES
MMA(41) LABOUR/N
il
3 BEESAM Daughter Female Nil Nil/Nil 313074501867
RAJITHA(1
8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.9 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219568/000

Household Verification Format Door No:7-7,vuragadda pally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BAGAVANTHU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BEESAM Self Male Nil AGRICULT 617410571549
ANJANEYU URE
LU(48) LABOUR
/Nil
2 BEESAM Wife Female Nil DAILY 985347951792
BONDAMM WAGES
A(41) LABOUR/N
il
3 BEESAM Son Male Nil AGRICULT 291880980284
GOPAL(29) URE
LABOUR
/Nil
4 BEESAM Son Male Nil AGRICULT 400039453214
SHIVA URE
KUMAR(24 LABOUR
) /Nil
5 BEESAM Daughter in Female Nil DAILY 568926234230
CHANDRA Law WAGES
KALA(25) LABOUR/N
il
6 BEESAM Grand Son Male Nil Nil/Nil 606650989863
UDEYKIRA
N(1)
7 BEESAM Grand Female Nil Nil/Nil 509981187183
AKSHAYA( Daughter
5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.7 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219569/000

Household Verification Format Door No:7-8,vuragadda pally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SWAMY Gas YES/HP/617311
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BEESAM Self Female Nil DO 930398757886
USHAMMA NOTHING/
(63) Nil
2 BEESAM Son Male Nil DAILY 243268662640
RAMCHAN WAGES
DRAIAH(39 LABOUR/N
) il
3 BEESAM Son Male Nil DRIVERS/N
SHANKER( il
36)
4 BEESAM Son Male Nil DRIVERS/N 459249274211
KRISHNAI il
AH(28)
5 BEESAM Daughter in Female Nil DAILY 677081303659
SUGUNAM Law WAGES
MA(36) LABOUR/N
il
6 BEESAM Daughter in Female Nil DRIVERS/N
LAVANYA( Law il
26)
7 BEESAM Grand Son Male Nil Nil/Nil 262409029477
SHIVA
KUMAR(10
)
8 BEESAM Grand Son Male Nil Nil/Nil 725029599162
SAIGANES
H(8)
9 BEESAM Grand Son Male Nil Nil/Nil 851923827831
SAIGANES
H(6)
10 BEESAM Grand Female Nil Nil/Nil 786450739897
SHIRISHA( Daughter
14)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:5.12 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219570/000

Household Verification Format Door No:7-9,vuragadda pally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband LAKSHMAIAH Gas YES/HP/634687
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SANDA Self Male Nil DAILY 686322948160
BALACHA WAGES
NDRAIAH( LABOUR/N
54) il
2 SANDA Wife Female Nil DAILY 580789423744
BALACHA WAGES
NDRAMMA LABOUR/N
(48) il
3 SANDA Son Male Nil Nil/Nil 423642705547
PANDU(30)

4 SANDA Son Male Nil DAILY 571034558409

LAKSHMAI WAGES
AH(28) LABOUR/N
il
5 SANDA Daughter Female Nil OTHER 493839003631
PADMA(28) SKILLED
WORKERS/
Nil
6 SANDA Daughter in Female Nil DAILY 295740073806
ALIVELA(2 Law WAGES
8) LABOUR/N
il
7 SANDA Son in Law Male Nil DAILY 546044427844
VENKATES WAGES
H(34) LABOUR/N
il
8 SANDA Grand Son Male Nil Nil/Nil
AMARNAT
H(1)
9 SANDA Grand Female Nil Nil/Nil 630225805015
AKSHITHA Daughter
(3)
10 SANDA Grand Female Nil Nil/Nil 225390500488
SPANDAN Daughter
A(6)
11 SANDA Grand Female Nil Nil/Nil 873297698327
THARANI(4 Daughter
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.62 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:
Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219571/000

Household Verification Format Door No:7-10,vuragadda pally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas YES/HP/616048
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 TATIKOND Self Male Nil PSU 790000386386
A Employee/Ni
BALAKRIS l
HNA(34)
2 TATIKOND Wife Female Nil HOUSE 805137146425
A WIFE/Nil
MANEMM
A(31)
3 TATIKOND Son Male Nil Nil/Nil 753424932621
A
SHIVUDU(4
)
4 TATIKOND Daughter Female Nil Nil/Nil 541904122578
A
BUVANES
HWARI(7)
5 TATIKOND Daughter Female Nil Nil/Nil 465353144050
A
AKHILAND
ESHWARI(
10)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0.45/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219572/000

Household Verification Format Door No:7-11,vuragadda pally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband HANMANTHU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 YALUGU Self Female Nil DAILY 241626975063
ANJANAM WAGES
MA(38) LABOUR/N
il
2 YALUGU Son Male Nil DAILY 514213658060
MAHESH(2 WAGES
2) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.78 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219573/000

Household Verification Format Door No:7-12,vuragadda pally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband BASHIMYA Gas YES/HP/617483
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAHAMA Self Male Nil SMALL 461248692896
D BUSINESS
RAHEMAA /Nil
N(43)
2 MAHAMA Wife Female Nil DAILY
D WAGES
SHAREFA LABOUR/N
BEGUM(33) il
3 MAHAMA Son Male Nil Nil/Nil 256518589732
D JABEER
PASHA(5)
4 MAHAMA Daughter Female Nil Nil/Nil 584259284211
D
MUNTHAA
J
BEGUM(9)
5 MAHAMA Daughter Female Nil Nil/Nil 771475329877
D
MAHABUB
I(14)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219574/000

Household Verification Format Door No:7-13,vuragadda pally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARISIMHA Gas YES/HP/615383
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 CHINTHAK Self Female Nil DO 870371595666
AYAL NOTHING/
ANJANAM Nil
MA(48)
2 CHINTHAK Son Male Nil Nil/Nil 850246471990
AYAL
UGENDHA
R(29)
3 CHINTHAK Son Male Nil DAILY 994878333549
AYAL WAGES
RAJU(31) LABOUR/N
il
4 CHINTHAK Daughter in Female Nil HOUSE 825565678384
AYAL Law WIFE/Nil
CHITTI(20)
5 CHINTHAK Daughter in Female Nil DAILY 219183121651
AYAL Law WAGES
BHARATHI LABOUR/N
(28) il
6 CHINTHAK Grand Son Male Nil Nil/Nil
AYAL
PRABAS(2)
7 CHINTHAK Grand Son Male Nil Nil/Nil 267686340666
AYAL
NARESH(6)
8 CHINTHAK Grand Son Male Nil Nil/Nil
AYAL
HARISH(1)
9 CHINTHAK Grand Female Nil Nil/Nil
AYAL Daughter
PORNAMI(
1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219575/000

Household Verification Format Door No:7-14,vuragadda pally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHENAPPA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BOYA B Self Male Nil AGRICULT
ANJANEYU URE
LU(60) LABOUR
/Nil
2 BOYA Wife Female Nil DAILY
CHENAMM WAGES
A(44) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:4 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219576/000

Household Verification Format Door No:7-15,vuragadda pally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband MALLAIAH Gas YES/HP/625688
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MIRIYALA Self Female Nil OTHER 726843997287
PARIJATH SKILLED
AMMA(58) WORKERS/
Nil
2 MIRIYALA Husband Male Nil Nil/Nil 431641886590
MALAIAH(
68)
3 MIRIYALA Son Male Nil Nil/Nil 577782600492
KRISHNA
MOHAN(34
)
4 MIRIYALA Daughter in Female Nil OTHER 399346655156
BAGYALA Law SKILLED
KSHMI(30) WORKERS/
Nil
5 MIRIYALA Grand Son Male Nil Nil/Nil 744918461294
ANAND
PRABU(3)
6 MIRIYALA Grand Female Nil Nil/Nil 927540235959
BAVYASRI Daughter
(2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219577/000

Household Verification Format Door No:7-19,VURAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NAGANNA Gas YES/HP/634041
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SERANGI Self Male Nil Nil/Nil 870171563826
GNGAPORI
(46)
2 SERANGI Wife Female Nil Nil/Nil 532535782193
GATTAMM
A(41)
3 SERANGI Son Male Nil DAILY 637463802298
TIRUPATH WAGES
AIAH(26) LABOUR/N
il
4 SERANGI Daughter in Female Nil DAILY
RANI(23) Law WAGES
LABOUR/N
il
5 SERANGI Grand Son Male Nil Nil/Nil 589302568524
NOMESHW
AR(4)
6 SERANGI Grand Female Nil Nil/Nil
HEMALAT Daughter
HA(1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219578/000

Household Verification Format Door No:7-20,VURAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NAGANNA Gas YES/HP/634770
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SERANGI Self Male Nil DAILY 965708347557
RAMULU(4 WAGES
3) LABOUR/N
il
2 SERANGI Wife Female Nil DAILY 828195933265
JAYAMMA WAGES
(38) LABOUR/N
il
3 SERANGI Wife Male Nil Nil/Nil 827997176438
LAKSHMAI
AH(37)
4 SERANGI Wife Female Nil DAILY 340992671745
EESHWAR WAGES
AMMA(32) LABOUR/N
il
5 SERANGI Son Male Nil Nil/Nil 742506949806
ANAND(15)

6 SERANGI Son Male Nil DAILY 386325071822

SHIVA(16) WAGES
LABOUR/N
il
7 SERANGI Son Male Nil Nil/Nil 922320094771
NARESH(12
)
8 SERANGI Son Male Nil Nil/Nil 449009135686
PAVAN(15)

9 SERANGI Daughter Female Nil Nil/Nil 473502226304

KALPANA(
17)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:8.95 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219579/000

Household Verification Format Door No:7-18,VURAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARAYANMA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 REYMUDD Self Male Nil DAILY 221281486638
ULA WAGES
TIRUMALA LABOUR/N
IAH(50) il
2 REYMUDD Wife Female Nil DAILY 283674818001
ULA WAGES
CHINAMM LABOUR/N
A(46) il
3 REYMUDD Son Male Nil DAILY
ULA WAGES
NARESH(18 LABOUR/N
) il
4 REYMUDD Daughter Female Nil DO 863535757861
ULA NOTHING/
NAVANET Nil
HA(16)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219580/000

Household Verification Format Door No:7-23,VURAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KASHANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 YALUGU Self Female Nil DO 203210211374
SAVARAM NOTHING/
MA(63) Nil
2 YALUGU Son Male Nil DAILY 382491775374
LAKSHMIK WAGES
ANTH(24) LABOUR/N
il
3 YALUGU Son Male Nil DAILY 590807566391
VENKATAI WAGES
AH(48) LABOUR/N
il
4 YALUGU Daughter in Female Nil DAILY 911628406855
THIRUPAT Law WAGES
HAMMA(46 LABOUR/N
) il
5 YALUGU Daughter in Female Nil Nil/Nil 407624081850
VARALAK Law
SHMI(21)
6 YALUGU Grand Son Male Nil Nil/Nil 469149915305
SHIVA
KUMAR(16
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.32 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219581/000

Household Verification Format Door No:7-22,VURAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband PEDDA NAGAIAHA Gas YES/Bharath/21968
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDIGOP Self Male Nil DAILY 795952746588
ULA WAGES
ANJANEYU LABOUR/N
LU(44) il
2 GADDIGOP Husband Female Nil Nil/Nil 788159622598
ULA SHIVA
KUMAR(15
)
3 GADDIGOP Wife Female Nil DAILY 276173287585
ULA WAGES
BALAMAN LABOUR/N
I(40) il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219582/000

Household Verification Format Door No:7-24/1,VURAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NAGAIAH Gas YES/Bharath/63879
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 YALUGU Self Male Nil DAILY 906676131456
YADAIAH( WAGES
38) LABOUR/N
il
2 YALUGU Wife Female Nil DAILY 792284119102
MANEMM WAGES
A(33) LABOUR/N
il
3 YALUGU Daughter Female Nil Nil/Nil
SANTOSHI(
12)
4 YALUGU Daughter Female Nil Nil/Nil 689068853504
NAGALAK
SHMI(10)
5 YALUGU Daughter Female Nil Nil/Nil 406831884643
SAVITHRI(
13)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219583/000

Household Verification Format Door No:7-26,VURAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband LAKSHMAIAH Gas YES/HP/615389
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 YADDULA Self Male Nil AGRICULT 455390699513
THIRUPAT URE
HAIAH(48) LABOUR
/Nil
2 YADDULA Wife Female Nil AGRICULT 291639408114
MANEMM URE
A(43) LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219584/000

Household Verification Format Door No:7-26/1,VURAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband THIRUPATHAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 YADDULA Self Male Nil AGRICULT 436320850092
SRINIVASU URE
LU(32) LABOUR
/Nil
2 YADDULA Wife Female Nil State Govt 315698037817
SUJATHA(2 Project
7) Employee
/Nil
3 YADDULA Son Male Nil DAILY 590937443860
PRANAVTE WAGES
JA(7) LABOUR/N
il
4 YADDULA Daughter Female Nil Nil/Nil
KAVYASRI
(4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0.8 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219585/000

Household Verification Format Door No:7-27,VURAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband PENTAIAH Gas YES/HP/623955
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NAKKA Self Male Nil DAILY 705548060982
CHANDRAI WAGES
AH(54) LABOUR/N
il
2 NAKKA Wife Female Nil DAILY 874359405589
LAKSHMA WAGES
MMA(48) LABOUR/N
il
3 NAKKA Son Male Nil Nil/Nil 923327098668
SUDHAKA
R(23)
4 NAKKA Son Male Nil OTHER 267632382972
KRANTHIK SKILLED
UMAR(30) WORKERS/
Nil
5 NAKKA Daughter in Female Nil HOUSE 796340357178
LAVANYA( Law WIFE/Nil
28)
6 NAKKA Grand Son Male Nil Nil/Nil 658523271262
JASHWAN
YH(4)
7 NAKKA Grand Son Male Nil Nil/Nil 276739136298
KISHOR(3)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.12 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219586/000

Household Verification Format Door No:7-11/1,VURAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KISTAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUNTI Self Male Nil DAILY 441138084099
NAGESH(3 WAGES
8) LABOUR/N
il
2 GUNTI Wife Female Nil MIGRATED 836506073189
USHAMMA LABOUR/N
(25) il
3 GUNTI Daughter Female Nil Nil/Nil 480287294521
NAGESHW
ARI(14)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219591/000

Household Verification Format Door No:6-7,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband HANUMANTHU Gas YES/HP/635109
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VAMULA Self Male Nil Nil/Nil 647789604590
JANNAIAH
(43)
2 VAMULA Wife Female Nil Nil/Nil 713566225126
LAXMAM
MA(38)
3 VAMULA Son Male Nil Nil/Nil 357286449499
CHANNAIA
H(19)
4 VAMULA Daughter Female Nil Nil/Nil 544078361532
ANITHA(11
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219592/000

Household Verification Format Door No:6-8,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband HANMANTHU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VAMULA Self Male Nil Nil/Nil 353327548235
THIRUPAT
HAIAH(50)
2 VAMULA Wife Female Nil Nil/Nil
JAYAMMA
(34)
3 VAMULA Wife Female Nil Nil/Nil 368794069927
CHITTAM
MA(38)
4 VAMULA Son Male Nil Nil/Nil 824824489164
VENKATES
H(19)
5 VAMULA Son Male Nil Nil/Nil
HANMANT
HU(11)
6 VAMULA Son Male Nil Nil/Nil
NAGARAJ
U(15)
7 VAMULA Son Male Nil Nil/Nil
MALLAES
H(20)
8 VAMULA Daughter Female Nil Nil/Nil
NAGAJOYT
HI(17)
9 VAMULA Daughter Female Nil Nil/Nil 487072634747
NAGAMAN
AMMA(7)
10 VAMULA Brother Male Nil Nil/Nil 394463020040
SHANTHA
MMA(37)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219593/000

Household Verification Format Door No:7-30,LATTUPALLY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband HANUMANTHU Gas YES/HP/632786
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAILU Self Male Nil Nil/Nil 525180557576
KRISHNAI
AH(43)
2 MAILU Wife Female Nil Nil/Nil 219217917802
MAHESHW
ARI(35)
3 MAILU Son Male Nil Nil/Nil 903910522218
DANUNJAI
(4)
4 MAILU Daughter Female Nil Nil/Nil 402020655835
SAILAXMI(
9)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.7 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219594/000

Household Verification Format Door No:7-31,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband HANMANTHU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAILU Self Male Nil Nil/Nil 418070599317
PAPANNA(
53)
2 MAILU Wife Female Nil Nil/Nil 288906551387
MANAMM
A(48)
3 MAILU Son Male Nil Nil/Nil 838419214321
SHIVAKU
MAR(2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219595/000

Household Verification Format Door No:7-32,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband REDDY Gas YES/HP/621009
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil Nil/Nil 433024017712
H
THAURU(5
6)
2 MUDAVAT Wife Female Nil Nil/Nil 521160361225
H DANI(52)

3 MUDAVAT Son Male Nil Nil/Nil 233557589222

H
PERYA(33)
4 MUDAVAT Daughter in Female Nil Nil/Nil 725194194371
H Law
CHITTAM
MA(28)
5 MUDAVAT Grand Son Male Nil Nil/Nil
H
ANAND(4)
6 MUDAVAT Grand Son Male Nil Nil/Nil 682110264555
H
VAMSI(11)
7 MUDAVAT Grand Female Nil Nil/Nil
H Daughter
PALLAVI(7
)
8 MUDAVAT Grand Female Nil Nil/Nil
H Daughter
MOUNIKA(
9)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219596/001

Household Verification Format Door No:7-33,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband HANUMANTHU Gas YES/Bharath/38797
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 YALUGU Self Male Nil Nil/Nil 823574083831
SRINIVASU
LU(43)
2 YALUGU Wife Female Nil Nil/Nil 380970426522
SHAMALA(
38)
3 YALUGU Son Male Nil Nil/Nil 445799825891
ANILKUM
AR(11)
4 YALUGU Son Male Nil Nil/Nil 719419597093
SHIVA(18)

5 YALUGU Daughter Female Nil Nil/Nil

SHERISA(1
5)
6 YALUGU Daughter Female Nil Nil/Nil
RAVATHI(1
2)
7 YALUGU Daughter Female Nil Nil/Nil
MOUNIKA(
14)
8 YALUGU Daughter Female Nil Nil/Nil
RANUKA(1
5)
9 YALUGU Brother Male Nil Nil/Nil
RAMASWA
MY(42)
10 YALUGU Sister in Law Female Nil Nil/Nil
LAXMI(31)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219596/002

Household Verification Format Door No:1-61,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband HANUMANTHU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 YALLUGU Son Male Nil Nil/Nil
ARVIND(8)
2 YALLUGU Son Male Nil Nil/Nil
HARESH(2)
3 YALLUGU Brother Male Nil Nil/Nil
THIRUPAT
AIAH(44)
4 YALLUGU Brother Male Nil Nil/Nil
SHAKER(31
)
5 YALLUGU Brother Male Nil Nil/Nil
BANGARA
M(27)
6 YALLUGU Sister in Law Female Nil Nil/Nil
LAXMI(38)
7 YALLUGU Sister in Law Female Nil Nil/Nil
RAKAH(21)
8 YALLUGU Sister in Law Female Nil Nil/Nil
SHIVAMM
A(25)
9 YALLUGU Non Male Nil Nil/Nil
KORAMAI Relatives
AH(61)
10 YALLUGU Non Female Nil Nil/Nil
NARAMMA Relatives
(56)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219597/000

Household Verification Format Door No:7-33,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband TAURU Gas YES/HP/629695
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil Nil/Nil 502758157511
H
DAULA(39)
2 MUDAVAT Wife Female Nil Nil/Nil 800805264000
H
MUTHYALI
(35)
3 MUDAVAT Son Male Nil Nil/Nil 477544930316
H
GANESH(1
4)
4 MUDAVAT Son Male Nil Nil/Nil
H
SHIVA(12)
5 MUDAVAT Daughter Female Nil Nil/Nil
H
PADMA(13)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:1.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219598/000

Household Verification Format Door No:7-34,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband REDDYA Gas YES/HP/639341
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil Nil/Nil 248959176442
H ANJA(45)

2 MUDAVAT Wife Female Nil Nil/Nil 772219511724

H
LAXMI(39)
3 MUDAVAT Son Male Nil Nil/Nil 869224856683
H
SAIKIRAN(
20)
4 MUDAVAT Son Male Nil Nil/Nil 298677700086
H RAJU(25)

5 MUDAVAT Daughter Female Nil Nil/Nil

H
HARITHA(1
4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.72 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219599/000

Household Verification Format Door No:7-39,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband DEEPLA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KHATAVA Self Male Nil Nil/Nil 610806047222
TH
SATYAM(4
1)
2 KHATAVA Wife Female Nil Nil/Nil 897749752286
TH
MANGAM
MA(36)
3 KHATAVA Son Male Nil Nil/Nil 367097971417
TH
HANMANT
HU(13)
4 KHATAVA Son Male Nil Nil/Nil 209931521185
TH
VISHNU(9)
5 KHATAVA Daughter Female Nil Nil/Nil 738878510055
TH
TULASI(19)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219600/000

Household Verification Format Door No:7-35,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband CHANDYA Gas YES/HP/238580
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KAHTAVA Self Male Nil Nil/Nil 544494965761
TH
SHANKAR(
38)
2 KAHTAVA Wife Female Nil Nil/Nil 296916389348
TH
VALI(33)
3 KAHTAVA Son Male Nil Nil/Nil
TH
RAMESH(1
1)
4 KAHTAVA Daughter Female Nil Nil/Nil 354831548794
TH
SARADHA(
14)
5 KAHTAVA Daughter Female Nil Nil/Nil
TH
SAILAJA(9)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219601/000

Household Verification Format Door No:7-35,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband CHANDYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KHATAVA Self Female Nil Nil/Nil
TH
DAVLI(59)
2 KHATAVA Son Male Nil Nil/Nil 644088322166
TH
GOPAL(31)
3 KHATAVA Daughter in Female Nil Nil/Nil 653183806630
TH Law
LAXMI(23)
4 KHATAVA Grand Son Male Nil Nil/Nil 278257120472
TH
SAICHARA
NTAJA(0)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219602/000

Household Verification Format Door No:7-37,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband SAKRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KHATAVA Self Male Nil Nil/Nil 377941513607
TH
LAXMAN(4
8)
2 KHATAVA Wife Female Nil Nil/Nil 913257822665
TH
GOBREE(43
)
3 KHATAVA Daughter Female Nil Nil/Nil 699900449099
TH
NEELA(14)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219603/000

Household Verification Format Door No:7-38,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband ANJANAILU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM Self Male Nil Nil/Nil 507632753553
SRINIVASU
LU(33)
2 JANGAM Wife Female Nil Nil/Nil 680630700655
PADMAM
MA(28)
3 JANGAM Son Male Nil Nil/Nil 523018328455
SHIVAKU
MAR(15)
4 JANGAM Daughter Female Nil Nil/Nil
SHERESA(1
1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219604/000

Household Verification Format Door No:7-40,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAME Self Male Nil Nil/Nil 684003117771
DI
KONDAIA
H(46)
2 GADDAME Wife Female Nil Nil/Nil 747086619644
DI
ALIVALU(4
3)
3 GADDAME Son Male Nil Nil/Nil 813732206493
DI
MAHESH(1
8)
4 GADDAME Daughter Female Nil Nil/Nil 284007957825
DI
MANJULA(
23)
5 GADDAME Daughter Female Nil Nil/Nil
DI
RANUKA(1
4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:6 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219605/000

Household Verification Format Door No:7-41,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband MANAMAIAH Gas YES/HP/626150
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NERADI Self Male Nil Nil/Nil 421982755208
YADAIAH(
39)
2 NERADI Wife Female Nil Nil/Nil 292677859560
KAMALAM
MA(34)
3 NERADI Son Male Nil Nil/Nil 351668219700
JAGADESH
(14)
4 NERADI Daughter Female Nil Nil/Nil 581529680190
ANURADH
A(19)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.18 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219606/000

Household Verification Format Door No:7-42,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SATYANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM Self Male Nil Nil/Nil 537355020792
BEMAIAH(
34)
2 JANGAM Wife Female Nil Nil/Nil 674478245690
SHAMALA(
28)
3 JANGAM Son Male Nil Nil/Nil
DANUSH(4)
4 JANGAM Son Male Nil Nil/Nil
GANESH(8)
5 JANGAM Son Male Nil Nil/Nil
SATYADA
V(1)
6 JANGAM Daughter Female Nil Nil/Nil 773133191151
AKILA(9)

7 JANGAM Daughter Female Nil Nil/Nil

HARIKA(3)
8 JANGAM Daughter Female Nil Nil/Nil 226863044674
DEEPIKA(6
)
9 JANGAM Brother Male Nil Nil/Nil
GOPAL(27)
10 JANGAM Sister in Law Female Nil Nil/Nil
SWAPNA(2
5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0.7 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219607/000

Household Verification Format Door No:7-43,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SATYANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM Self Male Nil Nil/Nil 461054068566
RAMASWA
MY(29)
2 JANGAM Wife Female Nil Nil/Nil 330585980979
SANTHOSA
(26)
3 JANGAM Son Male Nil Nil/Nil 768809105232
SHIVACHA
RAN(5)
4 JANGAM Daughter Female Nil Nil/Nil
PRATHUSA
(0)
5 JANGAM Brother Male Nil Nil/Nil
NARESH(24
)
6 JANGAM Sister in Law Female Nil Nil/Nil
NAGAMM
A(18)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.28 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219609/000

Household Verification Format Door No:7-47,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband KSNDYA Gas YES/HP/637545
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ESHLAVAT Self Male Nil Nil/Nil
H
CHANDYA(
43)
2 ESHLAVAT Wife Female Nil Nil/Nil 489373556615
H RAJI(38)

3 ESHLAVAT Son Male Nil Nil/Nil 266540776529

H
SANTHOSH
(15)
4 ESHLAVAT Son Male Nil Nil/Nil
H
AVINASH(1
1)
5 ESHLAVAT Daughter Female Nil Nil/Nil
H
SARADHA(
7)
6 ESHLAVAT Daughter Female Nil Nil/Nil
H
POOJA(11)
7 ESHLAVAT Daughter Female Nil Nil/Nil
H LEELA(2)
8 ESHLAVAT Daughter Female Nil Nil/Nil 237740688369
H
KAVITHA(
16)
9 ESHLAVAT Daughter Female Nil Nil/Nil
H
ANITHA(7)
10 ESHLAVAT Brother Male Nil Nil/Nil
H
BHASKER(
38)
11 ESHLAVAT Sister in Law Female Nil Nil/Nil
H
SHANTHI(3
1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.38 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:
Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219610/000

Household Verification Format Door No:7-48,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband SOMLA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KHATAVA Self Female Nil Nil/Nil 615898792731
TH
GANGE(48)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.82 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0219611/000

Household Verification Format Door No:7-449,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARAYANA Gas YES/HP/626077
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PANTHUL Self Male Nil Nil/Nil 336788408188
U
BAGIRAO(
63)
2 PANTHUL Wife Female Nil Nil/Nil 449720519936
U
BARATHA
MMA(58)
3 PANTHUL Son Male Nil Nil/Nil
U
MALLOGI(
31)
4 PANTHUL Son Male Nil Nil/Nil 742208979917
U
BUDGAGI(
35)
5 PANTHUL Daughter in Female Nil Nil/Nil
U Law
RAGENI(26
)
6 PANTHUL Daughter in Female Nil Nil/Nil 997560173495
U Law
SWAROOPI
NI(28)
7 PANTHUL Grand Son Male Nil Nil/Nil
U
KARTHIKA
YA(31)
8 PANTHUL Grand Female Nil Nil/Nil
U Daughter
SATHWEE
K(1)
9 PANTHUL Grand Female Nil Nil/Nil 354804752405
U Daughter
HARSHITH
A(6)
10 PANTHUL Grand Female Nil Nil/Nil
U Daughter
MANASA(2
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.52 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:
Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219612/000

Household Verification Format Door No:7-50,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SAYANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 THATIKON Self Male Nil Nil/Nil 934610949723
DA
VENKATAI
AH(60)
2 THATIKON Wife Female Nil Nil/Nil 387588772749
DA
SAYAMMA
(35)
3 THATIKON Son Male Nil Nil/Nil
DA
GANESH(9)
4 THATIKON Son Male Nil Nil/Nil 835066621391
DA
RAMESH(1
9)
5 THATIKON Daughter Female Nil Nil/Nil
DA
KRISHNAV
ANI(6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.85 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219613/000

Household Verification Format Door No:7-51,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SAYANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 THATIKON Self Male Nil Nil/Nil 695912045135
DA
KASANNA(
31)
2 THATIKON Wife Female Nil Nil/Nil 716311227816
DA
ANJAMMA
(27)
3 THATIKON Son Male Nil Nil/Nil
DA
SANTHOSH
(2)
4 THATIKON Son Male Nil Nil/Nil 621482589680
DA
SAIDUBAB
U(7)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219614/000

Household Verification Format Door No:7-52,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 THATIKON Self Male Nil Nil/Nil 917056668993
DA
SAYANNA(
73)
2 THATIKON Wife Female Nil Nil/Nil 969112699105
DA
CHANNAM
MA(63)
3 THATIKON Son Male Nil Nil/Nil 669234204231
DA
THIRUPAT
AIAH(31)
4 THATIKON Daughter in Female Nil Nil/Nil 383245925225
DA Law
ALIVALU(2
8)
5 THATIKON Grand Female Nil Nil/Nil 327993925197
DA Daughter
ANITHA(10
)
6 THATIKON Grand Female Nil Nil/Nil
DA Daughter
ANIKITHA(
7)
7 THATIKON Grand Female Nil Nil/Nil
DA Daughter
CHINNARI(
4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:2.52 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219615/000

Household Verification Format Door No:7-65/1,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KRISHNAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VANDHAN Self Male Nil Nil/Nil 898596635530
AM
THIRUPAT
AIAH(36)
2 VANDHAN Wife Female Nil Nil/Nil 729124814771
AM
LAXMI(30)
3 VANDHAN Son Male Nil Nil/Nil 966357090251
AM
KIRANKU
MAR(11)
4 VANDHAN Daughter Female Nil Nil/Nil 875145379560
AM
SHERESA(9
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219621/000

Household Verification Format Door No:7-65,7

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband GOKARAIAH Gas YES/HP/677318
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VANDANA Self Male Nil AGRICULT 376895825762
M URE
VENKATAI LABOUR
AH(50) /Nil
2 VANDANA Wife Female Nil Nil/Nil 884904382911
M
THIRUPAT
HAMMA(38
)
3 VANDANA Son Male Nil Nil/Nil 399812089685
M
RAJKUMA
R(19)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.18 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219622/000

Household Verification Format Door No:7-53,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SHIVARAJU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KAMMARI Self Female BLACKSMI Nil/Nil 736563418141
MANJULA( TH
27)
2 KAMMARI Husband Male BLACKSMI Nil/Nil 368054078400
SHIVARAJ TH
U(38)
3 KAMMARI Son Male Nil Nil/Nil 690777290306
VINODKU
MAR(14)
4 KAMMARI Daughter Female Nil Nil/Nil 966212722220
SHIRISHA(
13)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:1.52/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219623/000

Household Verification Format Door No:7-54,LATPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHENNAPPA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM Self Male Nil AGRICULT 828713969006
BADRAIAH URE
(65) LABOUR
/Nil
2 JANGAM Daughter in Female Nil Nil/Nil
SANTHOSH Law
(44)
3 JANGAM Grand Son Male Nil Nil/Nil
rajesh(15)
4 JANGAM Grand Son Male Nil Nil/Nil 501642125682
GHANESH(
20)
5 JANGAM Grand Female Nil Nil/Nil
KAVERI(18 Daughter
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219624/000

Household Verification Format Door No:7-55,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband GOPPANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KALVARA Self Male Nil OWN 527800661363
LA AGRICULT
SATHANN URE
A(53) /Nil
2 KALVARA Wife Female Nil OWN 419728857664
LA AGRICULT
BALAMMA URE
(48) /Nil
3 KALVARA Son Male Nil AGRICULT 990291458771
LA URE
RAVI(18) LABOUR
/Nil
4 KALVARA Daughter Female Nil Nil/Nil 941688216178
LA
SAMALA(1
6)
5 KALVARA Daughter in Female Nil AGRICULT 881899076295
LA Law URE
LAVANYA( LABOUR
15) /Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.75 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219625/000

Household Verification Format Door No:7-57,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KURUMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 THATIKON Self Male Nil OWN 211686315204
DA AGRICULT
RAMULU(6 URE
3) /Nil
2 THATIKON Wife Female Nil Nil/Nil 258194426844
DA
SANTHAM
MA(58)
3 THATIKON Son Male Nil Nil/Nil 641314115280
DA
THIARUPA
THAIAH(25
)
4 THATIKON Daughter in Female Nil Nil/Nil 863759508405
DA Law
YADAMM
A(22)
5 THATIKON Grand Female Nil Nil/Nil
DA Daughter
SHIVAMM
A(0)
6 THATIKON Grand Female Nil Nil/Nil 282559959229
DA Daughter
NIKITHA(3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0.1/DRY:2.2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219626/000

Household Verification Format Door No:7-59,LATUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KURUMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 THATIKON Self Male Nil OWN 218191118132
DA AGRICULT
LAXMAIA URE
H(43) /Nil
2 THATIKON Wife Female Nil OWN 668757058924
DA AGRICULT
SANTHAM URE
MA(37) /Nil
3 THATIKON Son Male Nil AGRICULT 530694912694
DA URE
RAMESH(2 LABOUR
0) /Nil
4 THATIKON Son Male Nil AGRICULT 228812600950
DA URE
SHIVA(16) LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0.75/DRY:2.25 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219627/000

Household Verification Format Door No:7-58,LATUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KURUMAIAH Gas YES/Bharath/52683
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 THATIKON Self Male Nil MIGRATED 448405562984
DA LABOUR/N
MANNEM( il
41)
2 THATIKON Wife Female Nil MIGRATED 744479531312
DA LABOUR/N
NILAMMA( il
37)
3 THATIKON Son Male Nil Nil/Nil 424675186434
DA
SURENDER
(13)
4 THATIKON Daughter Female Nil Nil/Nil
DA
SRAVANI(6
)
5 THATIKON Daughter Female Nil Nil/Nil 736823978674
DA
VARALAX
MI(17)
6 THATIKON Mother Female Nil Nil/Nil 265097907071
DA
PENTAMM
A(63)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0.75/DRY:2.25 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219628/000

Household Verification Format Door No:7-60,LATUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARSIMHULU Gas YES/HP/617480
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KUMMARI Self Male POTTERY Nil/Nil 555006582422
MANEMM
A(60)
2 KUMMARI Wife Female POTTERY Nil/Nil 756579682378
KASAMMA
(48)
3 KUMMARI Son Male Nil Nil/Nil 344824144182
SRINIVASU
LU(25)
4 KUMMARI Daughter Female Nil Nil/Nil 254661434301
KALAMMA
(29)PWD: Y
& Sadaran
No:1418939
0140113029
5 KUMMARI Daughter in Female Nil Nil/Nil 337587911112
MOUNIKA( Law
17)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:8.58 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219629/000

Household Verification Format Door No:7-60/1,LATUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband MANNEMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KUMMARI Self Male Nil OWN 732986035882
BALASWA AGRICULT
MY(33) URE
/Nil
2 KUMMARI Wife Female Nil OWN 473161178688
MALLESW AGRICULT
ARI(25) URE
/Nil
3 KUMMARI Son Male Nil Nil/Nil 606010168789
NAVEEN(6)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0.92 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219630/000

Household Verification Format Door No:7-61,LATUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BUCHNNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MANGANI Self Male Nil DAILY 295024719217
PALLI WAGES
BHIMAIAH LABOUR/N
(35) il
2 MANGANI Wife Female Nil State Govt 607572876698
PALLI Project
BAGYALA Employee
XMI(30) /Nil
3 MANGANI Daughter Female Nil Nil/Nil 778611762078
PALLI
KEERTHA
NA(11)
4 MANGANI Daughter Female Nil Nil/Nil 505641274766
PALLI
ARCHANA(
10)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219631/000

Household Verification Format Door No:7-63,LATUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas YES/HP/635817
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 THIMMAK Self Male Nil OWN 328619765446
KA AGRICULT
KRISHNAI URE
AHG(43) /Nil
2 THIMMAK Wife Female Nil OWN 910830197950
KA AGRICULT
BAGYAMM URE
A(36) /Nil
3 THIMMAK Mother Female Nil Nil/Nil 453087447295
KA
NARAMMA
(68)
4 THIMMAK Father Male Nil Nil/Nil 829963360244
KA
KONDAIA
H(78)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:9.2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219632/000

Household Verification Format Door No:7-62,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas YES/HP/639576
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 THIMMAK Self Male Nil OWN 421297388446
KA AGRICULT
RAMCHAN URE
DRAIAH(63 /Nil
)
2 THIMMAK Wife Female Nil OWN 525507885513
KA AGRICULT
ANJANAM URE
MA(53) /Nil
3 THIMMAK Son Male Nil DAILY 824340164068
KA WAGES
VENKATA LABOUR/N
SWAMY(33 il
)
4 THIMMAK Son Male Nil DAILY 473375727263
KA WAGES
THIRUPAT LABOUR/N
HAIAH(28) il
5 THIMMAK Son Male Nil DAILY 582598332959
KA WAGES
ASHOK(21) LABOUR/N
il
6 THIMMAK Daughter in Female Nil DAILY 374850179422
KA Law WAGES
SUNITHA(2 LABOUR/N
0) il
7 THIMMAK Daughter in Female Nil DAILY 623250923996
KA Law WAGES
VARALAX LABOUR/N
MI(23) il
8 THIMMAK Grand Female Nil Nil/Nil
KA Daughter
YASASWA
NI(1)
9 THIMMAK Grand Female Nil Nil/Nil
KA Daughter
THULASI(0
)
10 THIMMAK Grand Female Nil Nil/Nil 905878405394
KA Daughter
SRIVALLI(
4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:
Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219633/000

Household Verification Format Door No:7-64/1,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband HANUMANTH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 AGURAMB Self Female Nil Nil/Nil 995693118176
ADHA
NARAMMA
(65)
2 AGURAMB Son Male Nil MIGRATED
ADHA LABOUR/N
VENKATAI il
AH(36)
3 AGURAMB Daughter in Female Nil MIGRATED
ADHA Law LABOUR/N
SANTHAM il
MA(30)
4 AGURAMB Grand Son Male Nil Nil/Nil 440952043510
ADHA
KURUMUR
THY(9)
5 AGURAMB Grand Son Male Nil Nil/Nil 507325525635
ADHA
NARESH(12
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219634/000

Household Verification Format Door No:7-64,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband HANUMANTH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 AGURABA Self Male Nil DAILY 766534873806
NDHA WAGES
SRINIVAS( LABOUR/N
38) il
2 AGURABA Wife Female Nil DAILY 979617247988
NDHA WAGES
RAMULAM LABOUR/N
MA(30) il
3 AGURABA Son Male Nil Nil/Nil
NDHA
SHIVASAN
KAR(10)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219635/000

Household Verification Format Door No:7-147,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband LAXCMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM Self Female Nil Nil/Nil 514655704476
LAXMAIA
H(54)
2 JANGAM Son Male Nil DAILY 769533777436
SAILU(32) WAGES
LABOUR/N
il
3 JANGAM Son Male Nil DAILY 587726198260
BARAJU(33 WAGES
) LABOUR/N
il
4 JANGAM Son Male Nil Nil/Nil 497738963168
BALAKRIS
HNA(30)
5 JANGAM Daughter in Female Nil Nil/Nil 263763883555
KAVITHA( Law
28)
6 JANGAM Grand Son Male Nil DAILY 357962996736
PAWAN(6) WAGES
LABOUR/N
il
7 JANGAM Grand Son Male Nil Nil/Nil 517634425096
MADHU(11
)
8 JANGAM Grand Son Male Nil Nil/Nil 377657615774
SHIVA(8)

9 JANGAM Grand Female Nil Nil/Nil

BAGYA(14) Daughter
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.38 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219636/000

Household Verification Format Door No:7-148,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NEELLA Self Female Nil Nil/Nil 379544913849
BHIMAMM
A(64)
2 NEELLA Son Male Nil DAILY 970074530611
NARSIMM WAGES
A(27) LABOUR/N
il
3 NEELLA Daughter in Female Nil DAILY 261662560775
LAXMI(20) Law WAGES
LABOUR/N
il
4 NEELLA Grand Female Nil Nil/Nil 561015379296
RAMYA(1) Daughter

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.38 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219637/000

Household Verification Format Door No:7-145,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMASWAMY Gas YES/HP/637577
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ELUGU Self Male Nil DAILY 747586428670
VENKATAI WAGES
AH(35) LABOUR/N
il
2 ELUGU Wife Female Nil DAILY 404819739222
KALAVAT WAGES
HI(31) LABOUR/N
il
3 ELUGU Son Male Nil Nil/Nil 645164564074
SANTHOSH
KUMAR(14
)
4 ELUGU Son Male Nil Nil/Nil 959309103955
VENUKUM
AR(8)
5 ELUGU Son Male Nil Nil/Nil 684370692611
ARVIND
KUMAR(11
)
6 ELUGU Mother Female Nil Nil/Nil 893692470193
CHENNAM
MA(63)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0.38 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219638/000

Household Verification Format Door No:7-141,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PALAMUR Self Female Nil Nil/Nil 653976869532
U
RAMULAM
MA(53)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0219639/000

Household Verification Format Door No:7-142,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BOKKI Self Male Nil Nil/Nil 362100244324
BALAIAH(6
8)
2 BOKKI Wife Female Nil Nil/Nil 241200119511
NAGAMM
A(60)
3 BOKKI Daughter in Female Nil Nil/Nil 350117773751
CHITTEMM Law
A(28)
4 BOKKI Grand Female Nil Nil/Nil 333894187796
LAVANYA( Daughter
4)
5 BOKKI Grand Female Nil Nil/Nil
MOUNIKA( Daughter
6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:6.22 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219640/000

Household Verification Format Door No:7-141,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMOJI Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PANTHUL Self Female Nil DAILY 805545798979
A WAGES
THARABAI LABOUR/N
(48) il
2 PANTHUL Son Male Nil DAILY 850223823127
A WAGES
JANGOJI(26 LABOUR/N
) il
3 PANTHUL Daughter in Female Nil DAILY 769473287644
A Law WAGES
LALITHA(2 LABOUR/N
4) il
4 PANTHUL Grand Son Male Nil Nil/Nil 239367238101
A
SAIPRASA
D(1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219641/000

Household Verification Format Door No:7-139,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SAYANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ANIMONI Self Male Nil DAILY 864383169107
LAXMAIA WAGES
H(53) LABOUR/N
il
2 ANIMONI Wife Female Nil Nil/Nil 781752537410
ANANTHA
MMA(48)
3 ANIMONI Son Male Nil Nil/Nil 754754979578
SWAMY(20
)
4 ANIMONI Son Male Nil Nil/Nil 454071324229
SAI
BABU(16)
5 ANIMONI Daughter Female Nil Nil/Nil 701832847849
MANJULA(
12)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.52 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219642/000

Household Verification Format Door No:7-137,LATUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SAYANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NALGOND Self Male Nil Nil/Nil 514189633031
A
NARAYAN
A(68)
2 NALGOND Wife Female Nil Nil/Nil 875588679324
A
SINGAMM
A(59)
3 NALGOND Son Male Nil Nil/Nil
A
SWAMY(37
)
4 NALGOND Son Male Nil DAILY
A WAGES
NIRANJAN( LABOUR/N
33) il
5 NALGOND Daughter in Female Nil Nil/Nil
A Law
VASANTH
A(31)
6 NALGOND Daughter in Female Nil DAILY
A Law WAGES
JYOTHI(31) LABOUR/N
il
7 NALGOND Grand Son Male Nil Nil/Nil
A
HARICHAR
AN(3)
8 NALGOND Grand Son Male Nil Nil/Nil
A
MANICHA
RAN(5)
9 NALGOND Grand Son Female Nil Nil/Nil
A
VENKATA
SAIPRASA
D(2)
10 NALGOND Grand Female Nil Nil/Nil
A Daughter
THULASI(1
2)
11 NALGOND Grand Female Nil Nil/Nil
A Daughter
SHILPA(14)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.28 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL
Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219643/000

Household Verification Format Door No:7-136,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband JAMANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SANDHA Self Male Nil DAILY 556288022538
MASAIAH( WAGES
55) LABOUR/N
il
2 SANDHA Wife Female Nil DAILY 803538678979
NAGAMM WAGES
A(48) LABOUR/N
il
3 SANDHA Son Male Nil DAILY 390466618105
RAJU(30) WAGES
LABOUR/N
il
4 SANDHA Son Male Nil DAILY
RAVI(25) WAGES
LABOUR/N
il
5 SANDHA Daughter in Female Nil Nil/Nil 432983921087
SUJATHA(2 Law
7)
6 SANDHA Grand Son Male Nil Nil/Nil 509093219235
AKHIL(7)

7 SANDHA Grand Son Male Nil Nil/Nil 474611228217

CHAITANY
A(5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219645/000

Household Verification Format Door No:7-138,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband THULPA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATHLAV Self Male Nil DAILY 906144359790
ATH WAGES
REDYA(47) LABOUR/N
il
2 RATHLAV Wife Female Nil Nil/Nil 308943159412
ATH
BHIMNI(43)
3 RATHLAV Son Male Nil Nil/Nil 840657406772
ATH RAJU
KUMAR(13
)
4 RATHLAV Son Male Nil Nil/Nil 443138061897
ATH SHIVA
KUMAR(15
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219651/000

Household Verification Format Door No:7-143,urigadda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC NIL Father/Mother/husband BALAYY Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PALAMURI Self Female Nil Nil/Nil
BALAMMA
(55)
2 PALAMURI Son Male Nil Nil/Nil
SRINU(30)
3 PALAMURI Son Male Nil Nil/Nil
SRISAILLA
M(22)
4 PALAMURI Son Male Nil Nil/Nil
RAMULU(2
3)
5 PALAMURI Daughter in Female Nil Nil/Nil
VENKATA Law
MMA(23)
6 PALAMURI Son in Law Male Nil Nil/Nil
AA(22)
7 PALAMURI Grand Male Nil Nil/Nil
NAVEEN(3) Daughter
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219652/000

Household Verification Format Door No:7-140,URIGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband VEENANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ANAMONI Self Male Nil Nil/Nil
NAGANNA
(48)
2 ANAMONI Wife Male Nil Nil/Nil
THIRUPAT
HAMMA(38
)
3 ANAMONI Son Female Nil Nil/Nil
NARSIMHA
(26)
4 ANAMONI Son Female Nil Nil/Nil
ANJANEYU
LU(15)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0.52/DRY:1.52 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219653/000

Household Verification Format Door No:7-66,URIGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM Self Male Nil Nil/Nil
SHANTHA
YYA(37)
2 JANGAM Husband Female Nil Nil/Nil
LAXMI(31)
3 JANGAM Son Male Nil Nil/Nil
PAVANKA
LYAN(15)
4 JANGAM Daughter Male Nil Nil/Nil
ANJANRY
ULUI(9)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.45 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219654/000

Household Verification Format Door No:7-134,URIGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAJANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KURUMAL Self Male Nil Nil/Nil
A
BALASWA
MY(60)
2 KURUMAL Wife Female Nil Nil/Nil
A
YALAMMA
(55)
3 KURUMAL Son Male Nil Nil/Nil
A
MALLESH(
25)
4 KURUMAL Son Male Nil Nil/Nil
A
RAMU(20)
5 KURUMAL Son Male Nil Nil/Nil
A
BABU(35)
6 KURUMAL Daughter in Female Nil Nil/Nil
A Law
MADAMM
A(27)
7 KURUMAL Grand Male Nil Nil/Nil
A Daughter
VAMSHI(2)
8 KURUMAL Grand Male Nil Nil/Nil
A RUSHI(2) Daughter
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219655/000

Household Verification Format Door No:7-129,URIGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband ADIVAYYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BOKKA Self Female Nil Nil/Nil
BALAKRIS
HNA(18)
2 BOKKA Son Male Nil Nil/Nil
MANYAM(
25)
3 BOKKA Son Male Nil Nil/Nil
SRINU(23)
4 BOKKA Son Male Nil Nil/Nil
SRISAILLA
M(36)
5 BOKKA Daughter in Female Nil Nil/Nil
NARSAMM Law
A(27)
6 BOKKA Grand Male Nil Nil/Nil
MALLESH( Daughter
5)
7 BOKKA Grand Female Nil Nil/Nil
MOUNIKA( Daughter
5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.45 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219657/000

Household Verification Format Door No:7-132,URIGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARAYANA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM Self Male Nil Nil/Nil
CHENNAM
MA(46)
2 JANGAM Son Female Nil Nil/Nil
VENKATA
RAMANA(3
4)
3 JANGAM Son Male Nil Nil/Nil
SHANKAR(
27)
4 JANGAM Son Male Nil Nil/Nil
VISHNU(24
)
5 JANGAM Daughter in Male Nil Nil/Nil
BAGYALA Law
XMI(28)
6 JANGAM Daughter in Female Nil Nil/Nil
SHARADH Law
A(22)
7 JANGAM Grand Son Male Nil Nil/Nil
ASHVANT
HA(4)
8 JANGAM Grand Son Male Nil Nil/Nil
MAHESH(1
)
9 JANGAM Grand Female Nil Nil/Nil
HASIR(3) Daughter
10 JANGAM Grand Male Nil Nil/Nil
NANDINI(7 Daughter
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.55 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219658/000

Household Verification Format Door No:7-130,URIGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband JAMANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BOKKA Self Male Nil Nil/Nil
RAMULU(6
3)
2 BOKKA Wife Female Nil Nil/Nil
BALAMMA
(58)
3 BOKKA Son Male Nil Nil/Nil
SRISAILA
M(27)
4 BOKKA Son Male Nil Nil/Nil
MAHESH(1
9)
5 BOKKA Son Male Nil Nil/Nil
RAJU(33)
6 BOKKA Son Male Nil Nil/Nil
KRISHNA(3
3)
7 BOKKA Son Male Nil Nil/Nil
MAADAIA
H(21)
8 BOKKA Daughter in Female Nil Nil/Nil
RANI(29) Law
9 BOKKA Daughter in Female Nil Nil/Nil
MANJULA( Law
25)
10 BOKKA Daughter in Female Nil Nil/Nil
CHANDRA Law
KALA(28)
11 BOKKA Son in Law Male Nil Nil/Nil
JASHWAN
THA(3)
12 BOKKA Mother Female Nil Nil/Nil
SRILATHA(
8)
13 BOKKA Grand Male Nil Nil/Nil
PRASHANT Daughter
H(8)
14 BOKKA Grand Male Nil Nil/Nil
AMMULU( Daughter
5)
15 BOKKA Grand Male Nil Nil/Nil
SRIKANTH Daughter
(8)
16 BOKKA Grand Female Nil Nil/Nil
SHIREESH Daughter
A(10)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:6.3 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219659/000

Household Verification Format Door No:7-131,URIGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC NIL Father/Mother/husband KRISHNAJI Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KARNEKO Self Male Nil Nil/Nil
TA
SHIVASHA
NKAR(28)
2 KARNEKO Wife Female Nil Nil/Nil
TA
KAVITHA(
22)
3 KARNEKO Son Male Nil Nil/Nil
TA
BHANUPR
ASAD(5)
4 KARNEKO Daughter Female Nil Nil/Nil
TA
BHANUSRI
(2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219660/000

Household Verification Format Door No:7-130/1,URIGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BOKKA Self Male Nil Nil/Nil
SRINU(39)
2 BOKKA Wife Female Nil Nil/Nil
CHENAMM
A(35)
3 BOKKA Son Male Nil Nil/Nil
SHIVASHA
NKAR(14)
4 BOKKA Son Male Nil Nil/Nil
VAMSHI(13
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.48 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219661/000

Household Verification Format Door No:7-64,URIGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SAYANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 IGARAMB Self Male Nil Nil/Nil
ADA
HANMANT
HU(60)
2 IGARAMB Son Male Nil Nil/Nil
ADA
DEELIP(30)
3 IGARAMB Daughter Female Nil Nil/Nil
ADA
CHENAMM
A(23)
4 IGARAMB Grand Female Nil Nil/Nil
ADA Daughter
KAVYA(2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219662/000

Household Verification Format Door No:7-71,URIGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHENANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 YADAGAT Self Male Nil Nil/Nil
LA
SATHYAN
NA(57)
2 YADAGAT Daughter in Female Nil Nil/Nil
LA Law
MADAVI(2
2)
3 YADAGAT Daughter in Female Nil Nil/Nil
LA Law
CHANDRA
KALA(30)
4 YADAGAT Grand Son Male Nil Nil/Nil
LA
SHIVAYYA
(24)
5 YADAGAT Grand Son Male Nil Nil/Nil
LA
BALRAJU(8
)
6 YADAGAT Grand Son Male Nil Nil/Nil
LA
SAIKUMAR
(7)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.8 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219663/000

Household Verification Format Door No:7-73,URIGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC NIL Father/Mother/husband CHANDYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ISLAVTH Self Female Nil Nil/Nil
MUTHYAL
U(48)
2 ISLAVTH Son Male Nil Nil/Nil
RAVI(20)
3 ISLAVTH Daughter Female Nil Nil/Nil
CHITTI(19)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.7 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219664/000

Household Verification Format Door No:7-123/1,URIGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NAGAYYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KAMPALLI Self Male Nil Nil/Nil
ANJANEYU
LU(31)
2 KAMPALLI Wife Female Nil Nil/Nil
VENKATA
MMA(28)
3 KAMPALLI Daughter Female Nil Nil/Nil
RAJITHA(1
0)
4 KAMPALLI Daughter Male Nil Nil/Nil
MAHESHW
ARAMMA(
13)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219665/000

Household Verification Format Door No:7-129,URIGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KONDAYYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BOKKA Self Male Nil Nil/Nil
MAHESH(3
8)
2 BOKKA Wife Female Nil Nil/Nil
NAGALAX
MI(31)
3 BOKKA Daughter Female Nil Nil/Nil
SWAMY(10
)
4 BOKKA Daughter Female Nil Nil/Nil
MANASA(7
)
5 BOKKA Mother Female Nil Nil/Nil
DEVAMMA
(58)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.72 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219666/000

Household Verification Format Door No:7-123,URIGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband JAMANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SANDYA Self Male Nil Nil/Nil
BALAYYA(
50)
2 SANDYA Wife Female Nil Nil/Nil
MANEMM
A(41)
3 SANDYA Son Male Nil Nil/Nil
SHIVASHA
NKAR(20)
4 SANDYA Son Male Nil Nil/Nil
NERESH(16
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219667/000

Household Verification Format Door No:7-123/1,URIGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband JAMANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SANDA Self Male Nil MILCH 364244401038
SRINU(40) ANIMALS/
Nil
2 SANDA Wife Female Nil DAILY 928492924594
CHENAMM WAGES
A(36) LABOUR/N
il
3 SANDA Son Female Nil Nil/Nil 366418217149
VIJAY(16)

4 SANDA Daughter Female Nil Nil/Nil 210467356803

ANITHA(13
)
5 SANDA Daughter Female Nil Nil/Nil 826002492570
SUNITHA(2
2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219668/000

Household Verification Format Door No:7-112,URIGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHANDRAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 UDATHAL Self Male Nil Nil/Nil
A
HANMANT
HU(38)
2 UDATHAL Wife Female Nil Nil/Nil
A
LAXMI(33)
3 UDATHAL Son Male Nil Nil/Nil
A
ASHOK(11)
4 UDATHAL Daughter Female Nil Nil/Nil
A
HAMSA(14)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219669/000

Household Verification Format Door No:7-76,URIGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 YEDDULA Self Female Nil Nil/Nil
SHIVAYYA
(66)
2 YEDDULA Daughter Female Nil Nil/Nil
NAGAMM
A(48)
3 YEDDULA Son in Law Male Nil Nil/Nil
MANYAM(
55)
4 YEDDULA Grand Son Male Nil Nil/Nil
VENKATA
YYA(26)PW
D: Y &
Sadaran
No:1418939
0140113012
5 YEDDULA Grand Son Male Nil Nil/Nil
KUMAR(24
)
6 YEDDULA Grand Son Male Nil Nil/Nil
SHIVA(20)
7 YEDDULA Grand Son Male Nil Nil/Nil
KRISHNA(2
9)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219670/000

Household Verification Format Door No:7-76/1,URIGADDAA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 YADUGUA Self Female Nil Nil/Nil 296108633114
TA
ANJAMMA
(32)
2 YADUGUA Daughter Female Nil Nil/Nil
TA
MAHESHW
ARI(15)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219671/000

Household Verification Format Door No:7-110,URIGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHINNARAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BAKKA Self Male Nil Nil/Nil
NAGAYYA
(43)
2 BAKKA Wife Female Nil Nil/Nil
YELAMMA
(35)
3 BAKKA Son Male Nil Nil/Nil
RAMULU(1
6)
4 BAKKA Son Male Nil Nil/Nil
MALLESH(
18)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.62 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219672/000

Household Verification Format Door No:7-109,URIGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC NIL Father/Mother/husband USHALA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDDAM Self Male Nil Nil/Nil
NAGAYYA
(45)
2 MUDDAM Wife Female Nil Nil/Nil
SHANKAR
AMMA(41)
3 MUDDAM Son Male Nil Nil/Nil
HANMANT
HU(23)
4 MUDDAM Daughter in Female Nil Nil/Nil
NIRMALA( Law
43)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.92 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219673/000

Household Verification Format Door No:7-78,URIGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SWAMY Gas YES/HP/635921
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NEERADA Self Male Nil Nil/Nil
BALAPEER
U(43)
2 NEERADA Husband Male Nil Nil/Nil
MAHESH(2
2)
3 NEERADA Wife Female Nil Nil/Nil
PADMAM
MA(39)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219674/000

Household Verification Format Door No:7-79,URIGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband MANYAM Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NEERADA Father in Male Nil Nil/Nil 318648377434
VENKATA Law
YYA(41)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0219675/000

Household Verification Format Door No:7-80,URIGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BUCHAIAH Gas YES/HP/617479
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RANAMON Self Male Nil Nil/Nil
E
TIRUPATHI
(40)
2 RANAMON Wife Female Nil Nil/Nil
E
LAXMI(35)
3 RANAMON Son Male Nil Nil/Nil
E
YADAGIRI(
23)
4 RANAMON Son Male Nil Nil/Nil
E
MAHESH(1
)
5 RANAMON Son Male Nil Nil/Nil
E
RAMULU(1
9)
6 RANAMON Daughter Male Nil Nil/Nil
E
NAGALAX
MI(8)
7 RANAMON Daughter in Female Nil Nil/Nil
E Law
LALITHA(2
0)
8 RANAMON Grand Son Male Nil Nil/Nil
E
REVANTH(
1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.68 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219676/000

Household Verification Format Door No:7-80/1,URIGUDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BUCHANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAGAMON Self Male Nil Nil/Nil
A
ANJANELU
(45)
2 RAGAMON Wife Female Nil Nil/Nil
A
KURUVAM
MA(41)
3 RAGAMON Son Male Nil Nil/Nil
A
MAHESH(1
3)
4 RAGAMON Son Male Nil Nil/Nil
A
MAHESHW
AR(10)
5 RAGAMON Daughter Female Nil Nil/Nil
A
NANDINI(7
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.7 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219677/000

Household Verification Format Door No:7-8/1,URIGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband TIRUPATAYYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NEEREDI Self Male Nil Nil/Nil
ANJANEYU
LU(46)
2 NEEREDI Wife Female Nil Nil/Nil
VIJAYAM
MA(42)
3 NEEREDI Son Male Nil Nil/Nil
BINNY(6)
4 NEEREDI Son Male Nil Nil/Nil
SHASHWA
NTH(4)
5 NEEREDI Daughter Female Nil Nil/Nil
BHARGAVI
(12)
6 NEEREDI Mother Female Nil Nil/Nil
NARSAMM
A(58)
7 NEEREDI Brother Male Nil Nil/Nil
RAJU(30)
8 NEEREDI Sister in Law Female Nil Nil/Nil
SHARADH
A(26)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:1.52 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219678/000

Household Verification Format Door No:7-81,UIGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHANDRAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 URUTHAL Self Male Nil Nil/Nil
A
SRINU(37)
2 URUTHAL Wife Female Nil Nil/Nil
A
NEELAMM
A(33)
3 URUTHAL Son Male Nil Nil/Nil
A
ANAND(15)
4 URUTHAL Son Male Nil Nil/Nil
A
RAMULU(1
4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219681/000

Household Verification Format Door No:2-90,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALASAWMY Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NEELA Self Female Nil DAILY 611326092768
MANEMM WAGES
A(45) LABOUR/N
il
2 NEELA Son Male Nil AGRICULT 451412626836
NARASIMH URE
A(23) LABOUR
/Nil
3 NEELA Daughter Female Nil Nil/Nil 541818392184
NARASAM
MA(30)
4 NEELA Son in Law Male Nil DAILY 241289603108
SIDDU(33) WAGES
LABOUR/N
il
5 NEELA Grand Son Male Nil Nil/Nil 340241870097
NARESH(9)

6 NEELA Grand Female Nil DAILY 387040172691

ANURADH Daughter WAGES
A(10) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.98 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219682/000

Household Verification Format Door No:6-74,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHENNAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VANKAM Self Female Nil DAILY 215200331187
BALAMMA WAGES
(55) LABOUR/N
il
2 VANKAM Son Male Nil Nil/Nil 276713993099
CHANDRAI
AH(30)
3 VANKAM Son Male Nil Nil/Nil 384717644342
RAJU(15)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219683/000

Household Verification Format Door No:6-69,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband LAXMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PALAMURI Self Male Nil MIGRATED 554478011239
BALASWA LABOUR/N
MY(27) il
2 PALAMURI Wife Female Nil DAILY
SHARADH WAGES
A(22) LABOUR/N
il
3 PALAMURI Wife Female Nil Nil/Nil 780272129325
NEELAMM
A(22)
4 PALAMURI Wife Female Nil DAILY 530581968697
LAXMMA WAGES
MMA(23) LABOUR/N
il
5 PALAMURI Son Male Nil Nil/Nil 553724378959
CHANDU(7
)
6 PALAMURI Son Male Nil Nil/Nil 364030940068
VAMSHI(4)

7 PALAMURI Son Male Nil Nil/Nil 799159488363

BHARATH(
4)
8 PALAMURI Son Male Nil Nil/Nil 363883125407
GANESH(4)

9 PALAMURI Daughter Female Nil Nil/Nil

VARSHITA
(1)
10 PALAMURI Brother Male Nil DAILY 421724296789
SHIVA(22) WAGES
LABOUR/N
il
11 PALAMURI Brother Male Nil Nil/Nil 340119185013
CHINNAIA
H(26)
12 PALAMURI Brother Male Nil DAILY 968692135584
YADAIAH( WAGES
23) LABOUR/N
il
13 PALAMURI Brother Male Nil Nil/Nil 893238960177
GANGAPU
RI(27)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL
Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219684/000

Household Verification Format Door No:6-70,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARAYANA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MANGAMP Self Female Nil DAILY 556667056114
ET WAGES
BHAGYAM LABOUR/N
MA(53) il
2 MANGAMP Son Male Nil DAILY 848825283919
ET WAGES
KRISHNA(3 LABOUR/N
0) il
3 MANGAMP Daughter in Female Nil Nil/Nil 516547868272
ET Law
LAXMI(24)
4 MANGAMP Grand Female Nil Nil/Nil 773927214580
ET UMA(3) Daughter

5 MANGAMP Grand Female Nil Nil/Nil 429797006625

ET Daughter
RAMYASRI
(5)
6 MANGAMP Grand Female Nil Nil/Nil
ET Daughter
AVANTHI(
0)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.12 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219685/000

Household Verification Format Door No:99,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHANDRAIAH Gas YES/HP/639496
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 UDATHAL Self Male Nil DAILY 276742506745
A WAGES
LAXMAIA LABOUR/N
H(36) il
2 UDATHAL Wife Female Nil DAILY 641727509226
A WAGES
JANGAMM LABOUR/N
A(33) il
3 UDATHAL Son Male Nil Nil/Nil 740881711934
A
CHANDU(6
)
4 UDATHAL Son Male Nil Nil/Nil 501064482775
A
MAHESH(1
0)
5 UDATHAL Mother Female Nil DO 544296211811
A NOTHING/
BALAMMA Nil
(60)
6 UDATHAL Father Male Nil DO 855160309933
A NOTHING/
CHANDRAI Nil
AH(65)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:9.55 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219686/000

Household Verification Format Door No:99,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband JAMMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BOKKI Self Male Nil DAILY 815481760947
BALAIAH(4 WAGES
5) LABOUR/N
il
2 BOKKI Son Female TODDY Nil/Nil 428394725745
KARTHIK(1 TOPPERS
7)
3 BOKKI Son Female Nil DRIVERS/N 246770252267
NARESH(23 il
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219687/000

Household Verification Format Door No:6-70,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband DASHARADHAM Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BOKKI Self Male Nil OWN 966197422833
RAMASWA AGRICULT
MY(46) URE
/Nil
2 BOKKI Wife Female Nil DAILY 531224054393
NAGAMM WAGES
A(41) LABOUR/N
il
3 BOKKI Son Female Nil DRIVERS/N 633848181945
NARENDA il
R(22)
4 BOKKI Daughter Female Nil Nil/Nil 563663088475
MANJULA(
15)
5 BOKKI Daughter in Female Nil DAILY
SWAPNA(1 Law WAGES
8) LABOUR/N
il
6 BOKKI Mother Female Nil DAILY 641365171863
KASHAMM WAGES
A(62) LABOUR/N
il
7 BOKKI Sister Female Nil DAILY 923288695628
PARVATA WAGES
MMA(48) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219688/000

Household Verification Format Door No:6-75,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KONDAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BOKKI Self Male Nil DAILY 843978571717
RAMULU(4 WAGES
2) LABOUR/N
il
2 BOKKI Wife Female Nil DAILY 793911192742
KAMALAM WAGES
MA(30) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.72 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219689/000

Household Verification Format Door No:4-136,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KURMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 CHINTAKA Self Male Nil OWN 614485349053
YALA AGRICULT
CHINA URE
NARSIMHA /Nil
(60)
2 CHINTAKA Wife Female Nil OWN 671423350161
YALA AGRICULT
NAGAMM URE
A(50) /Nil
3 CHINTAKA Son Male Nil AGRICULT 792874501171
YALA URE
KURMAIA LABOUR
H(23) /Nil
4 CHINTAKA Son Male Nil Nil/Nil 959872778584
YALA
SHIVA(9)
5 CHINTAKA Daughter Female Nil DAILY
YALA WAGES
MANJULA( LABOUR/N
12) il
6 CHINTAKA Daughter Female Nil DAILY 692689334635
YALA WAGES
LAXMI(15) LABOUR/N
il
7 CHINTAKA Daughter in Female Nil DAILY
YALA Law WAGES
SHARADH LABOUR/N
A(19) il
8 CHINTAKA Grand Son Male Nil Nil/Nil
YALA
SHARADH
A BABU(0)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:5.98 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219690/000

Household Verification Format Door No:4-137/C,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KRISHNAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KALVARL Self Male Nil OWN 810032742112
A AGRICULT
VENKATAI URE
AH(50) /Nil
2 KALVARL Wife Female Nil DAILY 927816975177
A WAGES
VENKATA LABOUR/N
MMA(45) il
3 KALVARL Son Male Nil DRIVERS/N
A il
KRISHNAI
AH(24)
4 KALVARL Son Male Nil Nil/Nil 698815232213
A RAJESH
KUMAR(14
)
5 KALVARL Daughter in Female Nil DAILY 715723169294
A Law WAGES
SHYAMAL LABOUR/N
A(19) il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219691/000

Household Verification Format Door No:6-80,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BURAN Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MANGAMP Self Female Nil DAILY 933310289310
ET WAGES
RAMULAM LABOUR/N
MA(60) il
2 MANGAMP Son Male Nil MIGRATED 884623837148
ET LABOUR/N
RAJU(23) il
3 MANGAMP Son Male Nil DAILY 668908074543
ET WAGES
KRISHNA(3 LABOUR/N
1) il
4 MANGAMP Son Male Nil DAILY 994146470120
ET WAGES
NARAYAN LABOUR/N
A(27) il
5 MANGAMP Daughter in Female Nil DAILY 961707209371
ET Law WAGES
LAXMI(25) LABOUR/N
il
6 MANGAMP Daughter in Female Nil DAILY 821076794542
ET Law WAGES
MAMATHA LABOUR/N
(22) il
7 MANGAMP Grand Son Male Nil Nil/Nil
ET
OMKAR(0)
8 MANGAMP Grand Son Male Nil DAILY 411032543229
ET WAGES
CHANDU(6 LABOUR/N
) il
9 MANGAMP Grand Son Male Nil Nil/Nil 651580880793
ET
RANJITH
KUMAR(2)
10 MANGAMP Grand Female Nil Nil/Nil 364944734316
ET Daughter
SRILATHA(
4)
11 MANGAMP Grand Male Nil Nil/Nil 392134641395
ET Daughter
JYOTHI(3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.98 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:
Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219692/000

Household Verification Format Door No:6-76,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KRISHNASIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VANDHAN Self Male Nil DAILY 860843521701
AM WAGES
ANJANEYU LABOUR/N
LU(45) il
2 VANDHAN Wife Female Nil DAILY 727085360162
AM WAGES
GIRAMMA( LABOUR/N
35) il
3 VANDHAN Son Male Nil Nil/Nil 913310065901
AM
NAGARJU
NA(19)
4 VANDHAN Son Male Nil Nil/Nil 965035070469
AM SHIVA
KUMAR(17
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.38 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219693/000

Household Verification Format Door No:6-71,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RANGAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PALAMUR Self Male Nil OWN 432499117007
U AGRICULT
BHASHA(6 URE
2) /Nil
2 PALAMUR Wife Female Nil DAILY 237392302358
U WAGES
VENKATA LABOUR/N
MMA(55) il
3 PALAMUR Son Male Nil Nil/Nil 897310291546
U
JHANGEER
(20)
4 PALAMUR Son Male Nil Nil/Nil 486963892396
U
SHIVA(11)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.28 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219694/000

Household Verification Format Door No:32,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband laxmaiah Gas YES/HP/512651
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 aeddulla Self Male Nil DAILY 374847760900
KRISHNAI WAGES
AH(42) LABOUR/N
il
2 aeddulla Wife Female Nil DAILY 613502477634
LAXMMA WAGES
MMA(38) LABOUR/N
il
3 aeddulla Son Male Nil Nil/Nil 475675701877
NAGESH(1
5)
4 aeddulla Son Male Nil Nil/Nil 594550134397
SHIVA(17)

5 aeddulla Daughter Female Nil Nil/Nil 844467034559

VANITHA(
18)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:5.78 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219695/000

Household Verification Format Door No:33,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband VENKATAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 CHINTHAK Self Female Nil DAILY 232207240837
AYALA WAGES
BALAMMA LABOUR/N
(40) il
2 CHINTHAK Husband Male Nil DAILY 935279005495
AYALA WAGES
VENKATAI LABOUR/N
AH(51) il
3 CHINTHAK Son Male Nil DAILY 940798168672
AYALA WAGES
RAJU(18) LABOUR/N
il
4 CHINTHAK Daughter Female Nil DAILY 211042356664
AYALA WAGES
MAMATHA LABOUR/N
(16) il
5 CHINTHAK Daughter Female Nil Nil/Nil 483358000223
AYALA
POOJA(9)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219696/000

Household Verification Format Door No:6-72,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband LAXMAIAH Gas YES/HP/617575
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 AEDDULA Self Male Nil DAILY 541049939603
SULTHAN( WAGES
43) LABOUR/N
il
2 AEDDULA Wife Female Nil DAILY 537820154187
KOTAMMA WAGES
(37) LABOUR/N
il
3 AEDDULA Son Male Nil Nil/Nil 458839307885
NAGARAJ
U(20)
4 AEDDULA Daughter Female Nil Nil/Nil 297839668675
SUJATHA(2
5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219697/000

Household Verification Format Door No:2-85,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHINNAMALLAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM Self Male Nil DAILY 395315601509
BALAIAH(3 WAGES
5) LABOUR/N
il
2 JANGAM Wife Female Nil DAILY 429468658838
YELLAMM WAGES
A(32) LABOUR/N
il
3 JANGAM Son Male Nil Nil/Nil 485527834803
SHEKAR(4)

4 JANGAM Daughter Female Nil Nil/Nil

BABY(10)
5 JANGAM Daughter Female Nil Nil/Nil 688233363156
SHIREESH
A(9)
6 JANGAM Daughter Female Nil Nil/Nil 480544124413
NANDINI(2
)
7 JANGAM Daughter Female Nil Nil/Nil 583357762995
MADHAVI(
13)
8 JANGAM Brother Male Nil DAILY 683533345792
SRINU(30) WAGES
LABOUR/N
il
9 JANGAM Sister in Law Female Nil DAILY 477142868016
SUJATHA(2 WAGES
7) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.88 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219698/000

Household Verification Format Door No:6-81,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SAVARAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ALUGU Self Male Nil DAILY
KRISHNAI WAGES
AH(45) LABOUR/N
il
2 ALUGU Wife Female Nil DAILY
RATNAMM WAGES
A(37) LABOUR/N
il
3 ALUGU Son Male Nil Nil/Nil
SHIVA
SHANKAR(
21)
4 ALUGU Daughter Female Nil Nil/Nil
SHIREESH
A(16)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:1/DRY:2.65 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219699/000

Household Verification Format Door No:99,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SAVARAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ALUGU Self Male Nil DAILY 650555438187
TIRUPATAI WAGES
AH(61) LABOUR/N
il
2 ALUGU Wife Female Nil DAILY 378389379206
CHENNAM WAGES
MA(40) LABOUR/N
il
3 ALUGU Son Male Nil Nil/Nil 388654783444
HARIKRIS
HNA(12)
4 ALUGU Son Male Nil Nil/Nil 611853550125
KURUMUR
THI(10)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219700/000

Household Verification Format Door No:99,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SAYANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 THATIKON Self Male Nil DAILY 548715011653
DA PEDDA WAGES
VENKATA LABOUR/N
YYA(42) il
2 THATIKON Wife Female Nil DAILY 463258424095
DA WAGES
KONDAM LABOUR/N
MA(30) il
3 THATIKON Son Male Nil Nil/Nil 451788601255
DA
RAMESH(1
4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:2.6 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219701/000

Household Verification Format Door No:99,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM Self Male Nil OWN 237467830275
KRISHNAI AGRICULT
AH(55) URE
/Nil
2 JANGAM Wife Female Nil DAILY 209121689772
CHENNAM WAGES
MA(50) LABOUR/N
il
3 JANGAM Son Male Nil Nil/Nil 886302182502
SHIVA(16)

4 JANGAM Son Male Nil DAILY 963423788245

RAMULU(2 WAGES
6) LABOUR/N
il
5 JANGAM Daughter in Female Nil Nil/Nil
LAVANYA( Law
19)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219702/000

Household Verification Format Door No:99,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SAYANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM Self Male Nil DAILY 573768928346
MANNEM( WAGES
56) LABOUR/N
il
2 JANGAM Wife Female Nil DAILY 260575811618
LAXMI(35) WAGES
LABOUR/N
il
3 JANGAM Son Male Nil Nil/Nil 307386989271
NARASIMH
A(7)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219703/000

Household Verification Format Door No:2.00,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband ANJANEYULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM Self Male Nil DAILY 591123215007
SATYAIAH WAGES
(54) LABOUR/N
il
2 JANGAM Wife Female Nil DAILY 864951567134
NARSAMM WAGES
A(50) LABOUR/N
il
3 JANGAM Son Male Nil Nil/Nil 366020115990
NARASIMH
A(17)
4 JANGAM Daughter Female Nil Nil/Nil 725569594784
SRILATHA(
13)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219704/000

Household Verification Format Door No:99,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband PEDDA MALLAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM Self Male Nil DAILY 700458615217
BUCHANN WAGES
A(55) LABOUR/N
il
2 JANGAM Wife Female Nil DAILY 875905663881
NARSINGA WAGES
MMA(50) LABOUR/N
il
3 JANGAM Son Male Nil Nil/Nil 739371812682
SAI
KUMAR(7)
4 JANGAM Son Male Nil Nil/Nil 213896619511
NAGARAJ
U(10)
5 JANGAM Daughter Female Nil Nil/Nil 428281755614
BHAGYAM
MA(18)
6 JANGAM Daughter Female Nil Nil/Nil 562087545839
ANITHA(12
)
7 JANGAM Daughter Female Nil Nil/Nil
JYOTHI(9)
8 JANGAM Brother Male Nil DAILY 454459142507
RAMULU(3 WAGES
4) LABOUR/N
il
9 JANGAM Sister in Law Female Nil DAILY 478795155188
LAXMI(26) WAGES
LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.68 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219705/000

Household Verification Format Door No:99,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband MASANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 DULLA Self Male Nil DAILY 336451765371
NAGAIAH( WAGES
45) LABOUR/N
il
2 DULLA Wife Female Nil DAILY 510050056732
RAMULAM WAGES
MA(38) LABOUR/N
il
3 DULLA Daughter Female Nil Nil/Nil 766322234609
SHIVALEE
LA(6)
4 DULLA Daughter Female Nil Nil/Nil 247412581117
JYOTHI(14)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219706/000

Household Verification Format Door No:99,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband HANMANTHU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VANDHAN Self Male Nil DAILY 978060655113
AM WAGES
BALRAJU(3 LABOUR/N
3) il
2 VANDHAN Wife Female Nil DAILY 802439779978
AM WAGES
RENUKA(2 LABOUR/N
5) il
3 VANDHAN Son Male Nil Nil/Nil 438102397115
AM
GOVARDH
AN(4)
4 VANDHAN Daughter Female Nil Nil/Nil 466545097904
AM
PRASHANT
HI(9)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219707/000

Household Verification Format Door No:99,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PEDDAMIK Self Male Nil DAILY 407887631596
KALA WAGES
GANGAPU LABOUR/N
RI(50) il
2 PEDDAMIK Wife Female Nil DAILY 239173995053
KALA WAGES
MANEMM LABOUR/N
A(45) il
3 PEDDAMIK Son Male Nil Nil/Nil 497013798207
KALA
MAHESH(1
4)
4 PEDDAMIK Daughter Female Nil Nil/Nil
KALA
SHIVANI(1
1)
5 PEDDAMIK Daughter Female Nil DAILY 518850767273
KALA WAGES
LAXMI(17) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219708/000

Household Verification Format Door No:99,URAGADDA COLONY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SAILU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PALAMUR Self Male Nil DAILY
U WAGES
KESHAV(2 LABOUR/N
6) il
2 PALAMUR Wife Female Nil DAILY
U WAGES
SANTHOSH LABOUR/N
A(22) il
3 PALAMUR Son Male Nil Nil/Nil
U
SRIKANTH
(3)
4 PALAMUR Daughter Female Nil Nil/Nil
U
JYOTHI(2)
5 PALAMUR Father Male Nil DAILY
U WAGES
SAILU(60) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219711/000

Household Verification Format Door No:4-37/4,URAKONDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband BALAIH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BOYA Self Male Nil AGRICULT 925003996278
SRINU URE
SRINIVASU LABOUR
LU(40) /Nil
2 BOYA Wife Female Nil Nil/Nil 368294808420
SRINU
YADAMM
A(35)
3 BOYA Son Male Nil Nil/Nil 691140205215
SRINU
MOHAN(14
)
4 BOYA Son Male Nil Nil/Nil 346225195725
SRINU
RAMAKRIS
HNA(11)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.3 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219712/000

Household Verification Format Door No:4-37/5,URAGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband PEDDA MALAIAH Gas YES/Bharath/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM Self Male Nil OWN 694086881973
VENKTAIA AGRICULT
H(35) URE
/Nil
2 JANGAM Wife Female Nil Nil/Nil 273658747179
BHAGYAM
MA(32)
3 JANGAM Daughter Female Nil Nil/Nil 786917817015
NAGALAX
MY(12)
4 JANGAM Daughter Female Nil Nil/Nil 746734364930
MAHESWA
RY(8)
5 JANGAM Daughter Female Nil Nil/Nil
CHENNAM
MA(2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219713/000

Household Verification Format Door No:6-67,URAGADDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband PENTAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VANDHAN Self Male Nil AGRICULT 456720790454
AM URE
ANJANAIA LABOUR
H(65) /Nil
2 VANDHAN Husband Female Nil AGRICULT 387377936966
AM URE
ANJNAMM LABOUR
A(40) /Nil
3 VANDHAN Son Male Nil DAILY 221050862477
AM WAGES
SHEKAR(29 LABOUR/N
) il
4 VANDHAN Son Male Nil AGRICULT 874986052415
AM URE
RAJU(28) LABOUR
/Nil
5 VANDHAN Daughter Female Nil Nil/Nil 830745317839
AM
SRIHARI(8)
6 VANDHAN Daughter Female Nil Nil/Nil 457657410120
AM
ANITHA(10
)
7 VANDHAN Daughter in Female Nil AGRICULT 553526113967
AM Law URE
SHIRISHA( LABOUR
20) /Nil
8 VANDHAN Daughter in Female Nil DAILY
AM Law WAGES
ANITHA(19 LABOUR/N
) il
9 VANDHAN Grand Son Male Nil Nil/Nil
AM
GNANESH
WAR(1)
10 VANDHAN Grand Female Nil Nil/Nil
AM Daughter
BANU(3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:11.95 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:
Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219715/000

Household Verification Format Door No:7-93,URKONDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas YES/Bharath/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BOYA Self Male Nil AGRICULT 477780832006
VENKAIAH URE
(50) LABOUR
/Nil
2 BOYA Wife Female Nil Nil/Nil 869669515858
SHIVAMM
A(45)
3 BOYA Son Male Nil Nil/Nil 805249970356
RAMULU(2
0)
4 BOYA Son Male Nil Nil/Nil 245720608646
CHINNAIA
H(19)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.72 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219716/000

Household Verification Format Door No:3-57,URAKONDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband PULLAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 AUVJIMOG Self Female Nil DAILY 258605221528
GA WAGES
MANEMM LABOUR/N
A(50) il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0219717/000

Household Verification Format Door No:7-114,URAKONDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BOYA Self Male Nil DO 425417631358
BALAIAH(8 NOTHING/
0) Nil
2 BOYA Son Female Nil DAILY 205838561334
CHENNAIA WAGES
H(40) LABOUR/N
il
3 BOYA Daughter in Female Nil DAILY 562741996897
LAXMY Law WAGES
DEVAMMA LABOUR/N
(35) il
4 BOYA Grand Son Male Nil DO 446710438997
ESHWARA NOTHING/
MMA(11) Nil
5 BOYA Grand Female Nil DO 299261048541
SUNITHA(1 Daughter NOTHING/
3) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:7.98 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219718/000

Household Verification Format Door No:7-120,URAKONDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NAGAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM Self Male Nil DAILY 866123409020
BALAMMA WAGES
(60) LABOUR/N
il
2 JANGAM Son Male Nil DO 614278259976
SRISHAILA NOTHING/
M(15) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.72 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219719/000

Household Verification Format Door No:7-102/1,URAKONDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband narayana Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 janngam Self Male Nil AGRICULT
laxmaiah(40) URE
LABOUR
/Nil
2 janngam Wife Female Nil AGRICULT
nagamma(35 URE
) LABOUR
/Nil
3 janngam Son Male Nil Nil/Nil 351553188223
banu
praksah(18)
4 janngam Son Male Nil Nil/Nil 704113025214
RAJU(19)

5 janngam Daughter Female Nil Nil/Nil 994733902597

SHIRISHA(
16)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0.15/DRY:1.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219720/000

Household Verification Format Door No:7-93/1,URAKONDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SAVARAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VALUGU Self Male Nil DAILY 650555438187
THIRUPAT WAGES
HAIAH(61) LABOUR/N
il
2 VALUGU Wife Female Nil Nil/Nil 378389379206
CHENAMM
A(40)
3 VALUGU Son Male Nil Nil/Nil 611853550125
KURMURT
HY(9)
4 VALUGU Son Male Nil Nil/Nil 388654783444
HARIKRIS
HNA(12)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219721/000

Household Verification Format Door No:7-121,URAKONDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHINNA MALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM Self Female Nil DAILY 866144160765
VENKATA WAGES
MMA(50) LABOUR/N
il
2 JANGAM Son Male Nil OTHER 399327111598
SHIVA(26) SKILLED
WORKERS/
Nil
3 JANGAM Daughter in Female Nil DAILY 528261109614
LAXMY(24) Law WAGES
LABOUR/N
il
4 JANGAM Grand Female Nil DO 657991509640
ARCHANA( Daughter NOTHING/
2) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.38 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219722/000

Household Verification Format Door No:7-122,URAKONDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband EDDANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM Self Male Nil Nil/Nil 916665789608
BALAIAH(6
0)
2 JANGAM Son Male Nil Nil/Nil 345087937570
MAHESH(1
4)
3 JANGAM Daughter Female Nil Nil/Nil 348516568965
ESHWARA
MMA(18)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0.78 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219723/000

Household Verification Format Door No:7-123,URAKONDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BOKKA Self Male Nil DAILY 731541465102
YADAIAH( WAGES
38) LABOUR/N
il
2 BOKKA Wife Female Nil DAILY 208197366832
ANJAAMM WAGES
A(32) LABOUR/N
il
3 BOKKA Son Male Nil DO 502731949763
SHIVA(14) NOTHING/
Nil
4 BOKKA Daughter Female Nil DO 535066378392
PADMA(16) NOTHING/
Nil
5 BOKKA Daughter Female Nil DO 509786860338
JYHOTHI(1 NOTHING/
1) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219724/000

Household Verification Format Door No:7-123,URAKONDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SANDA Self Female Nil DAILY 293887587532
NAGAMM WAGES
A(40) LABOUR/N
il
2 SANDA Son Male Nil DO 893455561894
ESHWARA NOTHING/
MMA(16) Nil
3 SANDA Son Male Nil DO
SHIVA(18) NOTHING/
Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219725/000

Household Verification Format Door No:1-117/1,urakonda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHINNAIAH Gas YES/HP/629344
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 CHINTAKO Self Female Nil DAILY 723550958541
YALA WAGES
NAGAMM LABOUR/N
A(55) il
2 CHINTAKO Son Male Nil DAILY 444852458611
YALA WAGES
CHENNAK LABOUR/N
ESHAVUL il
U(24)
3 CHINTAKO Son Male Nil DAILY 417523153143
YALA WAGES
MALLIKAE LABOUR/N
JUN(23) il
4 CHINTAKO Son Male Nil DAILY 593163320531
YALA WAGES
KRISHNA(2 LABOUR/N
1) il
5 CHINTAKO Daughter in Female Nil DAILY
YALA Law WAGES
SHIVAMM LABOUR/N
A(21) il
6 CHINTAKO Grand Female Nil DAILY
YALA Daughter WAGES
ASMITHA( LABOUR/N
1) il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219726/000

Household Verification Format Door No:7-124,URAKONDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RANGAIAGH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PALAMUR Self Male Nil DAILY 401992907778
RAMULU(5 WAGES
8) LABOUR/N
il
2 PALAMUR Wife Female Nil DAILY 422097510481
MANGAM WAGES
MA(54) LABOUR/N
il
3 PALAMUR Daughter Female Nil DO 867175611099
SAVITHRI( NOTHING/
14) Nil
4 PALAMUR Daughter Female Nil DO 554331840668
SRIDEVI(16 NOTHING/
) Nil
5 PALAMUR Daughter Female Nil DAILY
ANJAMMA WAGES
(25) LABOUR/N
il
6 PALAMUR Grand Son Male Nil DO 946620359617
GOPI NOTHING/
CHAND(1) Nil
7 PALAMUR Grand Son Male Nil DO 470929112385
HARISH NOTHING/
NKUMAR(8 Nil
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.3 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219727/000

Household Verification Format Door No:7-125,URAKONDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHINNAMAALLAIA Gas NIL/-/
Name H Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 YALUGA Self Female Nil State 282885386798
BUCHAMM GovtEmploy
A(65) ee/Cntral
Govt
Pension
2 YALUGA Son Male Nil State 562371857226
MALLESH( GovtEmploy
35) ee/Nil
3 YALUGA Daughter in Female Nil Nil/Nil 261819507932
ARUNA(27) Law

4 YALUGA Grand Female Nil Nil/Nil 478268433086

SRIJA(7) Daughter

5 YALUGA Grand Female Nil Nil/Nil 497024380885

NAVYA(9) Daughter

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.25 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219728/000

Household Verification Format Door No:7-127,URAKONDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BOKKI Self Male Nil DAILY 797405882249
VENKATAI WAGES
AH(55) LABOUR/N
il
2 BOKKI Wife Female Nil DAILY 914598988141
VENKATA WAGES
MMA(50) LABOUR/N
il
3 BOKKI Son Male Nil DAILY 268319676081
CHAKRAV WAGES
ATHY(16) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0.72 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219729/000

Household Verification Format Door No:7-126,URAKONDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband ANJANEYULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BOKKI Self Female Nil DAILY 912382811241
PARVATH WAGES
AMMA(50) LABOUR/N
il
2 BOKKI Son Male Nil DAILY 392179852777
KURMURT WAGES
HY(22) LABOUR/N
il
3 BOKKI Son Male Nil DAILY
SRINU(21) WAGES
LABOUR/N
il
4 BOKKI Son Male Nil DAILY 658771725652
KRISHNA(1 WAGES
6) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.98 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219730/000

Household Verification Format Door No:7-126,URAKONDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BOKKI Self Male Nil DAILY 320891095887
KRISHNAI WAGES
AH(50) LABOUR/N
il
2 BOKKI Wife Female Nil DAILY 340878109377
INDIRAMM WAGES
A(45) LABOUR/N
il
3 BOKKI Son Male Nil DO 938690331065
SHIVA(15) NOTHING/
Nil
4 BOKKI Daughter Female Nil DO 341812461303
MAMATHA NOTHING/
(17) Nil
5 BOKKI Daughter Male Nil DO 562220478451
SHEKAR(13 NOTHING/
) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219731/000

Household Verification Format Door No:7-127/1,URAKONDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband GOKRAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VANDHAN Self Male Nil AGRICULT 229080568459
AM URE
yadaiah(35) LABOUR
/Nil
2 VANDHAN Wife Female Nil AGRICULT 630985942108
AM URE
BHAGYAL LABOUR
AXMY(25) /Nil
3 VANDHAN Son Male Nil Nil/Nil 726252695291
AM HINU
CHARAN(1
)
4 VANDHAN Son Male Nil Nil/Nil 213436790793
AM
SUMANTH
A(4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219732/000

Household Verification Format Door No:7-150,URAKONDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband VENKATAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VANDHAN Self Male Nil DRIVERS/N 912909310151
A il
thirupathaiah
(27)
2 VANDHAN Wife Female Nil DAILY 534887391303
A radha(23) WAGES
LABOUR/N
il
3 VANDHAN Mother Female Nil DAILY 259212849823
A WAGES
MALLAMM LABOUR/N
A(50) il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:5.82 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219733/000

Household Verification Format Door No:7-150,URAKONDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband VENKANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MELLA Self Male Nil DO 899977339321
KRISHNAI NOTHING/
AH(55) Nil
2 MELLA Wife Female Nil DAILY 835052153637
CHINTHAL WAGES
AMMA(48) LABOUR/N
il
3 MELLA Son Male Nil OTHER 876769344059
SRINU(38) SKILLED
WORKERS/
Nil
4 MELLA Son Male Nil OTHER 994732493081
NARENDH SKILLED
AR(40) WORKERS/
Nil
5 MELLA Daughter Female Nil DO 642417903886
SHIVALEE NOTHING/
LA(17) Nil
6 MELLA Daughter in Female Nil DO 378582816924
SARITHA(3 Law NOTHING/
0) Nil
7 MELLA Daughter in Female Nil DO 351170000043
ANANDH(2 Law NOTHING/
4) Nil
8 MELLA Grand Female Nil DO 555437850989
VARSHITH Daughter NOTHING/
A(2) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.62 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219734/000

Household Verification Format Door No:7-151,URAKONDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband VENKANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAILA Self Male Nil DRIVERS/N 919975575118
DEVAIAH( il
40)
2 MAILA Wife Female Nil AGRICULT 393446800199
CHENNAM URE
MA(37) LABOUR
/Nil
3 MAILA Son Male Nil DO 557238298965
KARTHIK(8 NOTHING/
) Nil
4 MAILA Daughter Female Nil DO 677356986509
SWAPNA(1 NOTHING/
1) Nil
5 MAILA Daughter Female Nil DO 444739107742
TULASI(18) NOTHING/
Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219735/000

Household Verification Format Door No:7-152,URAKONDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BHEEMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUMMAK Self Male Nil DAILY 739831436907
ONDA WAGES
MANYAM( LABOUR/N
53) il
2 GUMMAK Wife Female Nil DAILY 976506012370
ONDA WAGES
THIRUPAT LABOUR/N
HAMMA(45 il
)
3 GUMMAK Son Male Nil DAILY 407401705444
ONDA WAGES
YADAIAH( LABOUR/N
38) il
4 GUMMAK Son Male Nil DAILY 475376227279
ONDA WAGES
MAHESH(2 LABOUR/N
2) il
5 GUMMAK Daughter in Female Nil DAILY 336219977007
ONDA Law WAGES
DEVAMMA LABOUR/N
(24) il
6 GUMMAK Grand Son Male Nil DAILY 959465975094
ONDA WAGES
GANESH(2) LABOUR/N
il
7 GUMMAK Grand Son Male Nil DAILY 245936028288
ONDA WAGES
KURMURT LABOUR/N
HY(4) il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219736/000

Household Verification Format Door No:7-153,URAKONDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PANUGAN Self Male Nil DAILY 585974230019
TA WAGES
MANYAM( LABOUR/N
38) il
2 PANUGAN Wife Female Nil DAILY
TA WAGES
BALAMMA LABOUR/N
(32) il
3 PANUGAN Son Male Nil Nil/Nil 989299769014
TA
VISHNU(9)
4 PANUGAN Daughter Female Nil Nil/Nil 216625100219
TA
SHARADA(
14)
5 PANUGAN Daughter Female Nil Nil/Nil 278746035700
TA
BHUMIKA(
12)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219737/000

Household Verification Format Door No:7-155,URAKONDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband CHINNA SAYANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUMMAK Self Male Nil DAILY
ONDA WAGES
RAMULU(4 LABOUR/N
2) il
2 GUMMAK Wife Female Nil DAILY
ONDA WAGES
LAXMAM LABOUR/N
MA(31) il
3 GUMMAK Daughter Female Nil DO 530255082952
ONDA NOTHING/
SUVARNA( Nil
18)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.02 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219738/000

Household Verification Format Door No:7-117/1,URAKONDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband USHAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GOWRARA Self Male Nil DAILY 395501524485
M WAGES
THIRUPAT LABOUR/N
HAMMA(38 il
)
2 GOWRARA Wife Female Nil DAILY 812394673837
M WAGES
USHAIAH(4 LABOUR/N
0) il
3 GOWRARA Daughter Female Nil DO 973198814486
M NOTHING/
SUJATHA(1 Nil
4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219741/000

Household Verification Format Door No:7-156/A,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband PEDHA SAIANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUMMA Self Male Nil DO
KONDA NOTHING/
BHOOSHAI Nil
H(68)
2 GUMMA Wife Male Nil DAILY
KONDA WAGES
MANGAM LABOUR/N
MA(54) il
3 GUMMA Son Female Nil DO
KONDA NOTHING/
RAMDAS(2 Nil
3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219742/000

Household Verification Format Door No:7-156/1,lattupalli

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband bal chennaih Gas YES/HP/1
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 gummakond Self Female Nil DAILY
a WAGES
anjanamma( LABOUR/N
30) il
2 gummakond Son Male Nil DAILY
a ganesh(9) WAGES
LABOUR/N
il
3 gummakond Brother Male Nil DAILY
a baba(19) WAGES
LABOUR/N
il
4 gummakond Brother Male Nil DAILY
a WAGES
yadaiah(25) LABOUR/N
il
5 gummakond Sister in Law Female Nil DAILY
a WAGES
lakshmamma LABOUR/N
(22) il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219743/000

Household Verification Format Door No:7-157,LATUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC NIL Father/Mother/husband NARASIMHA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAILA Self Female Nil Nil/Nil 405475633501
PADMAM
MA(25)
2 MAILA Son Male Nil Nil/Nil 306048589886
GIRIBABU(
5)
3 MAILA Daughter Female Nil Nil/Nil 849863050644
LAKSHMI(
4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219744/000

Household Verification Format Door No:7-162,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband SOMLA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KETHAVA Husband Male Nil DAILY
TH WAGES
HANUMAI LABOUR/N
AH(37) il
2 KETHAVA Wife Female Nil DAILY
TH WAGES
SOMLI(32) LABOUR/N
il
3 KETHAVA Son Male Nil DO 531038952433
TH NOTHING/
RAMESH(1 Nil
1)
4 KETHAVA Daughter Female Nil DO 968388455779
TH NOTHING/
KAVITHA( Nil
20)
5 KETHAVA Daughter Female Nil DO 233875719944
TH NOTHING/
SHANTHI(1 Nil
7)
6 KETHAVA Daughter Female Nil DO 309660668680
TH NOTHING/
SHOBA(12) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219745/000

Household Verification Format Door No:7-160,LATUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC NIL Father/Mother/husband THIRUPATHAIH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NAKKA Self Male Nil Nil/Nil 239748421947
MALLAIAH
(34)
2 NAKKA Wife Female Nil Nil/Nil 938009418331
LAKSHMA
MMA(33)
3 NAKKA Son Female Nil Nil/Nil 270799299402
PRAVEEN(
6)
4 NAKKA Son Female Nil Nil/Nil 366395494785
KURMAIA
H(10)
5 NAKKA Daughter Female Nil Nil/Nil 888831698112
NAGALAK
SHMI(8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219746/000

Household Verification Format Door No:7-160/1,LATUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband PENTAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MANDLA Husband Male Nil DAILY 539290748726
RAMA WAGES
CHANDRAI LABOUR/N
AH(38) il
2 MANDLA Wife Female Nil DAILY 333945628518
MANEMM WAGES
A(33) LABOUR/N
il
3 MANDLA Son Male Nil Nil/Nil 369820950788
KARNAKA
R(19)
4 MANDLA Son Male Nil Nil/Nil 250849265423
RAJU(15)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:1.72/DRY:1.72 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219747/000

Household Verification Format Door No:7-162,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband SAKRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KETHAVA Self Male Nil DO 674169384501
TH NOTHING/
HARYA(64) Nil
2 KETHAVA Wife Female Nil DO 866128759813
TH NOTHING/
HASLI(44) Nil
3 KETHAVA Son Male Nil DAILY 711123822392
TH WAGES
MAIBU(20) LABOUR/N
il
4 KETHAVA Son Male Nil DAILY 476240982764
TH WAGES
SRINU(19) LABOUR/N
il
5 KETHAVA Daughter in Female Nil DAILY 453905639593
TH Law WAGES
MANGAM LABOUR/N
MA(34) il
6 KETHAVA Grand Son Male Nil Nil/Nil 897118613780
TH
PAVAN(10)
7 KETHAVA Grand Female Nil Nil/Nil 503530187936
TH Daughter
MOUNIKA(
9)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:1.55/DRY:1.55 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219748/000

Household Verification Format Door No:7-162/1,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband HARYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KETHAVA Husband Male Nil Nil/Nil 488478729151
TH
KRISHNA(3
1)
2 KETHAVA Wife Female Nil Nil/Nil 710270890779
TH
CHILUKA
MMA(28)
3 KETHAVA Daughter Female Nil Nil/Nil
TH
MINAKSHI(
1)
4 KETHAVA Daughter Female Nil Nil/Nil 705550332378
TH
VIJAYA(6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219750/000

Household Verification Format Door No:7-165,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband GALANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 EGURAMB Self Female Nil Nil/Nil
AD
GOPEMMA
(75)
2 EGURAMB Husband Male Nil DAILY 253652335213
AD WAGES
BHARATH LABOUR/N
AIH(46) il
3 EGURAMB Wife Female Nil DAILY 955981326667
AD WAGES
YELLAMM LABOUR/N
A(44) il
4 EGURAMB Son Male Nil DAILY 902775012237
AD WAGES
DEVENDA LABOUR/N
R(17) il
5 EGURAMB Son Male Nil DAILY 459154267320
AD WAGES
MAHESH(2 LABOUR/N
0) il
6 EGURAMB Daughter Female Nil Nil/Nil 918748208417
AD
SHIRISHA(
13)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219752/000

Household Verification Format Door No:7-166,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BALU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil Nil/Nil 781424850256
H
GANESH(1
8)
2 MUDAVAT Grand Father Male Nil Nil/Nil 789609536732
H
RATHLAV
ATH
SAKRU(65)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219753/000

Household Verification Format Door No:1-100,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband ABDUL GHANI Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAHAMO Self Male Nil Nil/Nil 696706326332
OD
FAYAZ(63)
2 MAHAMO Wife Female Nil Nil/Nil 626799314362
OD
MAIMUDB
HEGAM(60)
3 MAHAMO Son Male Nil Nil/Nil 234704698334
OD
HUSHAN(1
5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219754/000

Household Verification Format Door No:0,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARASIMHLU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GHOLLA Husband Male Nil AGRICULT 250939612078
NARASIMH URE
LU(34) LABOUR
/Nil
2 GHOLLA Wife Female Nil AGRICULT 255511688090
SOMESHW URE
ARI(28) LABOUR
/Nil
3 GHOLLA Daughter Female Nil Nil/Nil
SHIRISHA(
4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219755/000

Household Verification Format Door No:6-13,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband NAGAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 DHASARP Self Male Nil State 891849496585
ALLE GovtEmploy
NAGAIAH( ee/Nil
50)
2 DHASARP Wife Female Nil HOUSE 496768741920
ALLE WIFE/Nil
NAIRMAL
A(30)
3 DHASARP Daughter Female Nil Nil/Nil 661550388660
ALLE
VAISHNAV
I(9)
4 DHASARP Daughter Female Nil Nil/Nil 366527108409
ALLE
SHRAVANI
(7)
5 DHASARP Mother Female Nil Nil/Nil
ALLE
LAKSHMA
MMA(60)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:1.5/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219756/000

Household Verification Format Door No:6-13,LATUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband LAKSHMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAM Self Male Nil MIGRATED 986454170699
DHURGAIA LABOUR/N
H(38) il
2 GADDAM Wife Female Nil MIGRATED 442968146312
BHERAMM LABOUR/N
A(26) il
3 GADDAM Son Male Nil Nil/Nil 411889218152
LAKSHMI
NARASIMH
A(10)
4 GADDAM Son Male Nil Nil/Nil 204543251895
BHASKER(
4)
5 GADDAM Son Male Nil Nil/Nil 943415544700
MAHESH(7
)
6 GADDAM Brother Male Nil MIGRATED 633338509305
NAGARAJ LABOUR/N
U(30) il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:2.7/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219757/000

Household Verification Format Door No:6-21,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PANUGAN Self Male Nil Nil/Nil 716676167885
TI
BHOOSHAI
H(43)
2 PANUGAN Wife Female Nil Nil/Nil 905416960505
TI
YELLAMM
A(34)
3 PANUGAN Son Male Nil Nil/Nil 523820604438
TI
BALAKRIS
HNA(18)
4 PANUGAN Daughter Female Nil Nil/Nil 480052806024
TI
PUSHPA(16
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219758/000

Household Verification Format Door No:6-22/1,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband YELLAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUMMA Self Female Nil Nil/Nil 918548805742
KONDA
CHENAMM
A(34)
2 GUMMA Son Male Nil Nil/Nil 787445340273
KONDA
CHANDRA
SKEKAR(12
)
3 GUMMA Daughter Female Nil Nil/Nil 998300388752
KONDA
ANITHA(15
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.25 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219759/000

Household Verification Format Door No:6-22,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAM Self Female Nil DAILY 594981099611
LAKSHMA WAGES
MMA(45) LABOUR/N
il
2 GADDAM Son Male Nil DAILY
CHANDRAI WAGES
AH(31) LABOUR/N
il
3 GADDAM Daughter Female Nil Nil/Nil 749721388075
BANGARI(
13)
4 GADDAM Daughter in Female Nil DAILY 338176309495
SHANTHA Law WAGES
MMA(28) LABOUR/N
il
5 GADDAM Grand Son Male Nil Nil/Nil
LAVA
KUMAR(4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219760/000

Household Verification Format Door No:6-23,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband THIMMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUMMA Self Male Nil Nil/Nil 961984319422
KONDA
SHANTHAI
AH(48)
2 GUMMA Wife Female Nil Nil/Nil 795978271293
KONDA
YELLAMM
A(40)
3 GUMMA Son Male Nil Nil/Nil 412157051324
KONDA
YADAGIRI(
13)
4 GUMMA Daughter Female Nil Nil/Nil 801215812244
KONDA
ANJAMMA
(15)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219761/000

Household Verification Format Door No:6-24,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband THIMMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUMMAK Self Male Nil DO 490594515991
ONDA NOTHING/
pentaiah(65) Nil
2 GUMMAK Wife Female Nil DAILY 223622909561
ONDA WAGES
eshwaramma LABOUR/N
(58) il
3 GUMMAK Son Male Nil DAILY 471846560557
ONDA WAGES
subrmanaya LABOUR/N
m(30) il
4 GUMMAK Daughter in Female Nil DAILY 476782027224
ONDA Law WAGES
shyamalamm LABOUR/N
a(29) il
5 GUMMAK Grand Son Male Nil Nil/Nil 393873640216
ONDA
mahesh(7)
6 GUMMAK Grand Son Male Nil DAILY 985447707238
ONDA WAGES
rakesh(10) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.05 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219762/000

Household Verification Format Door No:6-24/A,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband PENTAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUMMA Self Male Nil Nil/Nil 955514464661
KONDA
KONDAIA
H(44)
2 GUMMA Wife Female Nil Nil/Nil 341487488682
KONDA
CHUKAMM
A(33)
3 GUMMA Son Male Nil Nil/Nil 980515974673
KONDA
ARUNKUM
AR(3)
4 GUMMA Daughter Female Nil Nil/Nil 620895033814
KONDA
GIRIJA(3)
5 GUMMA Brother Male Nil Nil/Nil 899754527308
KONDA
PARUSHUR
AM(40)
6 GUMMA Sister in Law Female Nil Nil/Nil
KONDA
SHARADA(
23)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219763/000

Household Verification Format Door No:6-25,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband HANUMANTHU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUMMAK Self Female Nil DO 596518400406
ONDA NOTHING/
LAKSHMA Nil
MMA(61)
2 GUMMAK Sister Female Nil DAILY 481693605228
ONDA BAL WAGES
CHANDRA LABOUR/N
MMA(55) il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:5.35 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219764/000

Household Verification Format Door No:9000977173,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband CHENAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GATTUKA Self Male Nil Nil/Nil 852863690521
DI
MANYAM(
65)
2 GATTUKA Wife Female Nil Nil/Nil 244897718240
DI
MUTHYAL
AMMA(60)
3 GATTUKA Son Male Nil Nil/Nil 975622203899
DI
GANESH(2
7)
4 GATTUKA Son Male Nil Nil/Nil 583461484292
DI
KRISHNA(3
8)
5 GATTUKA Son Male Nil Nil/Nil 999123409786
DI
RAMESH(1
7)
6 GATTUKA Daughter in Female Nil Nil/Nil 941438358119
DI Law
RENUKA(3
0)
7 GATTUKA Mother Female Nil Nil/Nil
DI
USHAMMA
(85)
8 GATTUKA Grand Son Male Nil Nil/Nil 594779895609
DI
VARUNTEJ
(5)
9 GATTUKA Grand Female Nil Nil/Nil 349067913747
DI Daughter
SOMESHW
ARI(7)
10 GATTUKA Grand Female Nil Nil/Nil
DI Daughter
CHANDAN
A(0)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.28 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:
Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219765/000

Household Verification Format Door No:6-26/1,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband CHENAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GATTU Self Female Nil Nil/Nil 863992610199
KADI
MASAMM
A(61)
2 GATTU Grand Female Nil Nil/Nil 686097815117
KADI Daughter
BANGARI(
11)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219766/000

Household Verification Format Door No:6-29,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband CHINNAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUMMAK Self Male Nil Nil/Nil 271236916705
ONDA
NARASIMH
A(60)
2 GUMMAK Daughter Female Nil Nil/Nil
ONDA
LAKSHMI(
22)
3 GUMMAK Son in Law Male Nil Nil/Nil
ONDA
SRINU(23)
4 GUMMAK Grand Female Nil Nil/Nil
ONDA Daughter
BLESI(3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.45 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219767/000

Household Verification Format Door No:0,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband CHENNAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GATTUKA Self Male Nil Nil/Nil 313225240656
DI
THIRUPAT
HAMMA(50
)
2 GATTUKA Wife Female Nil Nil/Nil 212299039016
DI
SHANTHA
MMA(45)
3 GATTUKA Son Male Nil Nil/Nil
DI
SHIVAIAH(
1)
4 GATTUKA Son Male Nil Nil/Nil 369802391995
DI
CHENNAIA
H(13)
5 GATTUKA Daughter Female Nil Nil/Nil 876826343696
DI
CHENNAM
MA(12)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219771/000

Household Verification Format Door No:6-28,sc

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband THIMMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUMMAK Self Male Nil AGRICULT 409083802538
ONDA URE
RAMULU(4 LABOUR
1) /Nil
2 GUMMAK Wife Female Nil Nil/Nil 255392039720
ONDA
BHUSHAM
MA(30)
3 GUMMAK Daughter Female Nil Nil/Nil 874432489330
ONDA
NAGAMM
A(12)
4 GUMMAK Daughter Female Nil Nil/Nil 209596532615
ONDA
NANDINI(8
)
5 GUMMAK Daughter Female Nil Nil/Nil 360750741947
ONDA
RENUKA(1
0)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:12.08 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed YES
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219772/000

Household Verification Format Door No:6-28/1,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SAYANNA Gas YES/HP/617734
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KINNERA Self Male Nil PRESENTL 221489416237
KRISHNAI Y
AH(63)PWD WORKING
:Y& BARBOUR/
Sadaran Nil
No:3643
2 KINNERA Wife Female Nil Nil/Nil 933288148459
LAXMIDEV
AMMA(60)
3 KINNERA Son Male Nil Nil/Nil 623945957263
DANUPRS
ASAD(10)
4 KINNERA Son Male Nil Nil/Nil 495698435199
SAI
KUMAR(12
)
5 KINNERA Daughter Female Nil PSU 367086468114
VASANTH Employee/Ni
A(31) l
6 KINNERA Son in Law Male Nil Nil/Nil 746259634601
RAJU(42)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0.15 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219773/000

Household Verification Format Door No:6-30,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband CHENNAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GATTUKA Self Male Nil AGRICULT 404114472394
DI URE
VENKATAI LABOUR
H(63) /Nil
2 GATTUKA Wife Female Nil Nil/Nil 800086201759
DI
KASHAMM
A(33)
3 GATTUKA Son Male Nil Nil/Nil 224999321729
DI
THIRUPAT
HAIAH(5)
4 GATTUKA Son Male Nil Nil/Nil 914724912584
DI
NAGARAJ
U(10)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.92 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219774/000

Household Verification Format Door No:6-36,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband CHENNAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GATTUKA Self Male Nil AGRICULT 453583364068
DI URE
MANNEMA LABOUR
IAH(60) /Nil
2 GATTUKA Wife Female Nil AGRICULT
DI URE
PENTAMM LABOUR
A(55) /Nil
3 GATTUKA Daughter Female Nil AGRICULT
DI URE
MANEMM LABOUR
A(35) /Nil
4 GATTUKA Son in Law Male Nil AGRICULT
DI URE
YELLAIAH LABOUR
(40) /Nil
5 GATTUKA Grand Son Male Nil Nil/Nil
DI
NARESH(11
)
6 GATTUKA Grand Son Male Nil AGRICULT
DI URE
RAMULU(1 LABOUR
6) /Nil
7 GATTUKA Grand Female Nil AGRICULT 978369797233
DI Daughter URE
YELLAMM LABOUR
A(19) /Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.95 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219775/000

Household Verification Format Door No:6-32,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband CHENNAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GATTUKA Self Male Nil AGRICULT 711126388857
ADI URE
NAGAIAH( LABOUR
55) /Nil
2 GATTUKA Wife Female Nil AGRICULT 795942892455
ADI URE
NAGAMM LABOUR
A(53) /Nil
3 GATTUKA Son Male Nil AGRICULT 527172802217
ADI URE
VENKATAI LABOUR
H(28) /Nil
4 GATTUKA Daughter in Female Nil AGRICULT 704753882942
ADI Law URE
ALIVELU(1 LABOUR
8) /Nil
5 GATTUKA Grand Son Male Nil Nil/Nil 517455259899
ADI
HAREESH(
4)
6 GATTUKA Grand Son Male Nil Nil/Nil 364956293359
ADI
NANDU(2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.95 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219776/000

Household Verification Format Door No:0,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband CHENNAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GATTUKA Self Male Nil AGRICULT 586710926082
DI URE
SHANTHAI LABOUR
AH(48) /Nil
2 GATTUKA Son Male Nil AGRICULT 899996256318
DI URE
RAMULU(2 LABOUR
1) /Nil
3 GATTUKA Daughter Female Nil AGRICULT
DI URE
ANJAMMA LABOUR
(27) /Nil
4 GATTUKA Daughter Female Nil Nil/Nil 605907616390
DI
NAGAMM
A(15)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.92 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219777/000

Household Verification Format Door No:6-47,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband LAXMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MIDDE Self Male Nil DAILY
RAMCHAN WAGES
DRAIAH(38 LABOUR/N
) il
2 MIDDE Wife Female Nil AGRICULT 707769624922
CHENNAM URE
MA(32) LABOUR
/Nil
3 MIDDE Son Male Nil DAILY 758895293519
NAVEEN WAGES
KUMAR(11 LABOUR/N
) il
4 MIDDE Daughter Female Nil Nil/Nil 436109325553
SOUMYA(8
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219778/000

Household Verification Format Door No:6-48,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband LAXMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MIDDE Self Male Nil AGRICULT 318315711000
BALAIAH(4 URE
8) LABOUR
/Nil
2 MIDDE Wife Female Nil AGRICULT 245178322046
YELLAMM URE
A(41) LABOUR
/Nil
3 MIDDE Son Male Nil DRIVERS/N 855739830788
KARUNAK il
AR(23)
4 MIDDE Mother Female Nil Nil/Nil 252369981574
CHANDRA
MMA(53)
5 MIDDE Brother Male Nil Nil/Nil 877351258176
MUNEEND
AR(43)PWD
:Y&
Sadaran
No:1418939
0140113045
6 MIDDE Brother Male Nil AGRICULT 990771114192
RAMULU(3 URE
8) LABOUR
/Nil
7 MIDDE Sister in Law Female Nil AGRICULT 521394256872
BHUSHAM URE
MA(33) LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.55 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219779/000

Household Verification Format Door No:6-48/1,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband KRISHNAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MIDDE Self Female Nil AGRICULT 907133546804
ANJANAM URE
MA(56) LABOUR
/Nil
2 MIDDE Daughter Female Nil AGRICULT 824721376372
RAMULAM URE
MA(16) LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219780/000

Household Verification Format Door No:6-52,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband POCHANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GATTUKK Self Male Nil AGRICULT 541549386542
ADI URE
KONDAIA LABOUR
H(63)PWD: /Nil
Y & Sadaran
No: Nil
2 GATTUKK Wife Female Nil AGRICULT 925314910011
ADI URE
KANTHAM LABOUR
MA(53) /Nil
3 GATTUKK Son Male Nil AGRICULT
ADI URE
NAGARAJ LABOUR
U(32) /Nil
4 GATTUKK Son Male Nil Nil/Nil 980543907765
ADI
SHEKAR(26
)
5 GATTUKK Daughter in Female Nil AGRICULT
ADI Law URE
NAGAMM LABOUR
A(27) /Nil
6 GATTUKK Grand Son Male Nil Nil/Nil
ADI
CHARAN(7
)
7 GATTUKK Grand Female Nil Nil/Nil
ADI Daughter
PALLAVI(5
)
8 GATTUKK Grand Female Nil Nil/Nil
ADI Daughter
SALOMI(10
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.42 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219781/000

Household Verification Format Door No:6-56,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband POCHANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GATTUKA Self Male Nil AGRICULT 459103899950
DI URE
SHANTHAI LABOUR
AH(55)PWD /Nil
:Y&
Sadaran No:
Nil
2 GATTUKA Wife Female Nil AGRICULT 760073517112
DI URE
BALAMMA LABOUR
(48) /Nil
3 GATTUKA Son Male Nil Nil/Nil 207128159077
DI
RAMMURT
HY(22)
4 GATTUKA Son Male Nil AGRICULT 538229746125
DI URE
VENKATAI LABOUR
AH(33) /Nil
5 GATTUKA Daughter in Female Nil AGRICULT 819771027539
DI Law URE
SUBANAM LABOUR
MA(28) /Nil
6 GATTUKA Grand Son Male Nil Nil/Nil 961839279211
DI
NAGARAJ
U(11)
7 GATTUKA Grand Female Nil Nil/Nil 281715730958
DI Daughter
AMRURHA
(2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.75 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219782/000

Household Verification Format Door No:6-56/1,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband POSHANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GATTUKA Self Male Nil AGRICULT 785764441648
ADI URE
CHINNA LABOUR
BALAIAH(6 /Nil
6)
2 GATTUKA Wife Female Nil AGRICULT 464277105150
ADI URE
MANEMM LABOUR
A(56) /Nil
3 GATTUKA Son Male Nil AGRICULT 957720329596
ADI URE
SREENIVA LABOUR
SULU(28) /Nil
4 GATTUKA Daughter in Female Nil AGRICULT 912165363972
ADI Law URE
NAGAMAN LABOUR
I(24) /Nil
5 GATTUKA Grand Female Nil AGRICULT
ADI Daughter URE
HARSHITH LABOUR
A(1) /Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.9 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219783/000

Household Verification Format Door No:6-58,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband VENKATAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAM Self Male Nil AGRICULT 826249709354
SREENU(27 URE
) LABOUR
/Nil
2 GADDAM Wife Female Nil AGRICULT 979674725296
SHIVAMM URE
A(25) LABOUR
/Nil
3 GADDAM Son Male Nil Nil/Nil 254036903535
ABHISHEK
(4)
4 GADDAM Daughter Female Nil Nil/Nil 976785678678
PATHRIRU
PA(2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219784/000

Household Verification Format Door No:6-55,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband VENKANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GATTUKA Self Male Nil AGRICULT 371501484464
DI URE
CHANDRAI LABOUR
AH(38)PWD /Nil
:Y&
Sadaran
No:1418939
0140113024
2 GATTUKA Wife Female Nil Nil/Nil 701530020281
DI
SHESHAM
MA(31)
3 GATTUKA Son Male Nil Nil/Nil 477260874690
DI
NAGARAJ
U(5)
4 GATTUKA Son Male Nil Nil/Nil 956499733611
DI
MAHESH(2
)
5 GATTUKA Daughter Female Nil Nil/Nil
DI UMA(8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.82 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219785/000

Household Verification Format Door No:6-54,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband VENKANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GATTUKA Self Male Nil AGRICULT 894278887919
DI URE
MANNEM( LABOUR
43) /Nil
2 GATTUKA Wife Female Nil AGRICULT 966927182328
DI URE
VENKATA LABOUR
MMA(49) /Nil
3 GATTUKA Daughter Female Nil Nil/Nil 903677813664
DI
NAVYA(14)
4 GATTUKA Daughter Female Nil Nil/Nil 294757576731
DI
BAGHYA(2
1)
5 GATTUKA Mother Female Nil AGRICULT
DI URE
BALAMMA LABOUR
(59) /Nil
6 GATTUKA Father Male Nil AGRICULT 664871059855
DI URE
VENKANN LABOUR
A(63) /Nil
7 GATTUKA Brother Male Nil AGRICULT 856403292330
DI URE
VENKATAI LABOUR
AH(41) /Nil
8 GATTUKA Sister in Law Female Nil Nil/Nil 314307769080
DI
GOURAMM
A(36)
9 GATTUKA Sister in Law Female Nil Nil/Nil
DI
NAGAMM
A(32)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.88 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219786/000

Household Verification Format Door No:6-53,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband BALAIAH Gas YES/HP/617333
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GATTUKA Self Female Nil AGRICULT 328307446048
ADI URE
BAGYAMM LABOUR
A(58) /Nil
2 GATTUKA Son Male Nil Nil/Nil 370969395864
ADI
venkataiah(3
3)
3 GATTUKA Son Male Nil Nil/Nil 954334819222
ADI
NAGENDA
R(22)
4 GATTUKA Daughter in Female Nil Nil/Nil 565810732581
ADI Law
renuka(31)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.92 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219787/000

Household Verification Format Door No:6-37,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GATTUKA Self Male Nil AGRICULT 975931900439
DI URE
KONDAIA LABOUR
H(63) /Nil
2 GATTUKA Wife Female Nil AGRICULT 408139809512
DI URE
BAKKAMM LABOUR
A(61) /Nil
3 GATTUKA Son Male Nil Nil/Nil 748022211546
DI
SREEKANT
H(25)
4 GATTUKA Son Male Nil AGRICULT
DI URE
MANUPRA LABOUR
KASH(27) /Nil
5 GATTUKA Son Male Nil AGRICULT 330285876590
DI URE
RAJU(35) LABOUR
/Nil
6 GATTUKA Daughter in Female Nil Nil/Nil 720553924691
DI Law
JYOTHI(22)
7 GATTUKA Daughter in Female Nil AGRICULT 307798262719
DI Law URE
NARSAMM LABOUR
A(33) /Nil
8 GATTUKA Grand Son Male Nil Nil/Nil 668904967589
DI
AKHIL(7)
9 GATTUKA Grand Son Male Nil Nil/Nil 811671200401
DI
HARISH(8)
10 GATTUKA Grand Male Nil Nil/Nil 511269462627
DI BESLI(3) Daughter

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.65 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219788/000

Household Verification Format Door No:6-28,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband CHENNAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GATTUKA Self Male Nil AGRICULT 705012872400
ADI URE
RAMULU(3 LABOUR
3) /Nil
2 GATTUKA Wife Female Nil AGRICULT 592955491272
ADI URE
SHANTHA LABOUR
MMA(33) /Nil
3 GATTUKA Son Male Nil AGRICULT 982852747165
ADI URE
SHIVAKU LABOUR
MAR(18) /Nil
4 GATTUKA Daughter Female Nil AGRICULT 901125174547
ADI URE
RENUKA(1 LABOUR
4) /Nil
5 GATTUKA Daughter Female Nil Nil/Nil
ADI
SHYAMAL
A(7)
6 GATTUKA Daughter Female Nil Nil/Nil 379907010963
ADI
BHARATHI
(3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219789/000

Household Verification Format Door No:6-35,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband CHINNAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUMMAK Self Male Nil Nil/Nil 384018941903
ONDA
DAKARAIA
H(46)
2 GUMMAK Wife Female Nil Nil/Nil 226343130991
ONDA
YADAMM
A(41)
3 GUMMAK Son Male Nil Nil/Nil 757350473471
ONDA
BHASKAR(
14)
4 GUMMAK Son Male Nil Nil/Nil 352801878538
ONDA
CHANDRA
KUMAR(20
)
5 GUMMAK Son Male Nil Nil/Nil 867488603451
ONDA
MAHESH(1
6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.75 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219790/000

Household Verification Format Door No:6-34,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband CHINNAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUMMAK Self Male Nil AGRICULT 433773709471
ONDA URE
LAXMAIA LABOUR
H(51) /Nil
2 GUMMAK Wife Female Nil AGRICULT 685749605284
ONDA URE
SHANTHA LABOUR
MMA(43) /Nil
3 GUMMAK Son Male Nil Nil/Nil
ONDA
PARAMES
H(20)
4 GUMMAK Daughter Female Nil Nil/Nil 809131781900
ONDA
CHANDAN
A(12)
5 GUMMAK Daughter Female Nil Nil/Nil 870926897073
ONDA
VIJITHA(17
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.48 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219791/000

Household Verification Format Door No:6-11,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband MANNEMAIAH Gas YES/HP/630728
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUMMAK Self Male Nil OTHERS(P 646965790942
ONDA ROVIDE
NAGAIAH( DETAILS)/
41) Nil
2 GUMMAK Wife Female Nil Nil/Nil 718715883607
ONDA
MANEMM
A(38)
3 GUMMAK Son Male Nil Nil/Nil 726163606665
ONDA
MAHESH(1
6)
4 GUMMAK Son Male Nil Nil/Nil 275278198977
ONDA
RAMESH(2
1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219792/000

Household Verification Format Door No:6-17,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband LAXMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUMMAK Self Male Nil AGRICULT 558740132076
ONDA URE
VENKATAI LABOUR
AH(48) /Nil
2 GUMMAK Wife Female Nil AGRICULT
ONDA URE
NARSAMM LABOUR
A(40) /Nil
3 GUMMAK Son Male Nil AGRICULT 455680349598
ONDA URE
BANGARAI LABOUR
AH(25) /Nil
4 GUMMAK Son Male Nil AGRICULT 241856599226
ONDA URE
PARSHURA LABOUR
MULU(11) /Nil
5 GUMMAK Daughter in Female Nil AGRICULT 837901585664
ONDA Law URE
BEEMAMM LABOUR
A(23) /Nil
6 GUMMAK Son in Law Male Nil Nil/Nil
ONDA
SHIVAKU
MAR(1)
7 GUMMAK Mother Female Nil AGRICULT 901282570665
ONDA URE
PENTAMM LABOUR
A(68) /Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219793/000

Household Verification Format Door No:6-16,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUMMAK Self Male Nil AGRICULT 227528290331
ONDA URE
RAMULU(4 LABOUR
3)PWD: Y & /Nil
Sadaran
No:1418939
0140113065
2 GUMMAK Wife Female Nil AGRICULT 414829947925
ONDA URE
AKKAMM LABOUR
A(38) /Nil
3 GUMMAK Son Male Nil Nil/Nil 723407034999
ONDA
MAHESH(1
7)
4 GUMMAK Son Male Nil Nil/Nil 538845439254
ONDA
SURESH(23
)
5 GUMMAK Daughter Female Nil Nil/Nil 938967083210
ONDA
SUVARNA(
15)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.25 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219794/000

Household Verification Format Door No:6-15,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUMMAK Self Male Nil AGRICULT 971223092495
ONDA URE
BALAIAH(6 LABOUR
3) /Nil
2 GUMMAK Wife Female Nil AGRICULT 408139740916
ONDA URE
ANJAMMA LABOUR
(25) /Nil
3 GUMMAK Wife Female Nil AGRICULT 248245473053
ONDA URE
BARAMMA LABOUR
(58) /Nil
4 GUMMAK Son Male Nil Nil/Nil 792525766438
ONDA
SREENU(7)
5 GUMMAK Son Male Nil AGRICULT
ONDA URE
VENKATAI LABOUR
AH(33) /Nil
6 GUMMAK Daughter Female Nil Nil/Nil 543239094915
ONDA
GOUTHAM
I(6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:3.62 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0219795/000

Household Verification Format Door No:6-10,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband MANNEMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUMMAK Self Male Nil AGRICULT 253702823882
ONDA URE
VENKATAI LABOUR
H(36) /Nil
2 GUMMAK Wife Female Nil AGRICULT
ONDA URE
YESAMMA LABOUR
(26) /Nil
3 GUMMAK Son Male Nil Nil/Nil 793420110395
ONDA
BHARATH(
5)
4 GUMMAK Son Male Nil Nil/Nil 588179077148
ONDA
MOHAN(11
)
5 GUMMAK Son Male Nil Nil/Nil 764752170067
ONDA
PRAVEEN(
10)
6 GUMMAK Daughter Female Nil Nil/Nil
ONDA
LADDU(7)
7 GUMMAK Daughter Female Nil Nil/Nil 493211503191
ONDA
RANI(12)
8 GUMMAK Brother Male Nil AGRICULT 706945158200
ONDA URE
BHUCHAIA LABOUR
H(38) /Nil
9 GUMMAK Sister in Law Female Nil AGRICULT
ONDA URE
PADMA(28) LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0271922/002

Household Verification Format Door No:13-44,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 CHANDI(6) Self Female Nil Nil/Nil
2 PUTNI(38) Husband Male Nil Nil/Nil
3 RAJESH(9) Son Male Nil Nil/Nil
4 SRIRAM(1) Son Male Nil Nil/Nil
5 Son Male Nil Nil/Nil
PRAKASH(
10)
6 SAKRI(25) Son Male Nil Nil/Nil 998747485554

7 SAIRAM(6) Daughter Female Nil Nil/Nil

8 SHALI(9) Daughter Female Nil Nil/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0271923/002

Household Verification Format Door No:13-57,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband SAKRI Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATLAVA Self Male Nil Nil/Nil 679269524516
TH
HANMANT
HU(28)
2 RATLAVA Wife Female Nil Nil/Nil 962363116141
TH
SHANTHI(2
6)
3 RATLAVA Son Male Nil Nil/Nil
TH
MAHESH(5
)
4 RATLAVA Daughter Female Nil Nil/Nil
TH SHIRI(7)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0311951/000

Household Verification Format Door No:1-83,99

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband appaih Gas YES/HP/603961
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 virivinti v Self Male Nil DO 216876263701
madangopal NOTHING/
sharma(64) Nil
2 virivinti v Wife Female Nil OTHERS(P 511971036202
sharada(54) ROVIDE
DETAILS)/
Nil
3 virivinti Son Male Nil Nil/Nil 237636017006
raghavendras
harma(27)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0313516/002

Household Verification Format Door No:2-18,gollageri

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband balaiah Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 bakka Self Male Nil OWN 353634193930
bakkaraju(28 AGRICULT
) URE
/Nil
2 bakka Husband Female Nil DAILY 926825827084
bagyamma(2 WAGES
9) LABOUR/N
il
3 bakka Daughter Female Nil STUDENT/ 963586543738
manjula(4) Nil

4 bakka Daughter Female Nil STUDENT/ 435325969504

nandini(5) Nil

5 bakka bakka Mother Female Nil DO 856318938366

chennamma( NOTHING/
78) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.65 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317410/000

Household Verification Format Door No:99,BORANGADDA TANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband PERU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MADNATH Self Male Nil Nil/Nil 340023634844
RAMULU(5
0)
2 MADNATH Wife Female Nil Nil/Nil
JAMINI(40)
3 MADNATH Son Male Nil Nil/Nil
PERU(9)
4 MADNATH Son Male Nil Nil/Nil
VIJAY
KUMAR(18
)
5 MADNATH Daughter Female Nil Nil/Nil
GOURADH
A(14)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317431/000

Household Verification Format Door No:12-38,eppathanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband pheer Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 moodavath Self Male Nil Nil/Nil 816681488229
moodavathra
mulu(55)
2 moodavath Wife Female Nil Nil/Nil 340023634844
m jemini(52)

3 moodavath Son Male Nil Nil/Nil

m
pheeru(11)
4 moodavath Son Male Nil Nil/Nil 846402544840
m gopal(47)

5 moodavath Son Male Nil Nil/Nil 530999632091

m
vijayakumar(
20)
6 moodavath Daughter Female Nil Nil/Nil 600517564099
m
sharadha(25)
7 moodavath Daughter in Female Nil Nil/Nil
m vijaya(38) Law
8 moodavath Grand Female Nil Nil/Nil 505462969951
m Daughter
swapna(30)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317462/000

Household Verification Format Door No:13-79,DAKUNTA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband DHANSING Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATGIVAT Self Male Nil Nil/Nil 299418251226
H
LACHI(62)
2 RATGIVAT Wife Female Nil Nil/Nil
H
THANTRI(5
8)
3 RATGIVAT Son Male Nil Nil/Nil 449411945168
H
MIDHYA(1
4)
4 RATGIVAT Son Male Nil Nil/Nil 838068351185
H
SRINU(34)
5 RATGIVAT Son Male Nil Nil/Nil 274622733963
H
PHIRU(38)
6 RATGIVAT Daughter Female Nil Nil/Nil 823256838683
H ANJI(28)

7 RATGIVAT Daughter in Female Nil Nil/Nil 439628479454

H ANJI(31) Law

8 RATGIVAT Daughter in Female Nil Nil/Nil 205230233709

H Law
JAMUNA(3
5)
9 RATGIVAT Daughter in Female Nil Nil/Nil 790628172832
H Law
MANEMM
A(30)
10 RATGIVAT Grand Son Male Nil Nil/Nil
H
SAIKUMAR
(7)
11 RATGIVAT Grand Son Male Nil Nil/Nil
H SRINU(7)
12 RATGIVAT Grand Son Male Nil Nil/Nil
H
HARIBHAI(
9)
13 RATGIVAT Grand Son Male Nil Nil/Nil 307616458117
H
RAVIKUM
AR(15)
14 RATGIVAT Grand Son Male Nil Nil/Nil 318622347591
H
RAMCHAR
AN(7)
15 RATGIVAT Grand Female Nil Nil/Nil
H Daughter
SHYLAJA(1
1)
16 RATGIVAT Grand Female Nil Nil/Nil
H Daughter
SHIRESHA(
11)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:4.58/DRY:2.1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317731/000

Household Verification Format Door No:9-79,jaganathanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband parsha Gas YES/HP/640139
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 rathaluvathu Self Male Nil DAILY 284788928234
pulyya(43) WAGES
LABOUR/N
il
2 rathaluvathu Wife Male Nil AGRICULT 318825963668
jijajali(28) URE
LABOUR
/Nil
3 rathaluvathu Son Male Nil DAILY 791786514235
madhu(17) WAGES
LABOUR/N
il
4 rathaluvathu Daughter Female Nil DAILY
sunitha(19) WAGES
LABOUR/N
il
5 rathaluvathu Mother Female Nil DAILY 524149580268
lali(81) WAGES
LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317732/000

Household Verification Format Door No:9-80,JAGNATHANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband CHINYYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATHLAV Self Male Nil MIGRATED 483774280422
ATHU LABOUR/N
laxman(28) il
2 RATHLAV Wife Female Nil MIGRATED 986712901721
ATHU LABOUR/N
LAXMI(24) il
3 RATHLAV Son Male Nil STUDENT/ 322556687078
ATHU Nil
GANESHE(
6)
4 RATHLAV Daughter Female Nil DO
ATHU NOTHING/
ANISHA(4) Nil
5 RATHLAV Daughter Female Nil STUDENT/ 784056225023
ATHU Nil
SHERISHA(
10)
6 RATHLAV Daughter Female Nil STUDENT/ 610403598396
ATHU Nil
SHANTHI(7
)
7 RATHLAV Daughter Female Nil STUDENT/ 755916742215
ATHU Nil
RENUKA(8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317733/000

Household Verification Format Door No:9-81,jagnathanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband CHINYYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 rathalavathu Self Male Nil MIGRATED 314589759306
BALU(39) LABOUR/N
il
2 rathalavathu Wife Female Nil MIGRATED 937275330519
MARONI(3 LABOUR/N
1) il
3 rathalavathu Son Male Nil DO 220842740995
VINOD(11) NOTHING/
Nil
4 rathalavathu Daughter Female Nil STUDENT/ 289143461476
JOTHYE(12 Nil
)
5 rathalavathu Daughter Female Nil MIGRATED 249237906382
BHARATR LABOUR/N
HI(15) il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:10.38 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317734/000

Household Verification Format Door No:9-82,JAGNNATHANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband LOBYYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATHALA Self Male Nil Nil/Nil 921056285062
VATHU
RAJU(26)
2 RATHALA Wife Female Nil Nil/Nil 284606958136
VATHU
KAMALAM
MA(22)
3 RATHALA Son Male Nil Nil/Nil
VATHU
CHERAN(1)
4 RATHALA Daughter Female Nil Nil/Nil 805184040472
VATHU
SOUJANYY
A(3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317735/000

Household Verification Format Door No:9-83,UDUGULAKUNTA THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband THARU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil OWN 212747034096
HU AGRICULT
HIRALALL URE
U(43) /Nil
2 MUDAVAT Wife Female Nil OWN 223569649610
HU AGRICULT
ASHAMMA URE
(37) /Nil
3 MUDAVAT Son Male Nil STUDENT/ 515557124066
HU Nil
VISHALKU
MAR(15)
4 MUDAVAT Son Male Nil STUDENT/
HU Nil
PAVAN(17)
5 MUDAVAT Daughter Female Nil DO 814914463229
HU NOTHING/
JAMMUNA Nil
(21)
6 MUDAVAT Daughter Female Nil STUDENT/ 517453463106
HU Nil
SUJATHA(2
0)
7 MUDAVAT Daughter Female Nil DO
HU NOTHING/
VIJAYA(25) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0.5/DRY:3.75 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317736/000

Household Verification Format Door No:9-83/1,UDUGULAKUNTA THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband THARU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil OTHERS(P 720474311081
HU ROVIDE
PEERU(50) DETAILS)/
Nil
2 MUDAVAT Wife Female Nil HOUSE 316875121141
HU WIFE/Nil
NIRAMAL
A(47)
3 MUDAVAT Son Male Nil STUDENT/ 484319879494
HU Nil
SRINIVAS(
22)
4 MUDAVAT Daughter Male Nil STUDENT/ 857675158111
HU Nil
SWATHI(25
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:7.88 WET/ID:____/DRY____:
3 4 Wheeler owners YES
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317737/000

Household Verification Format Door No:9-83/2,UDUGULAKUNTA THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband THARU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Female Nil DO 773039824921
HU NOTHING/
LAXMI(66) Nil
2 MUDAVAT Grand Female Nil OTHERS(P 838685668097
HU Daughter ROVIDE
BHARATHI DETAILS)/
(33) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:2.78/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317738/000

Household Verification Format Door No:9-84,UDUGULAKUNTA THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband THARU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil OTHERS(P 930212156199
HU ROVIDE
BALU(42) DETAILS)/
Nil
2 MUDAVAT Wife Male Nil HOUSE 714663622509
HU WIFE/Nil
SHANTHI(3
6)
3 MUDAVAT Son Male Nil STUDENT/ 921590108754
HU Nil
ARAVINDH
U(16)
4 MUDAVAT Daughter Male Nil STUDENT/ 785311668871
HU Nil
BHAVYA
SRI(11)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:1.05/DRY:3.72 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317739/000

Household Verification Format Door No:9-85,UDUGULAKUNTATHANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband THARU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil OWN 310882894493
HU AGRICULT
JANGEER(3 URE
8) /Nil
2 MUDAVAT Wife Female Nil OWN
HU AGRICULT
SEETHA(30 URE
) /Nil
3 MUDAVAT Son Male Nil STUDENT/ 434915604512
HU Nil
SRINATHU
(20)
4 MUDAVAT Son Male Nil STUDENT/
HU Nil
VIJAYE(12)
5 MUDAVAT Daughter Female Nil STUDENT/
HU Nil
BINDHU(18
)
6 MUDAVAT Mother Female Nil DO 907722899194
HU NOTHING/
RATHANM Nil
MA(68)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:3.05/DRY:3.85 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317740/000

Household Verification Format Door No:9-86,UDUGULLAKUNTA THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband DASU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KODAVAT Self Male Nil DAILY 940801917238
HU WAGES
JHANU(34) LABOUR/N
il
2 KODAVAT Wife Female Nil AGRICULT 510311302737
HU URE
MASRRI(30 LABOUR
) /Nil
3 KODAVAT Son Male Nil STUDENT/
HU Nil
SUNIL(12)
4 KODAVAT Son Male Nil STUDENT/ 662341136414
HU Nil
SANTHOSH
(9)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317741/000

Household Verification Format Door No:9-87,UDUGULAKLUNTA THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband PATYYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KODAVAT Self Male Nil AGRICULT 285945313312
HU URE
DASU(65) LABOUR
/Nil
2 KODAVAT Wife Female Nil AGRICULT 630321244108
HU URE
SUVALI(58) LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0.72/DRY:2.52 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317835/000

Household Verification Format Door No:10-65,1

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband balu Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 katravath Self Male Nil OWN 857342070558
hanmanth(33 AGRICULT
) URE
/Nil
2 katravath Wife Female Nil OWN 820166185178
sitha(30) AGRICULT
URE
/Nil
3 katravath Son Male Nil Nil/Nil 683089464091
srinu(5)

4 katravath Son Male Nil Nil/Nil 704912573865

sunith(5)

5 katravath Daughter Female Nil Nil/Nil 986731755037

akhila(11)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.28 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317836/000

Household Verification Format Door No:10-66,1

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband balu Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 katravath Self Male Nil OWN 758755441359
thirupathi(45 AGRICULT
) URE
/Nil
2 katravath Wife Female Nil OWN 483412420544
chavli(44) AGRICULT
URE
/Nil
3 katravath Daughter Female Nil Nil/Nil 329227964885
sharada(9)

4 katravath Daughter Female Nil Nil/Nil 815047195745

shanthi(16)

5 katravath Daughter in Male Nil Nil/Nil 926077959272

babu(12) Law

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.28 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317837/000

Household Verification Format Door No:10-67,1

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband badram Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 katravath Self Male Nil OWN 678548954136
devoji(40) AGRICULT
URE
/Nil
2 katravath Wife Female Nil OWN 216963131061
ramani(38) AGRICULT
URE
/Nil
3 katravath Son Male Nil Nil/Nil 534192898199
malesh(9)

4 katravath Son Male Nil Nil/Nil

ramesh(15)
5 katravath Daughter Female Nil Nil/Nil
jyothi(14)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.62 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317838/000

Household Verification Format Door No:10-68,1

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband balu Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 katravath Self Female Nil OWN 542393321430
hemlam(63) AGRICULT
URE
/Nil
2 katravath Son Male Nil DRIVERS/N 471276794997
perum(29) il

3 katravath Son Male Nil OWN 759285221679

baskar(25) AGRICULT
URE
/Nil
4 katravath Daughter in Female Nil HOUSE 456875605334
lali(27) Law WIFE/Nil

5 katravath Daughter in Female Nil OWN 762883895366

masuri(23) Law AGRICULT
URE
/Nil
6 katravath Grand Son Male Nil Nil/Nil
srinad(2)
7 katravath Grand Son Male Nil Nil/Nil 411564959368
saikumar(6)

8 katravath Grand Female Nil Nil/Nil

papy(1) Daughter
9 katravath Grand Female Nil Nil/Nil 365985110293
sandya(3) Daughter

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.32 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317839/000

Household Verification Format Door No:10-69,1

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband dansing Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 katravath Self Male Nil OWN 279261069662
vasya(71) AGRICULT
URE
/Nil
2 katravath Wife Female Nil OWN 265392613254
kesli(63) AGRICULT
URE
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.38 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317840/000

Household Verification Format Door No:10-72,1

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband budiya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mogavath Self Female Nil OWN 430408912604
laxmi(73) AGRICULT
URE
/Nil
2 mogavath Son Male Nil OWN 202638934576
ramulu(49) AGRICULT
URE
/Nil
3 mogavath Son Male Nil OWN 374364056111
perum(28) AGRICULT
URE
/Nil
4 mogavath Son Male Nil OWN 744061621587
pandu(28) AGRICULT
URE
/Nil
5 mogavath Daughter in Female Nil OWN 679620675454
chandi(27) Law AGRICULT
URE
/Nil
6 mogavath Daughter in Female Nil OWN 544142626510
jamrim(40) Law AGRICULT
URE
/Nil
7 mogavath Daughter in Female Nil OWN
shanthi(25) Law AGRICULT
URE
/Nil
8 mogavath Grand Son Male Nil Nil/Nil 282086640482
arun(7)

9 mogavath Grand Son Male Nil Nil/Nil 678997163089

babu(14)

10 mogavath Grand Son Male Nil Nil/Nil 640761315202

chinna(11)

11 mogavath Grand Son Male Nil Nil/Nil 913215770304

srinu(16)

12 mogavath Grand Female Nil Nil/Nil 279907807829

jyothi(8) Daughter

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL
Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317841/000

Household Verification Format Door No:10-71,1

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband lachiray Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 eslavath Self Male Nil DAILY 383326563421
girya(73) WAGES
LABOUR/N
il
2 eslavath Wife Female Nil DAILY 513753236719
heramma(67 WAGES
) LABOUR/N
il
3 eslavath Son Male Nil DAILY
prum(26) WAGES
LABOUR/N
il
4 eslavath Daughter in Female Nil DAILY 986274248102
parvathamm Law WAGES
a(25) LABOUR/N
il
5 eslavath Grand Son Male Nil Nil/Nil
babu(1)
6 eslavath Grand Female Nil Nil/Nil 666907126134
alekya(4) Daughter

7 eslavath Sister in Law Male Nil Nil/Nil 601250052197

ganesh(7)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317842/000

Household Verification Format Door No:10-72,1

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband thulbba Gas YES/Bharath/5708637
Name Connection(Y/N)/Agen./ 7
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 katravath Self Male Nil State 961153797135
pandu(29) GovtEmploy
ee/Nil
2 katravath Wife Female Nil HOUSE 413190024393
chittemma(2 WIFE/Nil
1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317843/000

Household Verification Format Door No:10-73,1

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband bagavanth Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ramvath Self Male Nil OWN 589393387201
sakrum(44) AGRICULT
URE
/Nil
2 ramvath Wife Female Nil OWN 650624163040
bavuli(34) AGRICULT
URE
/Nil
3 ramvath Son Male Nil Nil/Nil 985343986717
santhosh(15)

4 ramvath Son Male Nil OWN 533560142010

ramachandar AGRICULT
(25) URE
/Nil
5 ramvath Daughter Female Nil Nil/Nil 818403783081
nirmala(12)

6 ramvath Daughter in Female Nil OWN 544516273863

salamma(24) Law AGRICULT
URE
/Nil
7 ramvath Grand Son Male Nil Nil/Nil
balaji(2)
8 ramvath Grand Female Nil Nil/Nil 396970069202
divya(3) Daughter

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.7 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317845/000

Household Verification Format Door No:10-74,1

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband hanmanth Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ramavath Self Female Nil OWN 714329025786
RAJI(50) AGRICULT
URE
/Nil
2 ramavath Son Male Nil OWN 707305943215
KRISHNA(3 AGRICULT
0) URE
/Nil
3 ramavath Daughter Female Nil OWN 947633880179
MANJULA( AGRICULT
13) URE
/Nil
4 ramavath Daughter in Female Nil OWN 455843545298
KALI(27) Law AGRICULT
URE
/Nil
5 ramavath Grand Son Male Nil Nil/Nil 788930671728
NAVEEN(7)

6 ramavath Grand Son Male Nil Nil/Nil 862177136737

CHARAN(6
)
7 ramavath Grand Female Nil Nil/Nil 209275862178
NAVITHA( Daughter
7)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.7 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317846/000

Household Verification Format Door No:10-75,1

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband THUKMA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMVATH Self Male Nil OWN 443231182144
SATYAM(4 AGRICULT
8) URE
/Nil
2 RAMVATH Wife Female Nil OWN 223639710270
MANGLI(45 AGRICULT
) URE
/Nil
3 RAMVATH Son Male Nil Nil/Nil 263367444983
RAVINDHA
R(21)
4 RAMVATH Daughter in Female Nil Nil/Nil 887698347176
SHARADA( Law
17)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.42 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317848/000

Household Verification Format Door No:10-77,1

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband sakrum Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ramavath Self Female Nil OWN
bimani(60) AGRICULT
URE
/Nil
2 ramavath Son Male Nil OWN 343810929388
manem(26) AGRICULT
URE
/Nil
3 ramavath Daughter Female Nil OWN
shantham(16 AGRICULT
) URE
/Nil
4 ramavath Daughter in Female Nil OWN
lali(20) Law AGRICULT
URE
/Nil
5 ramavath Grand Son Male Nil Nil/Nil
malesh(15)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.65 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317849/000

Household Verification Format Door No:10-78,1

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband ramulu Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ramavath Self Female Nil OWN 373949153363
mutyali(65) AGRICULT
URE
/Nil
2 ramavath Son Male Nil OWN
pandu(32) AGRICULT
URE
/Nil
3 ramavath Daughter in Female Nil OWN
shanthi(30) Law AGRICULT
URE
/Nil
4 ramavath Grand Son Male Nil Nil/Nil
charan(2)
5 ramavath Grand Female Nil Nil/Nil 392024653165
sunitha(5) Daughter

6 ramavath Grand Female Nil Nil/Nil 810515259081

nandini(7) Daughter

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317851/000

Household Verification Format Door No:10-79,nakkala cheruvu thanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BHAGAVANTHU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMA Self Male Nil DAILY 392991366254
VATH WAGES
RAMAVAT LABOUR/N
HRAVI(23) il
2 RAMA Wife Female Nil DAILY 641140392175
VATH WAGES
RAKAMAL LABOUR/N
A(20) il
3 RAMA Son Male Nil DO
VATH NOTHING/
RAMAVAT Nil
H
KALYAN(1
)
4 RAMA Daughter Female Nil DO 724067669831
VATH NOTHING/
RAMAVAT Nil
H
UMADEVI(
4)
5 RAMA Daughter Female Nil DO
VATH NOTHING/
RAMAVAT Nil
H
AKHILA(0)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.22 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317852/000

Household Verification Format Door No:952,NAKKALA CHERUVU THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BHAGAVANTH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil DRIVERS/N 471365912248
H il
RAMAVAT
H
ANJANEYU
LU(20)
2 RAMAVAT Wife Female Nil DAILY
H WAGES
RAMAVAT LABOUR/N
H il
SUMA(18)
3 RAMAVAT Daughter Female Nil DO
H NOTHING/
RAMAVAT Nil
H
PARVATHI
(1)
4 RAMAVAT Father Male FISHER Nil/Nil 296333109690
H MAN
RAMAVAT
H
BHAGAVA
NTH (65)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317853/000

Household Verification Format Door No:10-81,nakkala cheruvu thanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil AGRICULT 880991709235
H URE
RAMAVAT LABOUR
H /Nil
SARAYA(3
6)
2 RAMAVAT Wife Female Nil AGRICULT 229423715586
H URE
RAMAVAT LABOUR
H /Nil
MANGA(31
)
3 RAMAVAT Son Male FISHER Nil/Nil 675873143924
H MAN
RAMAVAT
H RAU(17)
4 RAMAVAT Son Male Nil AGRICULT 460467388691
H URE
RAMAVAT LABOUR
H /Nil
SANTOSH(
13)
5 RAMAVAT Daughter Female Nil AGRICULT 840482258303
H URE
RAMAVAT LABOUR
H /Nil
NANUKA(1
7)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317854/000

Household Verification Format Door No:10-82,NAKKALA CHERUVU THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband PARSHA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil AGRICULT 396269149186
H URE
RAMAVAT LABOUR
H /Nil
SARIYA(43
)
2 RAMAVAT Wife Female Nil AGRICULT 666131181573
H URE
RAMAVAT LABOUR
H MANI(38) /Nil
3 RAMAVAT Son Male Nil DO 359504811476
H NOTHING/
RAMAVAT Nil
H
SRINU(10)
4 RAMAVAT Daughter Female Nil DO 820230305619
H NOTHING/
RAMAVAT Nil
H
VALLI(14)
5 RAMAVAT Daughter Female Nil DO 528101484492
H NOTHING/
SHANTHI(1 Nil
3)
6 RAMAVAT Daughter Female Nil AGRICULT 697947294493
H URE
SHANTHI(1 LABOUR
5) /Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317855/000

Household Verification Format Door No:10-38,NAKKALA CHERUVU THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband PARSHA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil AGRICULT 967466133067
H URE
RAMAVAT LABOUR
H BALU /Nil
NAYAK(50)
2 RAMAVAT Son Male Nil AGRICULT 295602277368
H URE
CHANDRU( LABOUR
23) /Nil
3 RAMAVAT Daughter Female Nil AGRICULT 994789591744
H URE
MARRI(18) LABOUR
/Nil
4 RAMAVAT Daughter in Female Nil AGRICULT 669224091528
H Law URE
SHOBA(22) LABOUR
/Nil
5 RAMAVAT Grand Son Male Nil DO
H NOTHING/
TANUSH(0) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317856/000

Household Verification Format Door No:10-84,NAKKALA CHERUVU THANADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband CHANDYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil AGRICULT 590058477087
H URE
RAMAVAT LABOUR
H /Nil
DHARMA(4
0)
2 RAMAVAT Wife Female Nil AGRICULT
H URE
SEETHA(36 LABOUR
) /Nil
3 RAMAVAT Son Male Nil DO
H NOTHING/
NAVEEN(1 Nil
0)
4 RAMAVAT Daughter Female Nil DO
H NOTHING/
SHARADH Nil
A(26)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317857/000

Household Verification Format Door No:10-58,NAKKALA CHERUVU THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband VALYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil OTHERS(P
H ROVIDE
RAMAVAT DETAILS)/
H Nil
KAMYA(62
)
2 RAMAVAT Wife Female Nil AGRICULT 249084146312
H URE
MANEMM LABOUR
A(56) /Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317858/000

Household Verification Format Door No:958,NAKKALA CHERUVU THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband VALYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil DO 913599705177
H NOTHING/
RAMAVAT Nil
H
PURYA(55)
2 RAMAVAT Wife Female Nil State Govt 416989312284
H OMKI(48) Project
Employee
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.65 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317860/000

Household Verification Format Door No:10-89,NAKKALA CHERUVU THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband DHARYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 UDHATHA Self Male Nil AGRICULT
L URE
UDHATHA LABOUR
L /Nil
MANYA(33
)
2 UDHATHA Wife Female Nil AGRICULT
L ANJI(23) URE
LABOUR
/Nil
3 UDHATHA Son Male Nil STUDENT/
L SAI Nil
KUMAR(7)
4 UDHATHA Daughter Female Nil Nil/Nil
L
UDHAVAT
H
MANYA(1)
5 UDHATHA Father Male Nil DO
L NOTHING/
UDHAVAT Nil
H
DHARYA(6
6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317861/000

Household Verification Format Door No:10-90,NAKKALA CHERUVU THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband DHARYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PUDHYA Self Male Nil DRIVERS/N
VATH il
UDHAVAT
H
KRISHNA(2
8)
2 PUDHYA Wife Female Nil HOUSE
VATH WIFE/Nil
LALITHA(2
5)
3 PUDHYA Son Male Nil DO 242193741416
VATH NOTHING/
VIJAYA(4) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317862/000

Household Verification Format Door No:10-91,NAKKALA CHERUVU THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband SOMLA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil OWN 375485245728
H AGRICULT
ROOPLA(48 URE
) /Nil
2 RAMAVAT Wife Female Nil AGRICULT 843393319558
H URE
ANJAMMA LABOUR
(44) /Nil
3 RAMAVAT Son Male Nil OWN 585508943513
H AGRICULT
KRISHNA(2 URE
3) /Nil
4 RAMAVAT Daughter Female Nil AGRICULT 892370163616
H URE
JAMUNA(1 LABOUR
8) /Nil
5 RAMAVAT Daughter in Female Nil AGRICULT 573181305156
H Law URE
LALITHA(2 LABOUR
2) /Nil
6 RAMAVAT Grand Son Male Nil Nil/Nil
H
SANDEEP(1
)
7 RAMAVAT Grand Female Nil Nil/Nil
H Daughter
SINDHU(2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317863/000

Household Verification Format Door No:10-92,NAKKALA CHERUVU THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband LALU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Son Male Nil STUDENT/ 707575181875
H SHIVA(7) Nil

2 RAMAVAT Daughter Female Nil STUDENT/ 625105846006

H Nil
MANJULA(
14)
3 RAMAVAT Mother Female Nil DO 32012868162
H NOTHING/
RAMAVAT Nil
H
LAXMI(68)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:5.28 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317864/000

Household Verification Format Door No:10-94,NAKKALA CHERUVU THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband VASURAM Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Daughter Female Nil STUDENT/ 303611785500
H Nil
RAMAVAT
H
BINDU(11)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0317865/000

Household Verification Format Door No:10-94,NAKKALA CHERUVU THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband VASURAM Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil DO 930438611027
H NOTHING/
RAMAVAT Nil
H
VASURAM(
68)
2 RAMAVAT Wife Female Nil DO 558565246595
H NOTHING/
RAMAVAT Nil
H
GOURI(63)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317866/000

Household Verification Format Door No:10-95,NAKKALA CHERUVU THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband VASURAM Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Wife Female Nil AGRICULT 613062346522
H URE
RAMAVAT LABOUR
H SONI(33) /Nil
2 RAMAVAT Son Male Nil STUDENT/ 357838150265
H Nil
SHIVA(68)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317867/000

Household Verification Format Door No:10-96,NAKKALA CHERUVU THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband SHANKER Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil STUDENT/ 314748401693
H Nil
RAMAVAT
H
BABU(15)
2 RAMAVAT Sister Female Nil STUDENT/ 438346450922
H Nil
DIVYA(10)
3 RAMAVAT Sister Female Nil STUDENT/ 858428075951
H Nil
ANUSHA(1
3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317868/000

Household Verification Format Door No:10-97,NAKKALA CHERUVU THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband GOPAL Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VEDHAVA Self Female Nil AGRICULT
TH URE
VEDHAVA LABOUR
TH /Nil
GAMLI(45)
2 VEDHAVA Son Male Nil STUDENT/
TH Nil
VENKATES
H(13)
3 VEDHAVA Son Male Nil STUDENT/
TH SHIVA Nil
PRASAD(14
)
4 VEDHAVA Daughter Female Nil STUDENT/
TH Nil
ARUNA(19)
5 VEDHAVA Daughter Female Nil STUDENT/
TH Nil
SUNITHA(1
5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317869/000

Household Verification Format Door No:10-98,NAKKALA CERUVU THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband THARU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil STUDENT/ 648015848168
H Nil
RAMAVAT
H
SRINU(14)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.4 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0317871/000

Household Verification Format Door No:10-100,NAKKAL CHERUVU THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband LALU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male BEEDI Nil/Nil 272435841305
H WORKERS
RAMAVAT
H
GOPAL(48)
2 RAMAVAT Wife Female Nil AGRICULT 739136571533
H GOJI(43) URE
LABOUR
/Nil
3 RAMAVAT Son Male Nil STUDENT/ 464795062095
H Nil
SRINU(10)
4 RAMAVAT Son Male Nil AGRICULT 549036067724
H HARI(13) URE
LABOUR
/Nil
5 RAMAVAT Daughter Female Nil AGRICULT
H URE
SHARADH LABOUR
A(11) /Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.38 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317872/000

Household Verification Format Door No:11-1,NAKKALA CHERUVU THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband LACHYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VEDHAVA Self Male Nil AGRICULT 521383028911
TH URE
VEDHAVA LABOUR
TH /Nil
SHANKAR
A(38)
2 VEDHAVA Wife Female Nil AGRICULT 459848732175
TH URE
VEDHAVA LABOUR
TH /Nil
MANGAM
MA(25)
3 VEDHAVA Son Male Nil STUDENT/ 243144798834
TH Nil
PRAVEEN
KUMAR(17
)
4 VEDHAVA Son Male Nil Nil/Nil 996266865997
TH
NAVEEN
KUMAR(19
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.88 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317873/000

Household Verification Format Door No:11-2,NAKKALA CHERUVU THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BADYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 UDHAVAT Self Female Nil DAILY 737356325614
H WAGES
UDAVATH LABOUR/N
LAXMI(63) il
2 UDHAVAT Grand Son Male Nil DAILY 561481062911
H WAGES
UDAVATH LABOUR/N
SANTOSH( il
9)
3 UDHAVAT Grand Son Male Nil DAILY 590307143336
H WAGES
UDAVATH LABOUR/N
MOHAN(12 il
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317875/000

Household Verification Format Door No:11-4,NAKKALA CHERUVU THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband JANU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PADMAVA Self Male Nil AGRICULT 667366990707
THI URE
VEDHAVA LABOUR
TH /Nil
NARYA(45)
2 PADMAVA Wife Female Nil AGRICULT 764189590291
THI URE
JAMARI(37 LABOUR
) /Nil
3 PADMAVA Son Male Nil STUDENT/ 770883047152
THI Nil
VEDHAVA
TH
MOHAN(16
)
4 PADMAVA Daughter Female Nil STUDENT/ 312323246549
THI Nil
VEDHAVA
TH
GEETHA(3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.35 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317971/000

Household Verification Format Door No:11-18,BHEEMUNI THANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BHEEMUDU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil OTHERS(P 898512121879
H ROVIDE
HARYA(50) DETAILS)/
Nil
2 MUDAVAT Wife Female Nil AGRICULT 434331792586
H URE
LAXMI(47) LABOUR
/Nil
3 MUDAVAT Son Male Nil DRIVERS/N 310598323252
H il
GOPAL(26)
4 MUDAVAT Son Male Nil STUDENT/ 562531598763
H Nil
RAJENDRA
PRASAD(20
)
5 MUDAVAT Daughter in Female Nil DAILY 851828082151
H BUJJI(23) Law WAGES
LABOUR/N
il
6 MUDAVAT Mother Female Nil Nil/Nil 464831173165
H
MANGAM
MA(90)
7 MUDAVAT Grand Son Male Nil Nil/Nil
H
REVANTH(
2)
8 MUDAVAT Grand Son Male Nil STUDENT/ 343228399127
H Nil
RAKESH(5)
9 MUDAVAT Grand Son Male Nil STUDENT/ 381351655086
H Nil
RAHUL(5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.22 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319201/000

Household Verification Format Door No:5-23,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband MASAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUMMAK Self Male Nil Nil/Nil 986640611147
ONDA
MANEYAM
(70)
2 GUMMAK Wife Female Nil Nil/Nil
ONDA
LAXMAM
MA(65)
3 GUMMAK Son Male Nil Nil/Nil
ONDA
RAMULU(2
3)
4 GUMMAK Daughter in Female Nil Nil/Nil
ONDA Law
CHITTI(22)
5 GUMMAK Grand Female Nil Nil/Nil
ONDA Daughter
AMULYA(2
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:5.15/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319202/000

Household Verification Format Door No:6-00,lattupalli

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband CHINNAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUMMAK Self Male Nil Nil/Nil
ONDA
BALAIAH(6
7)
2 GUMMAK Son Male Nil Nil/Nil 916292889667
ONDA
SHIVAKU
MAR(16)
3 GUMMAK Son Male Nil Nil/Nil 832057969752
ONDA
RAJESH(14)
4 GUMMAK Daughter Female Nil Nil/Nil 704065616719
ONDA
SRILATHA(
13)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319203/000

Household Verification Format Door No:4-59,LATTIUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband THIMMAPPA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUMMAK Self Male Nil Nil/Nil 271711390571
ONDA
BUSHAIAH
(56)
2 GUMMAK Wife Female Nil Nil/Nil
ONDA
MANEMM
A(48)
3 GUMMAK Son Male Nil Nil/Nil
ONDA
RAJU(23)
4 GUMMAK Son Male Nil Nil/Nil
ONDA
RAJUMALL
AIAH(32)
5 GUMMAK Son Male Nil Nil/Nil
ONDA
SHANKAR(
10)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:3.62/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319205/000

Household Verification Format Door No:4-93,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband CHANDRAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUMMAK Self Male Nil Nil/Nil
ONDA
BUSHAIAH
(34)
2 GUMMAK Wife Female Nil Nil/Nil
ONDA
RENUKA(3
0)
3 GUMMAK Son Male Nil Nil/Nil
ONDA
GANESH(4)
4 GUMMAK Daughter Female Nil Nil/Nil
ONDA
MANJULA(
10)
5 GUMMAK Daughter Female Nil Nil/Nil
ONDA
ANJALI(2)
6 GUMMAK Mother Female Nil Nil/Nil
ONDA
MASHAM
MA(76)
7 GUMMAK Father in Male Nil Nil/Nil
ONDA Law
SHIVAIAH(
17)
8 GUMMAK Mother in Male Nil Nil/Nil
ONDA Law
THIRUPAT
HAMMA(22
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319207/000

Household Verification Format Door No:4-99,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband PEDDASAYANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUMMAK Self Male Nil Nil/Nil
ONDA
THIRUPAT
HAIAH(45)
2 GUMMAK Wife Female Nil DAILY
ONDA WAGES
CHENNAM LABOUR/N
MA(38) il
3 GUMMAK Son Male Nil DAILY
ONDA WAGES
MALLESH( LABOUR/N
21) il
4 GUMMAK Daughter Female Nil Nil/Nil
ONDA
SAILILA(13
)
5 GUMMAK Daughter in Female Nil Nil/Nil
ONDA Law
anjanamma(
18)
6 GUMMAK Father in Male Nil Nil/Nil
ONDA Law
BUSHAIAH
(50)
7 GUMMAK Mother in Female Nil Nil/Nil
ONDA Law
chittemma(4
8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319208/000

Household Verification Format Door No:0-0,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband nagaiah Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 panugani P Self Male Nil Nil/Nil
RAMULU(7
6)
2 panugani Son Male Nil Nil/Nil
BALAIAHG
(65)
3 panugani Son Male Nil Nil/Nil
bangaram(5)
4 panugani Son Male Nil Nil/Nil
KARTHIK(2
3)
5 panugani Son Male Nil Nil/Nil
chandraiah(1
5)
6 panugani Son Male Nil Nil/Nil
praveen(17)
7 panugani Daughter in Female Nil Nil/Nil
nagamma(24 Law
)
8 panugani Daughter in Female Nil Nil/Nil
MANAGA Law
MMA(45)
9 panugani Father in Male Nil Nil/Nil
pavan Law
kumar(15)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319209/000

Household Verification Format Door No:4-100,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband bimaiah Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 gummakond Self Female Nil Nil/Nil
a
chennamma(
75)
2 gummakond Son Male Nil Nil/Nil
a
ushanna(28)
3 gummakond Son Female Nil Nil/Nil
a
bushaiah(34)
4 gummakond Son Male Nil Nil/Nil
a
RAGHU(16)
5 gummakond Son Male Nil Nil/Nil
a chanran(4)
6 gummakond Son Male Nil Nil/Nil
a
RAMESH(1
7)
7 gummakond Son Male Nil Nil/Nil
a ramulu(65)
8 gummakond Daughter in Female Nil Nil/Nil
a Law
GOURAMM
A(30)
9 gummakond Daughter in Female Nil Nil/Nil
a Law
USHAMMA
(23)
10 gummakond Grand Son Male Nil Nil/Nil
a lokesh(2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319210/000

Household Verification Format Door No:4-98,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband masaiah Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 gummakond Self Male Nil Nil/Nil
a
shanthaiah(7
8)
2 gummakond Son Male Nil Nil/Nil
a chandu(8)
3 gummakond Son Male Nil Nil/Nil
a
anjaneyulu(4
0)
4 gummakond Son Male Nil Nil/Nil
a naresh(11)
5 gummakond Son Male Nil Nil/Nil
a
narayana(35)
6 gummakond Daughter in Female Nil Nil/Nil
a Law
indiramma(3
0)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319211/001

Household Verification Format Door No:0-0,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC NIL Father/Mother/husband ramaiah Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 midde Self Male Nil Nil/Nil
ellaiah(45)
2 midde Wife Female Nil Nil/Nil
balamani(35)
3 midde Son Male Nil Nil/Nil
chititi(5)
4 midde Son Male Nil Nil/Nil
karnakar(4)
5 midde Daughter Female Nil Nil/Nil
kavitha(9)
6 midde Mother in Female Nil Nil/Nil
chennamma( Law
30)
7 midde Mother in Female Nil Nil/Nil
ellamma(30) Law
8 midde Brother Male Nil Nil/Nil
chennaiah(1
4)
9 midde Brother Male Nil Nil/Nil
parashramul
u(38)
10 midde Brother Male Nil Nil/Nil
kurmaiah(13
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:5.85/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319212/000

Household Verification Format Door No:5-20,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband balaiah Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 gaddam Self Male Nil Nil/Nil
venkataiah(3
1)
2 gaddam Wife Female Nil Nil/Nil
sujatha(28)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:1.78/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319213/000

Household Verification Format Door No:0-0,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband ellaiaj Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 gaddam Self Female Nil Nil/Nil
ALIVELU(4
5)
2 gaddam Son Male Nil Nil/Nil
MAHESH(5
)
3 gaddam Daughter Female Nil Nil/Nil
NAGEDRA(
18)
4 gaddam Sister in Law Male Nil Nil/Nil
BANGARAI
AHA(14)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319214/000

Household Verification Format Door No:5-18,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC NIL Father/Mother/husband KAREENNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAM Self Male Nil Nil/Nil
MANYAM(
65)
2 GADDAM Wife Female Nil Nil/Nil
ELLAMMA
(55)
3 GADDAM Son Male Nil Nil/Nil
VENKATAI
AH(31)
4 GADDAM Son Female Nil Nil/Nil
SRINU(21)
5 GADDAM Daughter in Female Nil Nil/Nil
SUVARNA( Law
28)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319215/000

Household Verification Format Door No:0-0,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC NIL Father/Mother/husband LAXMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MIDDE Self Male Nil Nil/Nil
NAGAIAH(
46)
2 MIDDE Wife Female Nil Nil/Nil
BALAMMA
(38)
3 MIDDE Son Male Nil Nil/Nil
SRINU(18)
4 MIDDE Son Male Nil Nil/Nil
NARSIMHA
(20)
5 MIDDE Daughter Female Nil Nil/Nil
BHARATHI
(1)
6 MIDDE Daughter Female Nil Nil/Nil
LAXMI(21)
7 MIDDE Daughter in Female Nil Nil/Nil
VASANTH Law
A(18)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319216/000

Household Verification Format Door No:5-48,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband LAXMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 LAXMAIA Self Male Nil Nil/Nil
H
LAXMAIA
H(65)
2 LAXMAIA Wife Female Nil Nil/Nil
H
BUCHAMM
A(55)
3 LAXMAIA Son Male Nil Nil/Nil
H
VENKATAI
AH(45)
4 LAXMAIA Daughter in Female Nil Nil/Nil
H Law
ANITHA(38
)
5 LAXMAIA Grand Son Male Nil Nil/Nil
H
ABIRAM(7)
6 LAXMAIA Grand Son Male Nil Nil/Nil
H
CHARAN(1
0)
7 LAXMAIA Grand Female Nil Nil/Nil
H Daughter
NANDINI(1
7)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319217/000

Household Verification Format Door No:0-0,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband LAXMIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAM Self Male Nil Nil/Nil
ANJANEYU
LU(45)
2 GADDAM Wife Female Nil Nil/Nil
ALIVELAM
MA(36)
3 GADDAM Daughter Female Nil Nil/Nil
SHIRIAH(1
4)
4 GADDAM Daughter Female Nil Nil/Nil
SHILAJA(1
1)
5 GADDAM Daughter Female Nil Nil/Nil
SWAPANA(
1)
6 GADDAM Daughter Female Nil Nil/Nil
SANJITHA(
24)
7 GADDAM Daughter Female Nil Nil/Nil
SRILATHA(
1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319219/000

Household Verification Format Door No:6-9,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband MANYAM Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAM Self Male Nil Nil/Nil
NAGAIAH(
24)
2 GADDAM Wife Female Nil Nil/Nil
ALIVELA(2
0)
3 GADDAM Son Female Nil Nil/Nil
RAM
CHANRAN(
3)
4 GADDAM Daughter Female Nil Nil/Nil
RANI(1)
5 GADDAM Daughter Female Nil Nil/Nil
JIVEETHA(
5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319220/000

Household Verification Format Door No:6-85,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband BUDDAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUMMAK Self Male Nil Nil/Nil
ONDA
MENYAM(
47)
2 GUMMAK Wife Female Nil Nil/Nil
ONDA
JYOTHI(36)
3 GUMMAK Son Male Nil Nil/Nil
ONDA
BUDDAIAH
(21)
4 GUMMAK Son Male Nil Nil/Nil
ONDA
NARSIMHA
(23)
5 GUMMAK Daughter Female Nil Nil/Nil
ONDA
MANJULA(
12)
6 GUMMAK Daughter Female Nil Nil/Nil
ONDA
ELLAMMA
(3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319221/001

Household Verification Format Door No:0-0,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband SAYANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAM Self Male Nil Nil/Nil
RAMULU(4
6)
2 GADDAM Wife Female Nil Nil/Nil
MASHAM
MA(38)
3 GADDAM Son Male Nil Nil/Nil
VENKATAI
AH(25)
4 GADDAM Son Male Nil Nil/Nil
SRIKATH(1
2)
5 GADDAM Daughter Female Nil Nil/Nil
SUSHILA(1
8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319221/002

Household Verification Format Door No:5-72,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband SAYANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAM Self Male Nil Nil/Nil
MANYAM(
48)
2 GADDAM Wife Female Nil Nil/Nil
BALAMMA
(38)
3 GADDAM Son Male Nil Nil/Nil
SHYAM
KUMAR(23
)
4 GADDAM Son Male Nil Nil/Nil
VENKATAI
AH(25)
5 GADDAM Daughter Female Nil Nil/Nil
SHARADA(
12)
6 GADDAM Daughter in Female Nil Nil/Nil
CHENNAM Law
MA(23)
7 GADDAM Grand Female Nil Nil/Nil
HARIPRIY Daughter
A(3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319222/000

Household Verification Format Door No:6-72,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband KONDAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAM Self Female Nil Nil/Nil
MASHAM
MA(75)
2 GADDAM Son Male Nil Nil/Nil
VENKATAI
AH(46)
3 GADDAM Son Male Nil Nil/Nil
SRISHOILA
M(38)
4 GADDAM Daughter in Female Nil Nil/Nil
BHANUPRI Law
YA(26)
5 GADDAM Daughter in Female Nil Nil/Nil
LALITHA(4 Law
0)
6 GADDAM Grand Son Male Nil Nil/Nil
CHARAN(1
)
7 GADDAM Grand Female Nil Nil/Nil
VISHNAVI( Daughter
2)
8 GADDAM Grand Female Nil Nil/Nil
KIRTHY(6) Daughter
9 GADDAM Grand Female Nil Nil/Nil
NIRAJA(4) Daughter
10 GADDAM Grand Female Nil Nil/Nil
RADHIKA( Daughter
3)
11 GADDAM Grand Female Nil Nil/Nil
GOUTHAM Daughter
I(4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319223/000

Household Verification Format Door No:6-72,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband kondaiah Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 gaddam Self Male Nil Nil/Nil
nagaraju(32)
2 gaddam Wife Female Nil Nil/Nil
laxmi(29)
3 gaddam Son Male Nil Nil/Nil
raghavendra(
16)
4 gaddam Son Male Nil Nil/Nil
venkateshy(3
)
5 gaddam Daughter Female Nil Nil/Nil
jaya(5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319224/000

Household Verification Format Door No:6-85,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband buddaiah Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 gummakond Self Male Nil Nil/Nil
a
VENKATAI
AH(50)
2 gummakond Wife Female Nil Nil/Nil
a
CHENNAM
MA(48)
3 gummakond Son Male Nil Nil/Nil
a
SHIVAKU
MAR(14)
4 gummakond Son Male Nil Nil/Nil
a
MALLESH(
13)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319225/000

Household Verification Format Door No:6-73,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband venkanna Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mala Self Male Nil Nil/Nil
VENKTAIA
H(48)
2 mala Wife Female Nil Nil/Nil
RAMULAM
MA(38)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319226/000

Household Verification Format Door No:6-78,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband ENKABNNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MALA Self Male Nil Nil/Nil
SAYANNA(
46)
2 MALA Wife Female Nil Nil/Nil
NAGAMM
A(38)
3 MALA Son Male Nil Nil/Nil
VENKATES
H(13)
4 MALA Daughter Female Nil Nil/Nil
YESHODA(
15)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319227/000

Household Verification Format Door No:6-75,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband POSHAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GATTUKA Self Male Nil Nil/Nil
DI
kistamma(55
)
2 GATTUKA Wife Female Nil Nil/Nil
DI
ellamma(46)
3 GATTUKA Son Male Nil Nil/Nil
DI ram
chandramma
(24)
4 GATTUKA Son Male Nil Nil/Nil
DI
venkatasway
(20)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:1.88/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319231/002

Household Verification Format Door No:6-77,HARIJANVADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband KARRE SAYANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAM Self Male Nil DAILY 230562625309
BALAIAH(6 WAGES
0) LABOUR/N
il
2 GADDAM Wife Female Nil DAILY 956406352540
PENTAMM WAGES
A(53) LABOUR/N
il
3 GADDAM Son Male Nil Nil/Nil
BALAKRIS
HNA(39)
4 GADDAM Daughter Female Nil Nil/Nil
VISHNU
PRIYA(4)
5 GADDAM Daughter Female Nil Nil/Nil
SWATHI
PRIYA(6)
6 GADDAM Daughter Female Nil Nil/Nil
ANJALI
PRIYA (1)
7 GADDAM Daughter in Female Nil Nil/Nil
SWAROOP Law
A(25)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.15 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319232/002

Household Verification Format Door No:6-77,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband SWAROOPA Gas NIL/-/
Name BALIAH Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAM Self Male Nil DAILY 946478884946
GADDAM WAGES
BALAKRIS LABOUR/N
HNA(39) il
2 GADDAM Wife Female Nil DAILY 252894510139
SWAROOP WAGES
A(25) LABOUR/N
il
3 GADDAM Daughter Female Nil Nil/Nil
ANJALI
PRIYA(1)
4 GADDAM Daughter Female Nil Nil/Nil 692245217839
VISHNU
PRIYA(4)
5 GADDAM Daughter Female Nil Nil/Nil 775563738204
SWATHI
PRIYA(6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319233/002

Household Verification Format Door No:6-79,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband KURMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUNTHA Self Male Nil MIGRATED 879146743804
KURMAIA LABOUR/N
H(43) il
2 GUNTHA Wife Female Nil MIGRATED 510315874262
LAXMAIA LABOUR/N
H(33) il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:5.15 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319234/001

Household Verification Format Door No:6-80,HARIJAN VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband KURMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUNTA Self Male Nil MIGRATED 534872608626
CHENNAIA LABOUR/N
H(41) il
2 GUNTA Wife Female Nil MIGRATED 289466792227
YELLAMM LABOUR/N
A(35) il
3 GUNTA Son Male Nil Nil/Nil 296365676529
UDDALA(1
3)
4 GUNTA Daughter Female Nil Nil/Nil 546315998807
RAJITHA(1
3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:5.15 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319235/001

Household Verification Format Door No:6-91,HARIJANVADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband KISTAPPA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GODA Self Male TODDY Nil/Nil 439256652188
VENKATAI TOPPERS
AH
GOUD(51)
2 GODA Wife Female Nil Nil/Nil 201214039010
PADMAM
MA(40)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:2/DRY:3 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319236/002

Household Verification Format Door No:6-57,HARIJANVADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband CHINNA BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAM Self Male Nil DAILY 347090613757
NARASIMH WAGES
A(48) LABOUR/N
il
2 GADDAM Wife Female Nil DAILY 461237615880
VENKATA WAGES
MMA(43) LABOUR/N
il
3 GADDAM Son Male Nil STUDENT/ 829987091625
SRIHARI(21 Nil
)
4 GADDAM Son Male Nil DAILY 810243360101
SHIVA WAGES
SHANKAR( LABOUR/N
17) il
5 GADDAM Son Male Nil STUDENT/ 308767453989
SRINIVASU Nil
LU(25)
6 GADDAM Daughter Female Nil STUDENT/ 781905654339
SUVARNA( Nil
18)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.98 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319237/001

Household Verification Format Door No:6-62,HARIJANVADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband BUCHANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAM Self Male Nil DAILY 357923697654
SRINIVASU WAGES
LU(38) LABOUR/N
il
2 GADDAM Wife Female Nil DAILY 654679859113
BUSAMMA WAGES
(33) LABOUR/N
il
3 GADDAM Son Male Nil Nil/Nil 687215809218
RAGHAVE
NDAR(3)
4 GADDAM Daughter Female Nil Nil/Nil 950626581397
RAJITHA(1
1)
5 GADDAM Daughter Female Nil Nil/Nil 386458093684
SOWJANY
A(7)
6 GADDAM Daughter Female Nil Nil/Nil 470522281266
SAROJA(14
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319238/002

Household Verification Format Door No:5-98/1,HARIJANVADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband PEDDA SAYANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAM Self Male Nil DAILY 913665732383
BUCHANN WAGES
A(63) LABOUR/N
il
2 GADDAM Wife Female Nil DAILY 968744598638
VINAYAK WAGES
AMMA(53) LABOUR/N
il
3 GADDAM Son Male Nil STUDENT/ 551921902880
ANIL Nil
KUMAR(28
)
4 GADDAM Daughter in Female Nil HOUSE 201379677128
SAVITHRI( Law WIFE/Nil
26)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.82 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319239/002

Household Verification Format Door No:6-92,HARIJANVADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KISHANJI Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KARNAKO Self Male Nil MIGRATED 448602366137
TI LABOUR/N
BALAJI(41) il
2 KARNAKO Wife Female Nil MIGRATED 521489131360
TI LABOUR/N
BHARATHI il
BABU(37)
3 KARNAKO Son Male Nil Nil/Nil 844526512083
TI
MALLOGI(
13)
4 KARNAKO Daughter Female Nil Nil/Nil 908569158298
TI
MAHESHW
ARY(15)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319240/002

Household Verification Format Door No:6-93,HARIJANVADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband YELLAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NALLOND Self Male Nil MIGRATED 587786911926
A LABOUR/N
SWAMY(39 il
)
2 NALLOND Wife Female Nil MIGRATED 301789117705
A LABOUR/N
NAGAMM il
A(32)
3 NALLOND Son Male Nil Nil/Nil 827889393367
A
VENKATES
H(4)
4 NALLOND Son Male Nil Nil/Nil 299278956744
A
UMASH(7)
5 NALLOND Son Male Nil Nil/Nil 412556683098
A SHIVA
KUMAR(12
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0.55 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319241/001

Household Verification Format Door No:6-96,HARIJANVADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband PASHA Gas YES/HP/618286
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAHAMM Self Male Nil AGRICULT 764997714784
ED URE
JHANGEER LABOUR
(36) /Nil
2 MAHAMM Wife Female Nil HOUSE 906751552642
ED WIFE/Nil
SHAHEEB(
28)
3 MAHAMM Wife Female Nil HOUSE 781950116460
ED WIFE/Nil
BOORAN
BEE(68)
4 MAHAMM Son Male Nil STUDENT/ 225686053129
ED Nil
SHAHAVA
Z(3)
5 MAHAMM Son Male Nil STUDENT/ 455041172592
ED Nil
SHAKEER(
2)
6 MAHAMM Daughter Female Nil STUDENT/ 495189257600
ED Nil
KARISHMA
(4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:7.3 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319242/001

Household Verification Format Door No:5-98,HAORIJANVADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband PEDDA SAYANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAM Self Male Nil DAILY 913665732383
BUCHANN WAGES
A(63) LABOUR/N
il
2 GADDAM Wife Female Nil DAILY 968744598638
VINAYAK WAGES
AMMA(53) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:3.62 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319243/002

Household Verification Format Door No:6-45,HARIJANVADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband BALSWAMY Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAM Self Male Nil AGRICULT 651937351702
BALASWA URE
MY(66) LABOUR
/Nil
2 GADDAM Wife Female Nil AGRICULT 458088968725
NILEEMA(6 URE
1) LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319244/002

Household Verification Format Door No:6-44,HARIJANVADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband VENKATAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAM Self Female Nil DAILY 818713403960
PAKIRAM WAGES
MA(42) LABOUR/N
il
2 GADDAM Son Male Nil DAILY 796101142585
MANYAM( WAGES
32) LABOUR/N
il
3 GADDAM Daughter in Female Nil Nil/Nil 525019743755
BONARAM Law
MA(26)
4 GADDAM Grand Son Male Nil Nil/Nil 687004648654
ASHOK(7)

5 GADDAM Grand Son Male Nil Nil/Nil 346694311689

GUNASHE
KAR(3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.05 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319245/001

Household Verification Format Door No:6-43,HARIJANVADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband NIRANJAN Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAM Self Male Nil AGRICULT 379517707415
NIRANJAN( URE
46) LABOUR
/Nil
2 GADDAM Wife Female Nil AGRICULT 709574356442
NAGAMM URE
A(39) LABOUR
/Nil
3 GADDAM Son Male Nil Nil/Nil 747786248483
SHANKAR(
22)
4 GADDAM Daughter Female Nil Nil/Nil 640794267004
SRILATHA(
15)
5 GADDAM Brother Female Nil Nil/Nil 793026854585
THIRUPAT
HAIAH(51)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:5.3 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319246/002

Household Verification Format Door No:6-41,HAIJANVADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband USHANNA Gas YES/HP/634070
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAM Self Male Nil AGRICULT 764878894574
RAMCHAN URE
DRAIAH(48 LABOUR
) /Nil
2 GADDAM Wife Female Nil HOUSE 232500656711
SUJATHA(3 WIFE/Nil
1)
3 GADDAM Son Female Nil STUDENT/ 333399942412
NAGAJYOT Nil
HI(8)
4 GADDAM Daughter Male Nil STUDENT/ 952227161592
SHIVA Nil
KUMAR(9)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319247/001

Household Verification Format Door No:6-38,HARIJANVADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MIDDA Self Male Nil DAILY 387632419928
NAGIAHA( WAGES
36) LABOUR/N
il
2 MIDDA Wife Female Nil DAILY 651073727140
LAXMAM WAGES
MA(32) LABOUR/N
il
3 MIDDA Daughter Female Nil STUDENT/ 801077306654
KAMALA(1 Nil
1)
4 MIDDA Daughter Female Nil STUDENT/ 458835506904
CHANDRA Nil
KALA(20)
5 MIDDA Mother Male Nil OTHERS(P 411106439079
BALAMMA ROVIDE
(68) DETAILS)/
Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.85 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319248/002

Household Verification Format Door No:3-38/1,HARIJANVADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MIDDA Self Male Nil MIGRATED 618981231004
VENKATAI LABOUR/N
AH(48) il
2 MIDDA Wife Female Nil MIGRATED 269671316973
ALIVALU(3 LABOUR/N
3) il
3 MIDDA Son Female Nil Nil/Nil 654507127899
RAMYA(4)

4 MIDDA Son Female Nil STUDENT/ 680283938832

SHIRISHA( Nil
11)
5 MIDDA Daughter Male Nil Nil/Nil
MAHENDH
AR(3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.88 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319249/001

Household Verification Format Door No:5-98,HARIJANVADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband PEDDA SAYANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAM Self Male Nil AGRICULT 883367150683
MASAIAH( URE
46) LABOUR
/Nil
2 GADDAM Wife Female Nil AGRICULT 422594131564
BALAKON URE
DAMMA(42 LABOUR
) /Nil
3 GADDAM Daughter Male Nil STUDENT/ 288052562341
DASHARA Nil
TH(23)
4 GADDAM Daughter Male Nil STUDENT/ 390809701766
SHIVA(17) Nil

5 GADDAM Daughter Male Nil STUDENT/ 636127203458

VISHNU(20 Nil
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.82 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319250/001

Household Verification Format Door No:5-87,HARIJANVADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband VENKANNA Gas YES/HP/64798
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAHILA Self Male Nil State 583077290464
RAMASWA GovtEmploy
MY(38) ee/Nil
2 MAHILA Wife Female Nil State Govt
SUMALAT Project
HA(31) Employee
/Nil
3 MAHILA Daughter Male Nil STUDENT/ 414700709885
VIJAY Nil
KUMAR(6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319251/002

Household Verification Format Door No:5-88,HARIJANVADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband CHINNA SAYANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUMMAK Self Male Nil MIGRATED 816708731029
ONDA LABOUR/N
RANGAIAH il
(54)
2 GUMMAK Wife Female Nil MIGRATED 896345807350
ONDA LABOUR/N
CHITTAM il
MA(50)
3 GUMMAK Son Male Nil STUDENT/ 815846548729
ONDA Nil
SHIVA
SHANKAR(
15)
4 GUMMAK Son Male Nil STUDENT/ 625478249537
ONDA Nil
SRISHAILA
M(17)
5 GUMMAK Daughter Female Nil STUDENT/ 784077019358
ONDA Nil
SHIVAMM
A(19)
6 GUMMAK Daughter Female Nil STUDENT/ 290691324500
ONDA Nil
NIRMALA
MMA(16)
7 GUMMAK Son in Law Male Nil Nil/Nil 871776535939
ONDA
PRAVEEN(
13)
8 GUMMAK Brother Male Nil DAILY 984070887879
ONDA WAGES
MAISAIAH( LABOUR/N
53) il
9 GUMMAK Sister Female Nil DAILY 578242797040
ONDA WAGES
RAMULAM LABOUR/N
MA(68) il
10 GUMMAK Sister in Law Female Nil DAILY 762966300386
ONDA WAGES
SHANTHA LABOUR/N
MMA(48) il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:1.5/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:
Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319252/002

Household Verification Format Door No:5-93,HARIJANVADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband XHINNA BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAM Self Male Nil DAILY 446426154009
YADAIAH( WAGES
48) LABOUR/N
il
2 GADDAM Wife Female Nil DAILY 593896494377
SUGUNAM WAGES
MA(39) LABOUR/N
il
3 GADDAM Son Male Nil SCAVENGE 746064150024
BANGARA R/Nil
M(18)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.92 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319253/002

Household Verification Format Door No:5-85,HARIJANVADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband KARRISAYANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAM Self Male Nil DAILY 567774297115
RAMASWA WAGES
MY(50) LABOUR/N
il
2 GADDAM Wife Female Nil DAILY 277746155350
BUDEVI(48 WAGES
) LABOUR/N
il
3 GADDAM Son Male Nil State Govt 397314113369
RAJU(22) Project
Employee
/Nil
4 GADDAM Son Male Nil STUDENT/ 341897785707
RAMULU(2 Nil
5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:8.02 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319254/001

Household Verification Format Door No:5-93/1,HARIJANVADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAM Self Male Nil DAILY
BUSHAIAH WAGES
(55) LABOUR/N
il
2 GADDAM Wife Female Nil DAILY 629100469355
KONDAM WAGES
MA(63) LABOUR/N
il
3 GADDAM Son Male Nil DAILY 461726039207
LINGAMM WAGES
A(31) LABOUR/N
il
4 GADDAM Daughter Female Nil DAILY
MANEMM WAGES
A(31) LABOUR/N
il
5 GADDAM Daughter in Female Nil DAILY
LAXMY(35) Law WAGES
LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.95 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319255/001

Household Verification Format Door No:5-92,HARIJANVADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband PULLAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GATTUKA Self Male Nil DAILY 884557628358
DI CHINNA WAGES
KONDAIA LABOUR/N
H(64) il
2 GATTUKA Son Male Nil DAILY 673263064874
DI WAGES
VENKATES LABOUR/N
H(24) il
3 GATTUKA Son Male Nil STUDENT/ 435060664759
DI Nil
RAJU(17)
4 GATTUKA Son Male Nil STUDENT/ 925009545655
DI Nil
RAMULU(2
1)
5 GATTUKA Daughter Female Nil STUDENT/ 507637664357
DI SHIVA Nil
LEELA(14)
6 GATTUKA Daughter in Female Nil DAILY 867429892817
DI Law WAGES
SAYAMMA LABOUR/N
(19) il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319256/001

Household Verification Format Door No:5-98/1,HARIJANVADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband CHINNA BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDAM Self Male Nil DAILY 495783496476
KRISHNAI WAGES
AH(46) LABOUR/N
il
2 GADDAM Wife Female Nil DAILY 634806394701
CHINNAM WAGES
MA(35) LABOUR/N
il
3 GADDAM Son Male Nil DAILY 428989827902
PRAVEEN WAGES
KUMAR(10 LABOUR/N
) il
4 GADDAM Daughter Female Nil STUDENT/ 513034893334
SANTHOSH Nil
I(18)
5 GADDAM Daughter Female Nil STUDENT/ 715127446726
MANJULA( Nil
20)
6 GADDAM Daughter Female Nil STUDENT/ 207535368254
NAGALAX Nil
MY(11)
7 GADDAM Sister Female Nil Nil/Nil 511012343001
VENKATA
MMA(68)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.92 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319261/000

Household Verification Format Door No:6-98,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband AYYAPPA Gas YES/HP/635728
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SHERUPAL Self Male Nil Nil/Nil
LI
SATYANA
RAYANA(3
2)
2 SHERUPAL Wife Female Nil Nil/Nil
LI
NIRMALA
MMA(24)
3 SHERUPAL Son Male Nil Nil/Nil
LI
NARSIMHA
(61)
4 SHERUPAL Daughter Female Nil Nil/Nil
LI
ROHITHAS
RI(8)
5 SHERUPAL Mother Female Nil Nil/Nil
LI
PITAMMA(
51)
6 SHERUPAL Father Male Nil Nil/Nil
LI
AYYAPPA(
61)
7 SHERUPAL Brother Male Nil Nil/Nil
LI RAJU(20)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.05 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319263/000

Household Verification Format Door No:99,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband VENKATACHARI Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KOUSOJU Self Male Nil Nil/Nil
BRAMHAN
ACHARY(3
8)
2 KOUSOJU Wife Female Nil Nil/Nil
LAXMAYY
A(33)
3 KOUSOJU Son Male Nil Nil/Nil
MADUSUD
AN(17)
4 KOUSOJU Daughter Female Nil Nil/Nil
VENKATES
HWARA(14
)
5 KOUSOJU Daughter Female Nil Nil/Nil
LAXMI(20)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319264/000

Household Verification Format Door No:6-100/1,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband VENKAT Gas YES/HP/625607
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KOUSOJU Self Male Nil Nil/Nil
KRISHNAC
HARY(34)
2 KOUSOJU Wife Female Nil Nil/Nil
AMARAVA
THI(29)
3 KOUSOJU Son Male Nil Nil/Nil
THARUN(1
2)
4 KOUSOJU Son Male Nil Nil/Nil
LOKESHK
UMAR(7)
5 KOUSOJU Mother Female Nil Nil/Nil
PARVATH
AMMA(63)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319265/000

Household Verification Format Door No:6-101,6

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMANAYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 POOLDAN Self Female Nil Nil/Nil
DI
SAKKUBH
AI(55)
2 POOLDAN Son Male Nil Nil/Nil
DI
SHIVAKU
MAR(30)
3 POOLDAN Daughter Female Nil Nil/Nil
DI
BAGYALA
XMI(32)
4 POOLDAN Daughter in Female Nil Nil/Nil
DI Law
SUJATHA(2
8)
5 POOLDAN Grand Son Male Nil Nil/Nil
DI
SHIVAPRA
SAD(15)
6 POOLDAN Grand Female Nil Nil/Nil
DI Daughter
SANDYA(1
2)
7 POOLDAN Grand Female Nil Nil/Nil
DI Daughter
NISHAL(4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319266/000

Household Verification Format Door No:6-100/1,6

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMANAYYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 POOLDAN Self Male Nil Nil/Nil
DI
NATRAJ(31
)
2 POOLDAN Wife Female Nil Nil/Nil
DI
MANJULA(
26)
3 POOLDAN Son Male Nil Nil/Nil
DI NANI(3)
4 POOLDAN Daughter Female Nil Nil/Nil
DI
AKSHITHA
(5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319267/000

Household Verification Format Door No:6-103,6

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KRISHNAYYA Gas YES/HP/615385
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GODA Self Male Nil Nil/Nil
GOPAL(54)
2 GODA Wife Female Nil Nil/Nil
YADAMM
A(48)
3 GODA Son Male Nil Nil/Nil
CHANDRA
SEKHAR(25
)
4 GODA Son Male Nil Nil/Nil
SHASHIDA
RGOUD(29)
5 GODA Son Male Nil Nil/Nil
SRIKANTH
(24)
6 GODA Daughter in Female Nil Nil/Nil
SWATHI(20 Law
)
7 GODA Daughter in Female Nil Nil/Nil
SHIREESH Law
A(25)
8 GODA Grand Son Male Nil Nil/Nil
AKHIL(2)
9 GODA Grand Female Nil Nil/Nil
BAVYA(4) Daughter
10 GODA Grand Female Nil Nil/Nil
AKSHAYA( Daughter
1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319268/000

Household Verification Format Door No:6-104,6

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband YELAPPA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUDLAVV Self Male Nil Nil/Nil
A
VANKATS
WAMY(48)
2 GUDLAVV Wife Female Nil Nil/Nil
A
BALAMMA
(42)
3 GUDLAVV Son Male Nil Nil/Nil
A
MANNEMK
ONDA(21)
4 GUDLAVV Daughter Female Nil Nil/Nil
A
NAGALAX
MI(15)
5 GUDLAVV Brother Male Nil Nil/Nil
A
LAXMAYY
A(50)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319269/000

Household Verification Format Door No:6-106,6

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NAGANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 YEDULA Wife Female Nil Nil/Nil
LAXMAYY
A(48)
2 YEDULA Son Male Nil Nil/Nil
NARESH(19
)
3 YEDULA Son Male Nil Nil/Nil
RAMULU(5
5)
4 YEDULA Son Male Nil Nil/Nil
GANGADA
R(21)
5 YEDULA Daughter Female Nil Nil/Nil
NAGAJYOT
HI(11)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319270/000

Household Verification Format Door No:6-107,6

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband YELLAPPA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NALGOND Self Male Nil Nil/Nil
A
NIRANJAN(
38)
2 NALGOND Wife Female Nil Nil/Nil
A
PARVATH
AMMA(32)
3 NALGOND Son Male Nil Nil/Nil
A
SHIVARAJ
U(14)
4 NALGOND Daughter Female Nil Nil/Nil
A
NAGALAX
MI(19)
5 NALGOND Daughter Female Nil Nil/Nil
A
JYOTHI(11)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319271/000

Household Verification Format Door No:6-108,6

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband YELLAPPA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NALGOND Self Male Nil Nil/Nil
A
VENKATS
WAMY(31)
2 NALGOND Wife Female Nil Nil/Nil
A
SHANTHA
MMA(28)
3 NALGOND Son Male Nil Nil/Nil
A
UPENDAR(
10)
4 NALGOND Son Male Nil Nil/Nil
A
AKASH(6)
5 NALGOND Daughter Female Nil Nil/Nil
A
HEMALAT
HA(3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319272/000

Household Verification Format Door No:6-86,6

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas YES/HP/640013
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KAVALI Self Male Nil Nil/Nil
THIRUPAT
HAIAH(45)
2 KAVALI Wife Female Nil Nil/Nil
LAXMI(36)
3 KAVALI Son Male Nil Nil/Nil
NAGRAJ(22
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319273/000

Household Verification Format Door No:6-86/1,6

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband PENTAREDDY Gas YES/HP/617332
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SAMBIRED Self Male Nil Nil/Nil
DY
VENKATR
EDD(49)
2 SAMBIRED Wife Female Nil Nil/Nil
DY
SHASHIKA
LA(42)
3 SAMBIRED Son Male Nil Nil/Nil
DY
SRIDAR(20)
4 SAMBIRED Son Male Nil Nil/Nil
DY
SRIKANTH
REDDY(24)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319274/000

Household Verification Format Door No:6-89,6

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NALGOND Self Male Nil Nil/Nil
A
MANNEM(
58)
2 NALGOND Wife Female Nil Nil/Nil
A
SHANTHA
MMA(54)
3 NALGOND Son Male Nil Nil/Nil
A
RAMULU(2
7)
4 NALGOND Daughter in Female Nil Nil/Nil
A Law
NIRANJAN
AMMA(22)
5 NALGOND Grand Female Nil Nil/Nil
A Daughter
MADAVI(4)
6 NALGOND Grand Female Nil Nil/Nil
A Daughter
SANGEETH
A(8)
7 NALGOND Grand Female Nil Nil/Nil
A Daughter
NAGALAX
MI(5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.58 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319275/000

Household Verification Format Door No:6-90,6

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband THIRUPATHAIAH Gas YES/HP/634153
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NEREDI Self Male Nil Nil/Nil
MYBU(41)
2 NEREDI Wife Female Nil Nil/Nil
THIRUPAT
HAMMA(26
)
3 NEREDI Son Male Nil Nil/Nil
SANDEEPS
AGAR(9)
4 NEREDI Son Male Nil Nil/Nil
SHIVASAG
AR(16)
5 NEREDI Daughter Female Nil Nil/Nil
SANDYAR
ANI(12)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319276/000

Household Verification Format Door No:6-90/1,6

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KRISHNAYYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NALGOND Self Male Nil Nil/Nil
A
GIRAYYA(
36)
2 NALGOND Wife Female Nil Nil/Nil
A
SHIVALEE
LA(27)
3 NALGOND Son Male Nil Nil/Nil
A
SHANKAR(
10)
4 NALGOND Son Male Nil Nil/Nil
A ANIL(8)
5 NALGOND Daughter Female Nil Nil/Nil
A
ANUSHA(6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319277/000

Household Verification Format Door No:6-83,6

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband VENKATAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NALGOND Self Female Nil Nil/Nil
A
SHIVALEE
LA(30)
2 NALGOND Daughter Female Nil Nil/Nil
A
SANDYA(3)
3 NALGOND Daughter Female Nil Nil/Nil
A
NANDUSH
A(9)
4 NALGOND Daughter Female Nil Nil/Nil
A
ANUSHA(7)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319278/000

Household Verification Format Door No:6-82,LAYPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KRUSHNAYYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NALGOND Self Transgender Nil Nil/Nil
A
SWAMY(33
)
2 NALGOND Wife Female Nil Nil/Nil
A
ANURADH
A(28)
3 NALGOND Daughter Female Nil Nil/Nil
A
SRIDAR(7)
4 NALGOND Daughter Female Nil Nil/Nil
A
SRAVANT
HI(5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319279/000

Household Verification Format Door No:7-170/1,LATPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband VENKATSWAMY Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BOYA Self Female Nil Nil/Nil
VENKATA
MMA(58)
2 BOYA Son Male Nil Nil/Nil
CHENNAY
A(25)
3 BOYA Daughter in Female Nil Nil/Nil
SHIVALEE Law
LA(22)
4 BOYA Grand Female Nil Nil/Nil
NAVYASRI Daughter
(3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319280/000

Household Verification Format Door No:7-170,LATPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband YELAMMA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NALGONA Self Female Nil Nil/Nil
DA
VENKATA
MMA(53)
2 NALGONA Son Male Nil Nil/Nil
DA
SATHISH(3
3)
3 NALGONA Daughter in Female Nil Nil/Nil
DA Law
MANJULA(
28)
4 NALGONA Grand Son Male Nil Nil/Nil
DA
NAGRAJ(11
)
5 NALGONA Grand Female Nil Nil/Nil
DA Daughter
NAGALAX
MI(8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319281/000

Household Verification Format Door No:7-170,LATUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BHANU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil Nil/Nil
H
CHANDYA(
48)
2 MUDAVAT Wife Female Nil Nil/Nil
H
PATNI(44)
3 MUDAVAT Son Male Nil Nil/Nil
H
GOPALA(2
2)
4 MUDAVAT Son Male Nil Nil/Nil
H
BAKYA(17)
5 MUDAVAT Daughter in Female Nil Nil/Nil
H Law
KAVITHA(
20)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.18 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319282/000

Household Verification Format Door No:7-171,LATPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BHANU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Female Nil Nil/Nil
H
JANKU(51)
2 MUDAVAT Son Male Nil Nil/Nil
H
SOMLA(28)
3 MUDAVAT Daughter in Female Nil Nil/Nil
H Law
LAXMI(20)
4 MUDAVAT Grand Son Male Nil Nil/Nil
H BABU(2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319283/000

Household Verification Format Door No:7-172,LATUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BALU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil Nil/Nil
H
RAMULU(3
0)
2 MUDAVAT Wife Female Nil Nil/Nil
H
MARANI(2
8)
3 MUDAVAT Son Male Nil Nil/Nil
H
JAANU(7)
4 MUDAVAT Son Male Nil Nil/Nil
H
SATHISH(5
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319284/000

Household Verification Format Door No:7-173,LATPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC NIL Father/Mother/husband BALAYYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 DOKURU Self Male Nil Nil/Nil
DASHARA
THAM(46)
2 DOKURU Wife Female Nil Nil/Nil
MANJULA(
35)
3 DOKURU Son Male Nil Nil/Nil
RAJSEKHA
R(14)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:5.15 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319287/000

Household Verification Format Door No:6-89,6

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NALGOND Self Male Nil Nil/Nil
A
SALESHW
ARAM(23)
2 NALGOND Wife Female Nil Nil/Nil
A
SARITHA(2
1)
3 NALGOND Son Male Nil Nil/Nil
A
NAGASUS
HANTH(1)
4 NALGOND Brother Male Nil Nil/Nil
A
SRINIVAS(
21)
5 NALGOND Sister in Law Female Nil Nil/Nil
A
PADMAVA
THI(19)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319288/000

Household Verification Format Door No:3-81,6

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NALGOND Son Male Nil Nil/Nil
A
ANILKUM
AR(14)
2 NALGOND Son Male Nil Nil/Nil
A
SRINU(19)
3 NALGOND Brother Male Nil Nil/Nil
A
KRUSHNA
YYA(19)
4 NALGOND Sister in Law Female Nil Nil/Nil
A
BADRAMM
A(39)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319289/000

Household Verification Format Door No:6-108,6

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband PEDDAYELLAPPA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NALGOND Self Male Nil Nil/Nil
A
KONDAYY
A(30)
2 NALGOND Wife Female Nil Nil/Nil
A
SHIVALEE
LA(26)
3 NALGOND Son Male Nil Nil/Nil
A
KARTHIK(2
)
4 NALGOND Daughter Female Nil Nil/Nil
A
ANITHA(1)
5 NALGOND Daughter Female Nil Nil/Nil
A
SUPRAJA(8
)
6 NALGOND Daughter Female Nil Nil/Nil
A
HARIKA(4)
7 NALGOND Daughter Female Nil Nil/Nil
A
BOOMIKA(
6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319291/001

Household Verification Format Door No:7-08,LATTUPALE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband POMLA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil AGRICULT 278597951468
H URE
SOMLA(49) LABOUR
/Nil
2 MUDAVAT Wife Female Nil AGRICULT 995682098541
H URE
BALAMMA LABOUR
(45) /Nil
3 MUDAVAT Son Male Nil DRIVERS/N 252901598974
H il
KRISHNA(2
8)
4 MUDAVAT Daughter in Male Nil DO 924519198266
H Law NOTHING/
YAMUNA(2 Nil
1)
5 MUDAVAT Grand Female Nil Nil/Nil
H Daughter
NIRMALA(
1)
6 MUDAVAT Grand Female Nil Nil/Nil
H Daughter
NIHARIKA(
0)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:1.68/DRY:3.75 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319292/002

Household Verification Format Door No:7-54,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband CHANDHRU Gas YES/Bharath/4050797
Name Connection(Y/N)/Agen./ 7883
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil AGRICULT 988007306734
H URE
GOBEERY LABOUR
A(63) /Nil
2 MUDAVAT Husband Male Nil DRIVERS/N 625070722754
H il
SANKAR(2
8)
3 MUDAVAT Wife Female Nil AGRICULT 222276881860
H URE
JAMUKA(5 LABOUR
9) /Nil
4 MUDAVAT Son Male Nil DRIVERS/N 667031815283
H il
KRISHNA(2
8)
5 MUDAVAT Daughter in Female Nil HOUSE 605151716343
H Law WIFE/Nil
LAXMI(23)
6 MUDAVAT Daughter in Female Nil Nil/Nil 577277372597
H Law
CHITTI(25)
7 MUDAVAT Grand Son Male Nil Nil/Nil 874104254896
H
KARTHIK(4
)
8 MUDAVAT Grand Son Male Nil Nil/Nil 534347966343
H
THARUN(5)
9 MUDAVAT Grand Female Nil Nil/Nil
H Daughter
PARIMALA
(0)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:4.57/DRY:5.22 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319293/001

Household Verification Format Door No:7-9,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband THARYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil AGRICULT 703627743649
H URE
BHASHYA( LABOUR
43) /Nil
2 MUDAVAT Wife Female Nil AGRICULT 303820271685
H URE
SAROJA(38 LABOUR
) /Nil
3 MUDAVAT Son Male Nil DRIVERS/N 830652149712
H il
NARENDH
AR(22)
4 MUDAVAT Son Male Nil Central Govt 506889183580
H Employee/Ni
SRINU(18) l
5 MUDAVAT Son Male Nil STUDENT/ 419966507343
H Nil
VINODH(12
)
6 MUDAVAT Daughter in Female Nil HOUSE 711125124080
H Law WIFE/Nil
NANKA(21)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:1.22/DRY:4.02 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319295/002

Household Verification Format Door No:0-00,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BALU Gas YES/HP/1029474
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Female Nil AGRICULT 534062628549
H URE
MANEMM LABOUR
A(39) /Nil
2 MUDAVAT Son Male Nil STUDENT/ 327705205314
H Nil
LAXMAN(1
8)
3 MUDAVAT Son Male Nil DRIVERS/N 351436914016
H il
SRINU(19)
4 MUDAVAT Son Male Nil DRIVERS/N 690299919967
H il
RAMU(18)
5 MUDAVAT Daughter in Female Nil HOUSE
H Law WIFE/State
SUNITHA(1 Govt
9) Pension
6 MUDAVAT Grand Female Nil Nil/Nil
H Daughter
VEDANJAL
I(1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:1/DRY:4.12 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319296/002

Household Verification Format Door No:8-20,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband POMYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Husband Male Nil State 557738703154
H GovtEmploy
PEERU(35) ee/Nil
2 MUDAVAT Wife Female Nil AGRICULT 596851868517
H URE
SANTHI(34) LABOUR
/Nil
3 MUDAVAT Son Male Nil Nil/Nil 880821747084
H
SANTHOSH
(15)
4 MUDAVAT Daughter Female Nil Nil/Nil 481537533692
H
RAJITHA(1
3)
5 MUDAVAT Daughter Female Nil Nil/Nil 565585508918
H
SUSHILA(1
6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:1/DRY:2.75 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319297/001

Household Verification Format Door No:7-31,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband CHANDHRU Gas YES/HP/1035242
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil AGRICULT 622458175364
H URE
JUMPAL(38 LABOUR
) /Nil
2 MUDAVAT Wife Female Nil AGRICULT 590440230086
H URE
NANKU(36) LABOUR
/Nil
3 MUDAVAT Son Male Nil STUDENT/ 317489312418
H SIVA(10) Nil

4 MUDAVAT Daughter Female Nil STUDENT/ 882182493807

H Nil
MANEESH
A(8)
5 MUDAVAT Daughter Female Nil Nil/Nil 690319178985
H RANI(2)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:1.12/DRY:3.18 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319298/002

Household Verification Format Door No:7-18,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband KANDRYA NAIK Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil AGRICULT 322176023381
H KISTYA URE
NAIK(78) LABOUR
/Nil
2 MUDAVAT Wife Female Nil AGRICULT 951192860208
H URE
MANEMM LABOUR
A(68) /Nil
3 MUDAVAT Son Male Nil Nil/Nil 693734343701
H
KRUSHNA(
22)
4 MUDAVAT Daughter in Female Nil Nil/Nil 413114866892
H Law
DHURGA(2
2)
5 MUDAVAT Grand Female Nil Nil/Nil
H Daughter
SAVITHRI(
0)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.68 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319299/001

Household Verification Format Door No:7-21,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband NARSIMGYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil AGRICULT 611536363917
H URE
POMYA(63) LABOUR
/Nil
2 MUDAVAT Wife Female Nil AGRICULT 819130805712
H URE
GAMSEE(5 LABOUR
8) /Nil
3 MUDAVAT Son Male Nil AGRICULT 291980182328
H URE
RAMUDU(2 LABOUR
8) /Nil
4 MUDAVAT Daughter in Female Nil AGRICULT 508609150621
H Law URE
LAXMI(23) LABOUR
/Nil
5 MUDAVAT Grand Son Male Nil Nil/Nil
H
THIRUPAT
HI(1)
6 MUDAVAT Grand Female Nil Nil/Nil 986553967386
H Daughter
GAYTHRI(4
)
7 MUDAVAT Grand Female Nil Nil/Nil 742555630921
H Daughter
RENUKA(8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:11.92 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319323/002

Household Verification Format Door No:8-12,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband dhasu Gas YES/HP/639859
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath Self Female Nil Central Govt
rajamma(60) Employee/Ni
l
2 mudavath Son Male Nil Nil/Nil 338070070255
krishna(28)

3 mudavath Daughter in Female Nil Nil/Nil 704054615540

vijya(23) Law

4 mudavath Grand Son Male Nil Nil/Nil 735984100485

mohandas(3)

5 mudavath Grand Son Male Nil Nil/Nil 801044982426

ganesh(2)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:2/DRY:2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319441/001

Household Verification Format Door No:9-4,ERRAKUNTATANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband NANU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil Nil/Nil 450308001271
H
GOPAOL(4
8)
2 RAMAVAT Wife Female Nil Nil/Nil
H VALI(34)
3 RAMAVAT Son Male Nil Nil/Nil 975304251839
H
RANESH(18
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.95 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319442/001

Household Verification Format Door No:9-5,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband DULYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ramavath Self Male Nil Nil/Nil 730763906296
vachya(55)

2 ramavath Son Male Nil Nil/Nil

shanker(19)
3 ramavath Sister in Law Female Nil Nil/Nil 901636458776
lali(45)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:6.68 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319443/002

Household Verification Format Door No:9-6,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband DULYa Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil Nil/Nil 298724743995
H
MANYA(45
)
2 RAMAVAT Wife Female Nil Nil/Nil
H
GANGADE
VI(19)
3 RAMAVAT Son Male Nil Nil/Nil
H
BHANUPR
AKASH(2)
4 RAMAVAT Daughter Female Nil Nil/Nil
H
HARITHA(3
)
5 RAMAVAT Mother Female Nil Nil/Nil 754713358067
H
CHAVULI(6
5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.58 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319444/003

Household Verification Format Door No:9-7,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BALYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil Nil/Nil 421987326797
H JANU(60)

2 RAMAVAT Wife Female Nil Nil/Nil 579063363670

H
BADDI(55)
3 RAMAVAT Son Male Nil Nil/Nil
H
REDYa(35)
4 RAMAVAT Daughter Female Nil Nil/Nil
H
SHANTHY(
19)
5 RAMAVAT Daughter in Female Nil Nil/Nil
H Law
SHARADA(
30)
6 RAMAVAT Grand Son Male Nil Nil/Nil
H
SRIKIANT
H(8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.55 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319445/001

Household Verification Format Door No:9-8,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband SANGYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil Nil/Nil 883265972962
H
CHATRU(5
5)
2 RAMAVAT Wife Female Nil Nil/Nil 417928344540
H
SWATHY(5
0)
3 RAMAVAT Son Male Nil Nil/Nil 642170854863
H
PANDU(32)
4 RAMAVAT Daughter in Female Nil Nil/Nil
H Law
CHITTY(28)
5 RAMAVAT Grand Son Male Nil Nil/Nil
H
GOUTAM(9
)
6 RAMAVAT Grand Female Nil Nil/Nil
H gayatry(3) Daughter
7 RAMAVAT Grand Female Nil Nil/Nil
H Daughter
ANUSHKA(
6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:8.85 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319446/002

Household Verification Format Door No:9-9,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband GOBRIA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil Nil/Nil 698751825424
H
MANYA(27
)
2 RAMAVAT Wife Female Nil Nil/Nil 380138896697
H
JOTHY(23)
3 RAMAVAT Son Male Nil Nil/Nil
H SANJU(1)
4 RAMAVAT Daughter Female Nil Nil/Nil
H
RADHIKA(
3)
5 RAMAVAT Mother Female Nil Nil/Nil
H
MUTYALI(
65)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.05 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319447/001

Household Verification Format Door No:9-10,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband SANGYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil Nil/Nil
H PIRU(65)
2 RAMAVAT Wife Female Nil Nil/Nil 921242722066
H
HANMYA(6
0)
3 RAMAVAT Son Male Nil Nil/Nil
H RAVI(14)
4 RAMAVAT Daughter Female Nil Nil/Nil 896352778383
H
GOURY(19)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:7.98 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319448/001

Household Verification Format Door No:9-10/A,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband PIRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil Nil/Nil 446505912561
H
SWHANKE
R(26)
2 RAMAVAT Wife Female Nil Nil/Nil 384570088191
H
SHANTHY(
22)
3 RAMAVAT Son Male Nil Nil/Nil
H
VIKESJH(4)
4 RAMAVAT Son Male Nil Nil/Nil
H
CHARAN(7
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319449/001

Household Verification Format Door No:9-11,LUTTPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband CHATRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil Nil/Nil 328367240803
H RAJU(28)

2 RAMAVAT Wife Female Nil Nil/Nil 719218884310

H
MANNI(26)
3 RAMAVAT Son Male Nil Nil/Nil
H
SRINATH(4
)
4 RAMAVAT Daughter Female Nil Nil/Nil
H
NANDINI(7
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319450/002

Household Verification Format Door No:9-12,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband sangya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil Nil/Nil 561781884407
H TARU(58)

2 RAMAVAT Wife Female Nil Nil/Nil 238242164287

H
MUTYALI(
55)
3 RAMAVAT Son Male Nil Nil/Nil 766236424584
H RAVI(25)

4 RAMAVAT Son Male Nil Nil/Nil

H
SHYANHK
ER(14)
5 RAMAVAT Daughter Female Nil Nil/Nil
H GORI(18)
6 RAMAVAT Daughter in Female Nil Nil/Nil
H Law
SHANTHY(
21)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319451/001

Household Verification Format Door No:9-13,LATTUAPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband TARUI Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil Nil/Nil 794466822490
H
GOVINDU(
28)
2 RAMAVAT Wife Female Nil Nil/Nil
H
MANGAM
MA(23)
3 RAMAVAT Son Female Nil Nil/Nil
H
NaRESH(5)
4 RAMAVAT Daughter Male Nil Nil/Nil
H
ANUSHKA(
1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319452/001

Household Verification Format Door No:9-13,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband taru Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ramavath Self Male Nil Nil/Nil
SOMLA(36)
2 ramavath Wife Female Nil Nil/Nil 206397936360
NILA(34)

3 ramavath Son Male Nil Nil/Nil

ANILOKU
MAR(11)
4 ramavath Daughter Female Nil Nil/Nil
SHARADA(
16)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319453/002

Household Verification Format Door No:9-14,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband PIRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ramavath Self Male Nil Nil/Nil 368828102417
GOPAL(41)

2 ramavath Wife Female Nil Nil/Nil 796094447995

SITAMMA(
35)
3 ramavath Son Male Nil Nil/Nil
PREMKUM
AR(14)
4 ramavath Daughter Female Nil Nil/Nil
SHIRIAHA(
11)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319454/002

Household Verification Format Door No:9-15,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband PIRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil Nil/Nil 474107914161
H
GOVINDU(
37)
2 RAMAVAT Wife Female Nil Nil/Nil 360808852654
H
MANGI(28)
3 RAMAVAT Son Male Nil Nil/Nil
H NAVIN(7)
4 RAMAVAT Daughter Female Nil Nil/Nil
H GITHA(5)
5 RAMAVAT Daughter Female Nil Nil/Nil
H
MANISHA(
11)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.05 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319455/001

Household Verification Format Door No:9-16,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband PIRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAMAVAT Self Male Nil Nil/Nil
H
SRINU(30)
2 RAMAVAT Wife Female Nil Nil/Nil 367151845879
H
LOURY(25)
3 RAMAVAT Son Male Nil Nil/Nil
H
SRIKANTH
(11)
4 RAMAVAT Son Male Nil Nil/Nil
H
SANTOSH(
7)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319456/002

Household Verification Format Door No:9-17,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband KRUSHNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil Nil/Nil 522182672083
H
HARYA(36)
2 MUDAVAT Wife Female Nil Nil/Nil 920545414315
H
MARONI(2
8)
3 MUDAVAT Son Male Nil Nil/Nil 566568264066
H
HANMANT
HGU(15)
4 MUDAVAT Daughter Female Nil Nil/Nil
H
RAJITHA(1
1)
5 MUDAVAT Daughter Female Nil Nil/Nil
H
ANJALI(10)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.8 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319457/001

Household Verification Format Door No:9-18,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband KRUSHNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil Nil/Nil 404939389657
H
BADYA(34)
2 MUDAVAT Wife Female Nil Nil/Nil 617091383430
H
CHITTY(25)
3 MUDAVAT Daughter Female Nil Nil/Nil
H
GAYATRY(
6)
4 MUDAVAT Mother Female Nil Nil/Nil
H
KAMALAM
MA(58)
5 MUDAVAT Father Male Nil Nil/Nil 819308061512
H
KRUSHNA(
60)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:5.78 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319458/002

Household Verification Format Door No:9-18/A,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband KRUSHNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil Nil/Nil 755344818161
H
SAKRU(33)
2 MUDAVAT Wife Female Nil Nil/Nil 598042614345
H
NARAMMA
(28)
3 MUDAVAT Son Male Nil Nil/Nil
H
SRIKANTH
(11)
4 MUDAVAT Daughter Female Nil Nil/Nil
H
SRILATHA(
8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.8 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319459/001

Household Verification Format Door No:9-8,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband RAGHU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SABAVAT Self Female Nil Nil/Nil 897221019963
MANGAM
MA(35)
2 SABAVAT Son Male Nil Nil/Nil
MADHU(12
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:0.98 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319460/001

Household Verification Format Door No:9-19,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband TODYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Female Nil Nil/Nil 721914248876
H RAJI(45)

2 MUDAVAT Son Male Nil Nil/Nil 421722117079

H
RAMESH(2
3)
3 MUDAVAT Daughter Female Nil Nil/Nil
H
SHANTHY(
15)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.95 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319461/001

Household Verification Format Door No:9-20,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband CHATRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil Nil/Nil
H BALU(62)
2 MUDAVAT Wife Female Nil Nil/Nil 977506829020
H
SITAMMA(
58)
3 MUDAVAT Son Male Nil Nil/Nil 414633860657
H
JAHANGIR(
17)
4 MUDAVAT Mother Female Nil Nil/Nil
H
CHAVULI(7
8)
5 MUDAVAT Father Male Nil Nil/Nil
H
CHATRU(8
2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:13.65 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319462/001

Household Verification Format Door No:9-21,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband SRINU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Female Nil Nil/Nil 632990411135
H
SHANTHY(
35)
2 MUDAVAT Son Male Nil Nil/Nil
H
MAHESH(7
)
3 MUDAVAT Son Male Nil Nil/Nil 647417029382
H
MAHENDE
R(10)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.52 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319463/001

Household Verification Format Door No:9-22,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband JANU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil Nil/Nil 604879277681
H
GUNDYA(5
5)
2 MUDAVAT Wife Female Nil Nil/Nil 402312978465
H LALI(48)

3 MUDAVAT Son Male Nil Nil/Nil 564336885736

H
NAGENDR
AM(21)
4 MUDAVAT Daughter Female Nil Nil/Nil 760446046482
H
BHARATH
Y(20)
5 MUDAVAT Daughter Female Nil Nil/Nil
H
SUJATHA(1
9)
6 MUDAVAT Mother Female Nil Nil/Nil
H JAI(70)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:6.52 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319464/002

Household Verification Format Door No:9-23,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband TARUSINGH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Female Nil Nil/Nil 771058439477
H
STAMMA(6
0)
2 MUDAVAT Son Male Nil Nil/Nil 343609460002
H
HANMAnth
u(16)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.88 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319465/002

Household Verification Format Door No:9-24,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband DEVULA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Female Nil Nil/Nil
H
BADDI(70)
2 MUDAVAT Son Male Nil Nil/Nil
H
CHANDRU(
40)
3 MUDAVAT Daughter in Female Nil Nil/Nil
H Law
HANMI(35)
4 MUDAVAT Grand Son Male Nil Nil/Nil
H
GANESH(1
0)
5 MUDAVAT Grand Son Male Nil Nil/Nil
H
MOHAN(12
)
6 MUDAVAT Grand Female Nil Nil/Nil
H Daughter
AKHILA(6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319466/002

Household Verification Format Door No:9-25,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband GUNDYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil Nil/Nil
H
SEVYA(46)
2 MUDAVAT Wife Female Nil Nil/Nil
H
LAXMI(30)
3 MUDAVAT Son Male Nil Nil/Nil
H
CHARAN(3
)
4 MUDAVAT Daughter Female Nil Nil/Nil 234833853713
H
KAVITHA(
18)
5 MUDAVAT Daughter Female Nil Nil/Nil
H
ARUNA(17)
6 MUDAVAT Daughter Female Nil Nil/Nil
H
MAMATHA
(5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.7 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319467/002

Household Verification Format Door No:9-26,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband GUNDYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil Nil/Nil 714286013487
H
SARYA(34)
2 MUDAVAT Wife Female Nil Nil/Nil 525551251308
H
MANNI(32)
3 MUDAVAT Son Male Nil Nil/Nil
H
SUDHAKE
R(10)
4 MUDAVAT Daughter Female Nil Nil/Nil
H
VASANTH
A(68)
5 MUDAVAT Daughter Female Nil Nil/Nil
H
JOTHY(14)
6 MUDAVAT Mother Female Nil Nil/Nil
H
BHAMINI(5
8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:6.85 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319468/000

Household Verification Format Door No:9-27,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband DASU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil Nil/Nil 771158432876
H
BASHA(37)
2 MUDAVAT Wife Female Nil Nil/Nil 512058943832
H
LAXMI(27)
3 MUDAVAT Son Male Nil Nil/Nil
H
LAXMAN(1
0)
4 MUDAVAT Son Male Nil Nil/Nil
H RAVI(7)
5 MUDAVAT Daughter Female Nil Nil/Nil
H
SAROJA(13
)
6 MUDAVAT Daughter Female Nil Nil/Nil 852974055738
H
RAJITHA(1
1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319469/000

Household Verification Format Door No:9-28,LATTEPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband JINGYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil Nil/Nil
H DASU(65)
2 MUDAVAT Wife Female Nil Nil/Nil
H MASRI(6)
3 MUDAVAT Son Male Nil Nil/Nil
H
SHANKER(
16)
4 MUDAVAT Daughter Female Nil Nil/Nil
H
SHARADA(
12)
5 MUDAVAT Daughter Female Nil Nil/Nil
H
SHANTHY(
14)
6 MUDAVAT Daughter in Female Nil Nil/Nil
H Law
SUNITHA(1
9)
7 MUDAVAT Grand Son Male Nil Nil/Nil
H
TARUN(1)
8 MUDAVAT Grand Female Nil Nil/Nil
H Daughter
ANURADH
A(2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.22 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319470/000

Household Verification Format Door No:9-20/1,LATTUPALLY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband BALU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil Nil/Nil
H RAVI(23)
2 MUDAVAT Wife Female Nil Nil/Nil
H
JAMMA(22)
3 MUDAVAT Son Male Nil Nil/Nil
H AKHIL(3)
4 MUDAVAT Daughter Female Nil Nil/Nil
H ROJA(4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319473/002

Household Verification Format Door No:8-19,yerrakunta tanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband narsngya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavat Self Male Nil Nil/Nil 494831190183
RAJYA(60)

2 mudavat Wife Female Nil Nil/Nil 743137775943

SITA(50)

3 mudavat Son Male Nil Nil/Nil 817358020416

GOPAL(38)

4 mudavat Son Male Nil Nil/Nil 545657524821

SHIVA(17)

5 mudavat Son Male Nil Nil/Nil 444088402900

PANDA(19)

6 mudavat Daughter in Female Nil Nil/Nil 919492654682

MANEMM Law
A(35)
7 mudavat Peternal Female Nil Nil/Nil 521824044462
ALIVELU(2 Grand
1) Mother
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:12.15 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319474/001

Household Verification Format Door No:8-20,YERRAKUNTA TANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband KANDRYA Gas YES/HP/637587
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MADAVAT Self Male Nil OWN 385072253822
GPOPAL(45 AGRICULT
) URE
/Nil
2 MADAVAT Wife Female Nil OWN 554261709967
BHARATHI AGRICULT
(42) URE
/Nil
3 MADAVAT Son Male Nil Nil/Nil 229878217312
VENKATES
H(21)
4 MADAVAT Son Male Nil DO 410683261774
VAMSI(32) NOTHING/
Nil
5 MADAVAT Son Male Nil DO 848367562292
SRINIVAS( NOTHING/
21) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.12 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319475/000

Household Verification Format Door No:8-29,YERRAKUNTA TANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband REDYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil OWN 356014455758
PEERU(65) AGRICULT
URE
/Nil
2 MUDAVAT Wife Female Nil Nil/Nil
SONI(56)
3 MUDAVAT Son Male Nil Nil/Nil
PANDA(32)
4 MUDAVAT Daughter in Female Nil Nil/Nil
HASLI(27) Law
5 MUDAVAT Peternal Female Nil Nil/Nil
BHARATHI Grand
(12) Mother
6 MUDAVAT Peternal Female Nil Nil/Nil
CHITTI(16)Grand
Mother
7 MUDAVAT Peternal Female Nil Nil/Nil
MANJULA( Grand
10) Mother
8 MUDAVAT Grand Son Male Nil Nil/Nil
NARESH(13
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.68 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319476/002

Household Verification Format Door No:8-80,YERRAKUNTA TANDA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband JATRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Female Nil Nil/Nil 653377632760
LAKSHMI(
68)
2 MUDAVAT Daughter in Female Nil Nil/Nil 610067017893
CHANDI(32 Law
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319477/002

Household Verification Format Door No:8-31,yerrakunta tanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband reddya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavat Self Male Nil Nil/Nil
laalu(42)
2 mudavat Wife Female Nil Nil/Nil
raaji(32)
3 mudavat sai Son Male Nil Nil/Nil
kiran(13)
4 mudavat Daughter Female Nil Nil/Nil
saritha(12)
5 mudavat Daughter Female Nil Nil/Nil
sharadha(21)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.7 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319478/002

Household Verification Format Door No:8-32,yerrakunta tanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband kesya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavat Self Male Nil Nil/Nil
manya(37)
2 mudavat Wife Female Nil Nil/Nil
mangli(32)
3 mudavat Son Male Nil Nil/Nil
shivakumar(
6)
4 mudavat Daughter Female Nil Nil/Nil 520538833490
bindu(4)

5 mudavat Daughter Female Nil Nil/Nil 872130191365

manisha(8)

6 mudavat Daughter Female Nil Nil/Nil 490906649645

shirisha(10)

7 mudavat Mother Female Nil Nil/Nil 717921598709

gamsi(62)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.78 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319479/002

Household Verification Format Door No:8-33,yerrakunta tanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband badru Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavat m Self Male Nil Nil/Nil 764967867644
bigini(62)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0319480/001

Household Verification Format Door No:7-80,yerrakunta tanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband kandrya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavat Self Male Nil OWN 222952553017
thukya(40) AGRICULT
URE
/Nil
2 mudavat Wife Female Nil OWN 748368823275
thulasi(38) AGRICULT
URE
/Nil
3 mudavat Daughter Female Nil Nil/Nil 865782289098
mamatha(12)

4 mudavat Daughter Female Nil Nil/Nil 455020032272

shirisha(13)

5 mudavat Daughter Female Nil Nil/Nil 626762264582

vaishali(1)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.28 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319480/003

Household Verification Format Door No:9-38,yerrakunta tanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavat Self Male Nil Nil/Nil
thukya(40)
2 mudavat Wife Female Nil Nil/Nil 844488695410
shanti(38)

3 mudavat Daughter Female Nil Nil/Nil

pooja(9)
4 mudavat Daughter Female Nil Nil/Nil 655220499304
sunitha(14)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319481/001

Household Verification Format Door No:8-33,yerragunta tanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband badru Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 madavat Self Male Nil OWN 641701143554
hranya(37) AGRICULT
URE
/Nil
2 madavat Wife Female Nil OWN 207948180780
anji(33) AGRICULT
URE
/Nil
3 madavat Son Male Nil Nil/Nil 825295662171
srikanth(11)

4 madavat Son Male Nil Nil/Nil 439011362670

srishanth(6)

5 madavat Daughter Female Nil Nil/Nil 498110445726

nandini(7)

6 madavat Daughter Female Nil Nil/Nil 565095674012

saritha(14)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.65 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319482/001

Household Verification Format Door No:8-36,yerrakunta tanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband devula Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavat Self Male Nil OWN 736415391087
shankar(37) AGRICULT
URE
/Nil
2 mudavat Wife Female Nil OWN 305005678464
mangli(35) AGRICULT
URE
/Nil
3 mudavat Son Male Nil Nil/Nil 831743842231
naresh(15)

4 mudavat Daughter Female Nil Nil/Nil 553190941581

sunitha(12)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319483/002

Household Verification Format Door No:8-36,yerrakunta tanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband devula Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavat Wife Female Nil Nil/Nil 476467336713
saali(27)

2 mudavat Son Male Nil Nil/Nil 539756177479

eeswar(29)

3 mudavat Daughter Female Nil Nil/Nil 301881925821

pooja(3)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319484/001

Household Verification Format Door No:8-36,yerrakunta thanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband lingya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavat Self Male Nil OWN 290549957828
devula(63) AGRICULT
URE
/Nil
2 mudavat Wife Female Nil Nil/Nil 200076688518
heeri(53)

3 mudavat Son Male Nil Nil/Nil

madhu(4)
4 mudavat Son Male Nil Nil/Nil 912625598193
krishna(23)

5 mudavat Daughter Female Nil Nil/Nil 643546044210

anusha(7)

6 mudavat Daughter in Female Nil Nil/Nil 283330773601

kamalamma( Law
21)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:7.92 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319485/001

Household Verification Format Door No:8-43,yerrakunta tanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband bhikya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 nudavat Self Male Nil Nil/Nil 337912354200
heerya(34)

2 nudavat Wife Female Nil Nil/Nil 495634801241

shivamma(3
0)
3 nudavat Son Male Nil Nil/Nil 695976015101
ranchandar(8
)
4 nudavat Daughter Female Nil Nil/Nil 348783346300
shireesha(12
)
5 nudavat Daughter Female Nil Nil/Nil 585898177439
maheswari(1
0)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.88 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319486/001

Household Verification Format Door No:816/33,yerragunta tanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband chandya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavat Wife Female Nil OWN
chinna AGRICULT
mangamma( URE
41) /Nil
2 mudavat Wife Female Nil OWN 959291776133
pedda AGRICULT
mangamma( URE
42) /Nil
3 mudavat Son Male Nil Nil/Nil 383660211188
venkatesh(20
)
4 mudavat Son Male Nil Nil/Nil 738723896187
srinu(16)

5 mudavat Daughter Female Nil Nil/Nil 551849092438

lakshmi(12)

6 mudavat Father in Male Nil OWN 393462558916

surya(45) Law AGRICULT
URE
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319487/001

Household Verification Format Door No:8-40,yerrakunta tanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband chandya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavat Self Male Nil Nil/Nil 970646686073
darya(59)

2 mudavat Wife Female Nil Nil/Nil 310050589419

mudvat(56)

3 mudavat Son Male Nil Nil/Nil 388236566728

lakshman(28
)
4 mudavat Son Male Nil Nil/Nil 585975291667
suresh(21)

5 mudavat Daughter in Female Nil Nil/Nil 837854318307

lakshmi(26) Law

6 mudavat Peternal Female Nil Nil/Nil

gaethri(1) Grand
Mother
7 mudavat Grand Son Male Nil Nil/Nil 858442531215
charan(5)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.3 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319488/002

Household Verification Format Door No:8-41,yerrakunta tanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband sankiraiah Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavat Self Male Nil Nil/Nil
jaaie(80)
2 mudavat Daughter in Female Nil Nil/Nil
shanti(21) Law
3 mudavat Daughter in Female Nil Nil/Nil
gori(43) Law
4 mudavat Peternal Female Nil Nil/Nil
nandini(3) Grand
Mother
5 mudavat Peternal Female Nil Nil/Nil
shirisha(5) Grand
Mother
6 mudavat Grand Son Male Nil Nil/Nil
hanmanthu(2
4)
7 mudavat Grand Son Male Nil Nil/Nil
raju(15)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0.68 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319489/002

Household Verification Format Door No:4-42,yerrakuntla tanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband vaalya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavat Self Male Nil Nil/Nil 850880144397
peeeru(33)

2 mudavat Wife Female Nil Nil/Nil 840606498947

keeslee(29)

3 mudavat Son Male Nil Nil/Nil 623628872636

srinu(20)

4 mudavat Daughter Female Nil Nil/Nil 468682812119

sujatha(10)

5 mudavat Daughter Female Nil Nil/Nil

mownika(12
)
6 mudavat Mother Female Nil Nil/Nil 536972079235
haslee(70)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.08 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319490/002

Household Verification Format Door No:8-43,yerrakunta tanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband chandya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavat Self Male Nil OWN 311081557754
bikya(68) AGRICULT
URE
/Nil
2 mudavat Wife Female Nil Nil/Nil 572519953469
douvli(58)

3 mudavat Son Male Nil OWN 816282101914

krishna(32) AGRICULT
URE
/Nil
4 mudavat Daughter in Female Nil Nil/Nil
anjamma(27) Law
5 mudavat Peternal Female Nil Nil/Nil 416321420799
nandini(8) Grand
Mother
6 mudavat Grand Son Male Nil Nil/Nil
madhu(6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.95 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319491/002

Household Verification Format Door No:8-45,yerrakunta tanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband chandya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavat Self Male Nil Nil/Nil
matru(60)
2 mudavat Wife Female Nil Nil/Nil
banny(52)
3 mudavat Son Male Nil Nil/Nil
narsmuiha(1
9)
4 mudavat Daughter Female Nil Nil/Nil
shanti(18)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319492/002

Household Verification Format Door No:8-43,yerrakunta tanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband bikya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavat Self Male Nil OWN 679221253602
tavuru(37) AGRICULT
URE
/Nil
2 mudavat Wife Female Nil Nil/Nil 484724246312
anji(32)

3 mudavat Son Male Nil Nil/Nil 877188550909

shiva(16)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.8 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319493/002

Household Verification Format Door No:8-74,yerrakunta tanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband maalya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavat Self Female Nil Nil/Nil 482269420253
magemma(4
2)
2 mudavat Daughter Female Nil Nil/Nil 944919745615
saijyothi(15)

3 mudavat Daughter Female Nil Nil/Nil 497412957048

lakshmamma
(15)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.28 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319494/002

Household Verification Format Door No:8-44,yerrakunta tanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband dakya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavat Self Female Nil Nil/Nil 566110593951
anjamma(40)

2 mudavat Son Male Nil Nil/Nil 355617411788

ravi(20)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319495/002

Household Verification Format Door No:825/33,yerrakunta tanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband darjya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavat Wife Female Nil Nil/Nil
naramma(27
)
2 mudavat Son Male Nil Nil/Nil 261454706529
rahul(6)

3 mudavat Daughter Female Nil Nil/Nil

lavvnya(10)
4 mudavat Father in Male Nil Nil/Nil
gopal(30) Law
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.95 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319501/001

Household Verification Format Door No:2-11,gollageri

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband narayana reddy Gas YES/HP/618285
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 pantulla Self Male Nil Nil/Nil 643206283279
pantula
tirupati
reddy(52)
2 pantulla p Wife Female Nil Nil/Nil
saritha(33)
3 pantulla p Wife Female Nil Nil/Nil
radha(15)
4 pantulla Wife Female Nil Nil/Nil
chandrakala(
42)
5 pantulla Son Male Nil Nil/Nil
nitish kumar
reddy(12)
6 pantulla sai Son Male Nil Nil/Nil
dathakumar
reddy(15)
7 pantulla sai Son Female Nil Nil/Nil
teja
reddy(11)
8 pantulla p Son Male Nil Nil/Nil
abilasah
reddy(15)
9 pantulla p Daughter Female Nil Nil/Nil
varsha(9)
10 pantulla p Daughter Female Nil Nil/Nil
shirisha(18)P
WD: Y &
Sadaran
No:2326
11 pantulla p Brother Male Nil Nil/Nil
balakrishnar
eddy(49)
12 pantulla Brother Male Nil Nil/Nil
sreenivasred
dy(43)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:8.3/DRY:13.68 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319502/002

Household Verification Format Door No:2-212,gollageri

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband ayyapureddy Gas YES/HP/639169
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 vavilla v Self Male Nil DO 823994362889
mohan NOTHING/
reddy(61)P Nil
WD: Y &
Sadaran
No:1418939
0140113023
2 vavilla v Husband Female Nil DO 970009784309
syamalamma NOTHING/
(58) Nil
3 vavilla v Son Male Nil DAILY 978554325448
ayyapureddy WAGES
(25) LABOUR/N
il
4 vavilla v Son Male Nil Nil/Nil 235969797751
mahender
reddy(22)
5 vavilla y hari Grand Female Nil Nil/Nil 478531453565
priya(12) Daughter

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319503/001

Household Verification Format Door No:2-10,gollageri

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband hanuman singh Gas YES/HP/613602
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath m Self Male Nil DAILY 435759796918
pratap WAGES
singh(47) LABOUR/N
il
2 mudavath Wife Female Nil DO 670815168936
sunita NOTHING/
bai(37) Nil
3 mudavath m Son Male Nil STUDENT/ 462793211577
santosh(19) Nil

4 mudavath Son Male Nil STUDENT/ 482669616308

ma vijay(15) Nil

5 mudavath m Daughter Female Nil STUDENT/ 929880017343

shirisha(18) Nil

6 mudavath n Brother in Male Nil DO 914711700730

krishna(24) Law NOTHING/
Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed YES
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319504/001

Household Verification Format Door No:2-9,gollageri

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband narayana Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 kompala Self Female Nil DO 335397903705
kompala NOTHING/
venkatamma Nil
(70)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0319505/002

Household Verification Format Door No:2-8,golla geri

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband hanuman singh Gas YES/HP/619608
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath m Self Male Nil DAILY
sardar WAGES
singh(39) LABOUR/N
il
2 mudavath Wife Female Nil HOUSE 353324723573
jamunabai(2 WIFE/Nil
8)
3 mudavath m Daughter Female Nil STUDENT/ 515200486278
aishwarya(6) Nil

4 mudavath m Son in Law Male Nil DAILY 581987576921

ragavendra(1 WAGES
7) LABOUR/N
il
5 mudavath m Mother Female Nil DO 765257292301
tara bai(70) NOTHING/
Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319506/001

Household Verification Format Door No:1-88,gollageri

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband narayan Gas YES/HP/618280
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 nambi Self Male Nil Nil/Nil
anjanelu(34)
2 nambi Wife Female Nil Nil/Nil
anitha(28)
3 nambi Son Male Nil Nil/Nil
ravicharan(6
)
4 nambi Daughter Female Nil Nil/Nil
sreedevi(8)
5 nambi Daughter Female Nil Nil/Nil
sweta(4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319507/002

Household Verification Format Door No:1-87,gollageri

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband narayana Gas YES/HP/631929
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 poodathu p Self Male Nil State Govt
keshavaiah(3 Project
4) Employee
/Nil
2 poodathu p Wife Transgender Nil Nil/Nil 867011354089
jyothi(30)

3 poodathu p Son Male Nil Nil/Nil 843045907657

sreedar(5)

4 poodathu p Daughter Female Nil Nil/Nil 520730547825

ragapriya(10
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319508/001

Household Verification Format Door No:1-86,golageri

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband narayana Gas YES/HP/632859
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 poodatta p Self Male Nil Nil/Nil
sreenivasulu(
36)
2 poodatta p Wife Female Nil Nil/Nil
vasundara(2
7)
3 poodatta p Son Male Nil Nil/Nil
nitish
kumar(14)
4 poodatta Son Male Nil Nil/Nil
naveen
kumar(9)
5 poodatta Daughter Female Nil Nil/Nil
mounika(10)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:2.6/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319509/001

Household Verification Format Door No:1-84,near temple

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband narayana achari Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 yaroju m Self Male Nil Nil/Nil
balarajuacha
ri(43)
2 yaroju Wife Female Nil Nil/Nil
rajeswari(39)
3 yaroju m Son Male Nil Nil/Nil
ajay
kumar(16)
4 yaroju m Son Male Nil Nil/Nil
sanjai
kumar(15)
5 yaroju m Brother Male Nil Nil/Nil
shantaiah(32
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319511/001

Household Verification Format Door No:1-83/1,gollageri

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband goopaiah achari Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 kapoju k Self Male Nil Nil/Nil 898928407784
aramachari(8
2)
2 kapoju k Son Male Nil Nil/Nil 587082252809
vijay bhaskar
achari(44)
3 kapoju k Son Male Nil Nil/Nil 405511581982
sreedara
chari(39)
4 kapoju k Daughter in Female Nil Nil/Nil 223031119579
suguna(30) Law

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319512/001

Household Verification Format Door No:2-13/1,gollapalli

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband ramreddy Gas YES/Indane/279
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mavilla v Self Male Nil Nil/Nil
krishnareddy
(38)
2 mavilla v Wife Female Nil Nil/Nil
sunitha(28)
3 mavilla v Son Male Nil Nil/Nil
tanush
reddy(4)
4 mavilla v Son Male Nil Nil/Nil
tarun kumar
reddy(8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319513/002

Household Verification Format Door No:2-13,gollageri

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband ayyapureddy Gas YES/HP/610728
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 vvilla ram Self Male Nil OWN 651224948797
reddy v ram AGRICULT
reddy(64) URE
/Nil
2 vvilla ram Wife Female Nil OWN 946144564225
reddy v AGRICULT
anasuyamma URE
(52) /Nil
3 vvilla ram Son Male Nil OTHERS(P
reddy ROVIDE
nagireddy(42 DETAILS)/
) Nil
4 vvilla ram Daughter in Female Nil Nil/Nil 843645163756
reddy Law
manjula(35)
5 vvilla ram Grand Son Male Nil Nil/Nil 512056400304
reddy v
arunkumar(9
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.65 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319514/002

Household Verification Format Door No:2-14,gollageri

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband bakka balaiah Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 bakka b Self Male Nil OWN
ramachandra AGRICULT
iah(40) URE
/Nil
2 bakka b Wife Female Nil Nil/Nil 484832440462
satyamma(2
7)
3 bakka Son Male Nil Nil/Nil 983247353747
balakrishna(
20)
4 bakka Son Male Nil Nil/Nil 482263607299
saiteja(11)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:5.12 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319517/002

Household Verification Format Door No:2-19,gollageri

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband chinna ramulu Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 bakka Self Male Nil Nil/Nil
anjanelu
anjaneyelu(5
6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0319518/002

Household Verification Format Door No:2-19/1,gollageri

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband yellaiah Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 bakka bakka Self Male Nil MIGRATED
tirupataiah(4 LABOUR/N
0) il
2 bakka bakka Wife Female Nil MIGRATED
jayamma(21) LABOUR/N
il
3 bakka Wife Female Nil MIGRATED
padma(25) LABOUR/N
il
4 bakka Son Male Nil STUDENT/
rajesh(13) Nil
5 bakka Son Male Nil DO
harshavardha NOTHING/
n(3) Nil
6 bakka Son Female Nil DO
charan(4) NOTHING/
Nil
7 bakka Daughter Female Nil HOUSE
rajitha(7) WIFE/Nil
8 bakka b Daughter Female Nil STUDENT/
sreelatha(5) Nil
9 bakka b Mother Female Nil MIGRATED
laxmamma(6 LABOUR/N
8) il
10 bakka Brother Male Nil STUDENT/
anandha(31) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.95 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319519/001

Household Verification Format Door No:2-20,gollacolony

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband yellaiah Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 bakka bakka Self Male Nil MIGRATED 296260786872
nagaiah(41) LABOUR/N
il
2 bakka b Wife Female Nil Nil/Nil 921827078958
nagamma(36
)
3 bakka Son Male Nil Nil/Nil 226345690887
sreesailem(1
3)
4 bakka b Son Male Nil Nil/Nil 385104723795
sivakumar(4)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319520/002

Household Verification Format Door No:2-21,gollageri

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband laxmaiah Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 kandi k Self Female Nil DAILY 921402665981
venkatamma WAGES
(53) LABOUR/N
il
2 kandi k Son Male Nil OWN 510135650746
nagauiah(33) AGRICULT
URE
/Nil
3 kandi Daughter in Female Nil DAILY 736565734494
anitha(28) Law WAGES
LABOUR/N
il
4 kandi Grand Female Nil Nil/Nil 913058001000
nageswari(1) Daughter

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.75 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319521/002

Household Verification Format Door No:2-22,goolageri

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband nagaiah Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 kandi Self Male Nil Nil/Nil
narayana(49)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0319522/002

Household Verification Format Door No:2-23,golla geri

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband nagaiah Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 kandi Wife Female Nil DAILY 369871695374
CHENNAIA WAGES
H(52) LABOUR/N
il
2 kandi Son Male Nil ANIMAL 389934084950
nagender(16) HERDER/Ni
l
3 kandi Daughter Female Nil DAILY 969122729828
sansosha(12) WAGES
LABOUR/N
il
4 kandi k Sister Male Nil DO 277325987012
venkataiah(6 NOTHING/
3) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319523/002

Household Verification Format Door No:2-24,99

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband no name Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mekala Self Male Nil Nil/Nil
naganna
naganna(58)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0319524/001

Household Verification Format Door No:2-25,gollapalli

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband balaiah Gas YES/HP/626376
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 muddam m Self Male Nil OWN
sreenivasulu( AGRICULT
40) URE
/Nil
2 muddam m Wife Female Nil DAILY 263131032359
shantamma( WAGES
38) LABOUR/N
il
3 muddam m Son Male Nil STUDENT/ 825664493102
mahesh(12) Nil

4 muddam Son Male Nil STUDENT/ 816562541276

pavankumar( Nil
14)
5 muddam Mother Female Nil DO 998062390655
buchamma(5 NOTHING/
8) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.25 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319525/002

Household Verification Format Door No:2-26,99

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband balaiah Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 muddam m Self Male Nil OWN 426616538019
nagaiah(29) AGRICULT
URE
/Nil
2 muddam m Wife Female Nil DAILY 497277110541
padma(28) WAGES
LABOUR/N
il
3 muddam m Daughter Female Nil STUDENT/ 260833254388
chandana(5) Nil

4 muddam m Daughter Female Nil STUDENT/ 838001554816

jyothi(4) Nil

5 muddam Daughter Female Nil STUDENT/ 398146974722

maheswari(9 Nil
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.58 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319526/001

Household Verification Format Door No:2-27,gola geri

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband narasimha reddy Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 kamatam k Self Female Nil OWN 840340142804
manemma(5 AGRICULT
1) URE
/Nil
2 kamatam Son Male Nil OWN
rajavardhan AGRICULT
reddy(32) URE
/Nil
3 kamatam Son Male Nil OWN
harshavardha AGRICULT
n reddy(35) URE
/Nil
4 kamatam k Daughter in Female Nil OWN
saritha(26) Law AGRICULT
URE
/Nil
5 kamatam Daughter in Female Nil OWN
laxmi(30) Law AGRICULT
URE
/Nil
6 kamatam Grand Son Male Nil STUDENT/
navadeep Nil
reddy(3)
7 kamatam Grand Son Male Nil STUDENT/
gangadar Nil
reddy(7)
8 kamatam Grand Female Nil STUDENT/
gayatri(4) Daughter Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:1.62/DRY:8.48 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319527/002

Household Verification Format Door No:1-85,golla geri

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband venugopal Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 nambi n Self Female Nil DO 533687070426
sugunamma( NOTHING/
51) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0319528/001

Household Verification Format Door No:99,99

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband narayanareddy Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 gujja g Self Male Nil OWN 219734921175
surareddy(45 AGRICULT
) URE
/Nil
2 gujja Wife Female Nil HOUSE 495091936347
sugunamma( WIFE/Nil
40)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319529/001

Household Verification Format Door No:99,99

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband narayanareddy Gas YES/HP/625562
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 gujja g Self Male Nil OWN 532854068258
subbareddy( AGRICULT
40) URE
/Nil
2 gujja Wife Female Nil OWN
nagamani(37 AGRICULT
) URE
/Nil
3 gujja satish Son Male Nil STUDENT/
reddy(20) Nil
4 gujja vinodh Son Male Nil STUDENT/
reddy(17) Nil
5 gujja Mother Female Nil DO
manemma(7 NOTHING/
0) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:5.6 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319531/001

Household Verification Format Door No:101/5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BUCHAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MANDHAD Self Male Nil OWN 415598573572
I AGRICULT
MANDHAD URE
I /Nil
KONDAIA
H(46)PWD:
Y & Sadaran
No:189/13.6
91
2 MANDHAD Wife Female Nil OWN 299117531226
I AGRICULT
ANJANAM URE
MA(44) /Nil
3 MANDHAD Son Male Nil STUDENT/
I Nil
NAGARAJ
U(14)
4 MANDHAD Daughter Female Nil DO
I NOTHING/
NAGAMM Nil
A(24)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:5.88 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319532/002

Household Verification Format Door No:102/5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband PEDDA KURMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VANKAM Self Male Nil AGRICULT 895023133145
KARRENN URE
A(65) LABOUR
/Nil
2 VANKAM Wife Female Nil AGRICULT
MASAMM URE
A(55) LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.52 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319533/002

Household Verification Format Door No:103/5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband MASAIAH Gas YES/HP/623959
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MANDHAD Self Male Nil DO 663854117142
I NOTHING/
MANDHAD Nil
I
BHUCHAN
NA(75)
2 MANDHAD Wife Female Nil HOUSE 294001654788
I WIFE/Nil
BUDDANN
A(65)
3 MANDHAD Grand Son Male Nil OWN
I AGRICULT
RAMULU(2 URE
1) /Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.72 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319534/002

Household Verification Format Door No:102/5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband PEDDA KURMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VANKAM Self Male Nil AGRICULT 894528010986
VANKAM URE
BUSHAIAH LABOUR
(45) /Nil
2 VANKAM Wife Female Nil AGRICULT 293834858261
VENKATA URE
MMA(35) LABOUR
/Nil
3 VANKAM Son Male Nil AGRICULT
KESHAVU URE
LU(16) LABOUR
/Nil
4 VANKAM Daughter Female Nil STUDENT/
ANITHA(12 Nil
)
5 VANKAM Daughter Female Nil DAILY
KAVITHA( WAGES
16) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.52 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319536/001

Household Verification Format Door No:105/5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MANDHAD Self Male Nil AGRICULT 579537079370
I URE
MANDHAD LABOUR
I /Nil
SRISHYLA
M(48)
2 MANDHAD Daughter Female Nil DAILY 312206127714
I WAGES
SHIRISHA( LABOUR/N
17) il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.18 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319537/001

Household Verification Format Door No:105/5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MANDHAD Self Male Nil AGRICULT 268240193791
I URE
MANDHAD LABOUR
I /Nil
MALLAIAH
(36)
2 MANDHAD Wife Female Nil ANIMAL 301758273629
I HERDER/Ni
BHIMAIAH l
(32)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319538/002

Household Verification Format Door No:106/5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PENDEM Self Female Nil DAILY 335105542130
PENDEM WAGES
MUSHILA LABOUR/N
MMA(55) il
2 PENDEM Son Male Nil ANIMAL 259887311462
NAGARAJ HERDER/Ni
U(23) l
3 PENDEM Daughter Female Nil DAILY
RENUKA(1 WAGES
7) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319539/001

Household Verification Format Door No:107/5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband JANGAIAH Gas YES/HP/623954
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAGANI Self Female Nil State Govt
MAGANI Project
ANJANAM Employee
MA(45) /Nil
2 MAGANI Daughter Female Nil STUDENT/
REVATHI(1 Nil
1)
3 MAGANI Daughter Female Nil OTHER 683387829409
BARATHI(2 SKILLED
4) WORKERS/
Nil
4 MAGANI Son in Law Male Nil MIGRATED
DHARMES LABOUR/N
H(27) il
5 MAGANI Grand Son Male Nil STUDENT/
YAGNESH Nil
WAR(24)
6 MAGANI Grand Female Nil DO
HINDHU(3) Daughter NOTHING/
Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319540/001

Household Verification Format Door No:108/5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KONDAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 DASARLA Self Male Nil DAILY 418558691109
DASARLA WAGES
GOPAL(43) LABOUR/N
il
2 DASARLA Wife Female Nil DAILY 720813984346
LALITHAM WAGES
MA(41) LABOUR/N
il
3 DASARLA Son Male Nil Nil/Nil
SRI
KRISHNA(1
9)
4 DASARLA Son Male Nil Nil/Nil
RAJ
KUMAR(12
)
5 DASARLA Son Male Nil DAILY
RAMULU(2 WAGES
4) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:21 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319541/001

Household Verification Format Door No:109/5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband VENKAT REDDY Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NELLIKAN Self Male Nil OWN 301595333765
TI AGRICULT
NELLIKAN URE
TI /Nil
RAMREDD
Y(58)
2 NELLIKAN Wife Female Nil OWN 853973690010
TI AGRICULT
PREMALA URE
THA(48) /Nil
3 NELLIKAN Son Male Nil Nil/Nil
TI
SATHISH
REDDY(25)
4 NELLIKAN Son Male Nil Nil/Nil
TI
SANTHOSH
REDDY(24)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:1.42/DRY:5.15 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319542/002

Household Verification Format Door No:110/5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALASWAMY Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PASUPULA Self Male Nil MIGRATED 848925972409
PASUPULA LABOUR/N
GANESH(2 il
7)
2 PASUPULA Wife Female Nil HOUSE 231093950688
ISHWARY WIFE/Nil
A(21)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319543/001

Household Verification Format Door No:111/5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 DASARLA Self Male Nil DO 324713112552
DASARLA NOTHING/
KURMAIA Nil
H(41)
2 DASARLA Wife Female Nil DAILY 869817734221
JAYAMMA WAGES
(31) LABOUR/N
il
3 DASARLA Son Male Nil DO
JAYARAM NOTHING/
ULU(16) Nil
4 DASARLA Daughter Female Nil Nil/Nil
CHANDRIK
A(5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319544/001

Household Verification Format Door No:112/5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas YES/HP/627104
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 DASARLA Self Male Nil PSU 567363775383
DASARLA Employee/Ni
GOKARAIA l
H(55)
2 DASARLA Wife Female Nil HOUSE 418270137896
SULOCHA WIFE/Nil
NA(45)
3 DASARLA Daughter Female Nil STUDENT/
SOUNDAR Nil
YA(21)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319545/001

Household Verification Format Door No:113/5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARAYANA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAROJU Self Male CARPENTE Nil/Nil 728310620703
MAROJU R
BRAMHAI
AH(60)
2 MAROJU Wife Female Nil HOUSE
BALISHWA WIFE/Nil
RAMMA(55
)
3 MAROJU Grand Female Nil STUDENT/
HARIKA(4) Daughter Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.02 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319546/001

Household Verification Format Door No:113/5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BRAMAIAHA Gas YES/HP/636499
Name CHARY Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAKOJU Self Male CARPENTE Nil/Nil 512548866305
JALANDAR R
A(32)
2 MAKOJU Wife Female Nil Nil/Nil 722575747193
RAJESHWA
RI(31)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319548/002

Household Verification Format Door No:113-5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BRAMAYYA Gas NIL/-/
Name CHARY Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAROJU Self Male Nil DAILY 600805333527
YUGANDA WAGES
RA LABOUR/N
CHARY(34) il
2 MAROJU Wife Female Nil Nil/Nil 267763813660
BHARAGA
VI(32)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319549/001

Household Verification Format Door No:114-5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband MALLAYA Gas YES/HP/635730
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MARAJU Self Female Nil HOUSE 834151355677
VARALAK WIFE/Nil
SHMI(40)
2 MARAJU Son Male Nil DAILY
NARESH(28 WAGES
) LABOUR/N
il
3 MARAJU Daughter in Female Nil Nil/Nil 380823674806
JYOTHI(21) Law

4 MARAJU Grand Son Male Nil Nil/Nil

KARTHIK(1
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319550/002

Household Verification Format Door No:115,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband LAXMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDDAM Self Female Nil DAILY 878501748664
MANEMM WAGES
A(53) LABOUR/N
il
2 MUDDAM Daughter Female Nil Nil/Nil 669670898215
CHENNAM
MA(38)
3 MUDDAM Grand Son Male Nil Nil/Nil
SAI
PRAVEEN(
6)
4 MUDDAM Grand Female Nil Nil/Nil 747993067633
NANDINI(1 Daughter
3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319551/001

Household Verification Format Door No:116-5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas YES/HP/422273
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BAKKA Self Male Nil Nil/Nil 847979761759
BAKKAYY
A(49)
2 BAKKA Wife Female Nil DAILY 451033139838
BALAMMA WAGES
(44) LABOUR/N
il
3 BAKKA Son Male Nil Nil/Nil
SRINU(18)
4 BAKKA Son Male Nil Nil/Nil 612777280582
NAGARAJ
U(28)
5 BAKKA Son Male Nil Nil/Nil 492515106724
SRISHYLA
M(25)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319552/002

Household Verification Format Door No:117-5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KRISNAIAH Gas YES/Indane/2056484
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BAKKA Self Female Nil MIGRATED 843478694290
BOJJAMM LABOUR/N
A(40) il
2 BAKKA Son Male Nil Nil/Nil 755337412905
MALLESH(
21)
3 BAKKA Daughter Female Nil Nil/Nil
RAJESHWA
RI(15)
4 BAKKA Daughter Female Nil Nil/Nil
SRIDEVI(18
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319553/001

Household Verification Format Door No:118,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband AASSHI REDDY Gas YES/HP/669652
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KAMATHA Self Male Nil OWN 387640741429
M AGRICULT
SUDHKAE URE
R /Nil
REDDY(71)
2 KAMATHA Wife Female Nil Nil/Nil 260546633515
M
PADMAMA
A(60)
3 KAMATHA Son Male Nil Nil/Nil 234306646774
M
SRINIVAS
REDDY(25)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0.7/DRY:7.35 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319554/002

Household Verification Format Door No:119-5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband CHANDRA REDDY Gas YES/HP/627537
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KAMATHA Self Male Nil OWN 234885081151
M AGRICULT
RAGHUPA URE
THI(53) /Nil
2 KAMATHA Wife Female Nil Nil/Nil 268426323096
M
MAHESHW
ARAMMA(
48)
3 KAMATHA Son Male Nil Nil/Nil 851888334831
M SAI
REDDY(23)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0.98/DRY:7.32 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319555/000

Household Verification Format Door No:120-5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband PAPIREDDY Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KAMATAH Self Male Nil OWN 948700018978
AM AGRICULT
DHARMA URE
REDDY(55) /Nil
2 KAMATAH Wife Female Nil OWN 791336171864
AM AGRICULT
BHARATH URE
AMMA(53) /Nil
3 KAMATAH Son Male Nil OWN 529091946241
AM AGRICULT
NARESH(30 URE
) /Nil
4 KAMATAH Son Male Nil Nil/Nil
AM
SURESH
REDDY(28)
5 KAMATAH Daughter in Female Nil Nil/Nil
AM Law
SWAPNA(2
8)
6 KAMATAH Brother Male Nil Nil/Nil
AM
BHASKER(
42)
7 KAMATAH Grand Female Nil Nil/Nil
AM Daughter
NANDINI(6
)
8 KAMATAH Grand Female Nil Nil/Nil
AM Daughter
HARINI(1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0.32/DRY:8.35 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319556/000

Household Verification Format Door No:121-5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband MEGHA REDDY Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KAMATHA Self Male Nil State 270794065045
M GovtEmploy
PRABHKER ee/Nil
REDDY(61)
2 KAMATHA Wife Female Nil Nil/Nil 65528572275
M
RADHIKA(
48)
3 KAMATHA Daughter Female Nil Nil/Nil 354322351250
M
MEGHANA
(11)
4 KAMATHA Daughter Female Nil Nil/Nil 666919846868
M SAI
NITHYA(13
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0.62/DRY:2.68 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319557/000

Household Verification Format Door No:121-5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband MEGHA REDDY Gas YES/HP/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KAMATHA Self Male Nil SMALL 309576042480
M BUSINESS
RATHNAK /Nil
ER
RDEEY(58)
2 KAMATHA Wife Female Nil Nil/Nil 417515618993
M
NARMADA
(48)
3 KAMATHA Daughter Female Nil Nil/Nil 535411842620
M
ASHWITHA
(27)
4 KAMATHA Daughter Female Nil Nil/Nil 350558822201
M
PRANEETH
A(16)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0.75 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319558/000

Household Verification Format Door No:121-5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband MEGHA REDDY Gas YES/HP/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KAMATHA Self Male Nil OWN 334119591393
M AGRICULT
SUDHAKE URE
R /Nil
REDDY(44)
2 KAMATHA Wife Female Nil HOUSE
M WIFE/Nil
SUVARNA(
38)
3 KAMATHA Son Male Nil Nil/Nil
M
ROHITH(1)
4 KAMATHA Son Male Nil Nil/Nil 866806969729
M SAI
NATAH(6)
5 KAMATHA Mother Female Nil Nil/Nil
M
PADMAM
MA(72)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0.78/DRY:6.28 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319559/000

Household Verification Format Door No:122-5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband KARRA REDDY Gas YES/HP/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 AALETI Self Male Nil DRIVERS/N 308376443051
BUCHIRED il
DY(45)
2 AALETI Wife Female Nil HOUSE 928442680340
LAVANYA( WIFE/Nil
35)
3 AALETI Son Male Nil Nil/Nil
ANIKETH(6
)
4 AALETI Son Male Nil Nil/Nil
AADIKESH
V(12)
5 AALETI Son Male Nil Nil/Nil
SHIVAKU
MAR(15)
6 AALETI Daughter Female Nil Nil/Nil
NIKITHA(1
1)
7 AALETI Daughter Female Nil Nil/Nil
GOUTHAM
I(7)
8 AALETI Father Male Nil Nil/Nil
KARRARE
DDY(71)
9 AALETI Brother Male Nil Nil/Nil
THIRUPAT
HI(38)
10 AALETI Sister in Law Female Nil Nil/Nil
SUVARNA(
35)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0.18/DRY:15.38 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319560/000

Household Verification Format Door No:123-5,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband VENKAT REDDY Gas YES/HP/9131065
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUJJA Self Male Nil AGRICULT 937588931727
RAVINDER URE
REDDY(30) LABOUR
/Nil
2 GUJJA Wife Female Nil State 638744687829
RADHIKA( GovtEmploy
32)PWD: Y ee/Nil
& Sadaran
No:1413021
0260128017
3 GUJJA Son Male Nil Nil/Nil
VARUN(5)
4 GUJJA Son Male Nil Nil/Nil
SHASHANT
H(1)
5 GUJJA Daughter Female Nil Nil/Nil
MANASA(3
)
6 GUJJA Daughter Female Nil Nil/Nil
PAVANI(2)
7 GUJJA Daughter Female Nil Nil/Nil
SRIJA(4)
8 GUJJA Mother Female Nil Nil/Nil
LAXMI
DEVI(54)
9 GUJJA Brother Male Nil Nil/Nil
RAMREDD
Y(38)
10 GUJJA Sister in Law Female Nil Nil/Nil
RADHIKA(
36)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319561/001

Household Verification Format Door No:2-47,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband HANMANTH Gas NIL/-/
Name REDDY Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUJJA Self Male Nil OWN 762172044892
BHASKER AGRICULT
REDDY(45) URE
/Nil
2 GUJJA Wife Female Nil OWN 748251522938
PADMAM AGRICULT
MA(43) URE
/Nil
3 GUJJA Son Male Nil Nil/Nil 433963772614
NARENDE
R
REDDY(18)
4 GUJJA Son Male Nil Nil/Nil 968580722128
suresh(15)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:10.58/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319562/002

Household Verification Format Door No:2-49,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband LAXMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDDAM Self Female Nil AGRICULT 783447287789
BALA URE
MANEMM LABOUR
A(55) /Nil
2 MUDDAM Daughter Female Nil AGRICULT 598922194806
NAGALAX URE
MI(18) LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:1/DRY:4.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319563/002

Household Verification Format Door No:2-50,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NAGAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BATHULA Self Female Nil State Govt 459783719831
PARVATA Project
MMA(44) Employee
/State Govt
Pension
2 BATHULA Son Male Nil AGRICULT 968583996644
MALLESH( URE
25) LABOUR
/Nil
3 BATHULA Daughter in Female Nil AGRICULT 838106491330
NAGAMM Law URE
A(21) LABOUR
/Nil
4 BATHULA Peternal Female Nil Nil/Nil 903049647182
NAVANEE Grand
THA(3) Mother
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319564/002

Household Verification Format Door No:2-67,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband JIMMANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SANDA Self Male Nil Nil/Nil 981935323276
ANJANEYU
LU(62)
2 SANDA Wife Female Nil Nil/Nil 649482819315
SATYAMM
AQ(48)
3 SANDA Son Male Nil DAILY 423310162581
RAMESH(2 WAGES
8) LABOUR/N
il
4 SANDA Son Male Nil Nil/Nil 354147979933
MAHESH(1
4)
5 SANDA Daughter Female Nil Nil/Nil 317462794736
SUJATHA(1
7)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319565/002

Household Verification Format Door No:2-67,LATTUPALI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband ANJANEYULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SANDA Self Male Nil MIGRATED 230526952033
BABU(35) LABOUR/N
il
2 SANDA Wife Female Nil MIGRATED 217501975158
NAGAMAN LABOUR/N
I(29) il
3 SANDA Son Male Nil Nil/Nil
RAJESH(3)
4 SANDA Son Male Nil Nil/Nil 913184930081
CHANDU(9
)
5 SANDA Daughter Female Nil Nil/Nil
RAJESHWA
RI(3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319566/002

Household Verification Format Door No:99,LATTUPALI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband RAMREDDY Gas YES/HP/632634
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KATLA Self Male Nil OWN 662845298908
SAIREDDY AGRICULT
(41) URE
/Nil
2 KATLA Wife Female Nil State Govt 447659984521
VENKATES Project
HWARAM Employee
MA(36) /Nil
3 KATLA Daughter Female Nil Nil/Nil 541300737922
SWARUPA(
16)
4 KATLA Daughter Female Nil Nil/Nil 693141408435
SUSMITHA
(12)
5 KATLA Peternal Female Nil Nil/Nil 331155625369
RAMULAM Grand
MA(78) Mother
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0.92/DRY:0.92 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319567/002

Household Verification Format Door No:2-66,LATTUPALI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband RAMREDDY Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KATLA Self Male Nil Central Govt 749674032259
VENKATR Employee/St
EDDY(58) ate Govt
Pension
2 KATLA Wife Female Nil Central Govt 513380990109
LAXMIDEV Employee/St
AMMMA(5 ate Govt
0) Pension
3 KATLA Son Male Nil Central Govt 623235315039
SATHESHK Employee/St
UMAR(23) ate Govt
Pension
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0.72/DRY:7.02 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319568/001

Household Verification Format Door No:2-69,LATTUPALI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDDAM Self Male Nil Central Govt 861890792306
NAGAIAH( Employee/Ni
33) l
2 MUDDAM Wife Female Nil OWN 740668070913
MANJULA( AGRICULT
26) URE
/Nil
3 MUDDAM Son Male Nil Nil/Nil 720073638639
MAHESH(6
)
4 MUDDAM Daughter Female Nil Nil/Nil 552232593022
SINDU(4)

5 MUDDAM Mother Female Nil Nil/Nil 764116261339

SOWDAM
MA(74)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:5.12/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319569/002

Household Verification Format Door No:2-73,LATTUPALI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband VENKATAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDDAM Self Female Nil OWN 884695607620
NAGAMM AGRICULT
A(54) URE
/Nil
2 MUDDAM Son Male Nil Nil/Nil 813836443158
VISHNU(19
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319570/001

Household Verification Format Door No:2-74,LATTUPALI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband PENTAIAH Gas YES/HP/640389
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDDAM Self Male Nil Nil/Nil 916941287887
NARAYAN
A(65)
2 MUDDAM Son Male Nil Nil/Nil 310318123844
ANJANEYU
LU(14)
3 MUDDAM Son Male Nil Nil/Nil 269636179134
SHEKAR(17
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.22 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319571/002

Household Verification Format Door No:2-75,LATTUPALI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband PENTAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDDAM Self Male Nil OWN 549183750050
KARRENN AGRICULT
A(54) URE
/Nil
2 MUDDAM Wife Female Nil OWN 870612623993
VENKATA AGRICULT
MMA(48) URE
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.22 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319572/002

Household Verification Format Door No:2-75,LATTUPALI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KARRENNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDDAM Wife Female Nil AGRICULT 974850452644
SAVATHRI URE
(28) LABOUR
/Nil
2 MUDDAM Son Male Nil AGRICULT 640511273007
NAGAIAH( URE
32) LABOUR
/Nil
3 MUDDAM Son Male Nil Nil/Nil 999219527296
SRINY(4)

4 MUDDAM Daughter Female Nil Nil/Nil

NAGALAX
MI(7)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319573/000

Household Verification Format Door No:2-75,LATTUPALI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KARRENNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDDAM Wife Female Nil AGRICULT 687296874749
RAJITHA(1 URE
7) LABOUR
/Nil
2 MUDDAM Father Male Nil AGRICULT 211345496788
RAMULU(2 URE
2) LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319574/001

Household Verification Format Door No:2-76,LATTUPALI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SAYANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 EGURAMB Self Male Nil AGRICULT 296971447739
ADA URE
HANMANT LABOUR
H(45) /Nil
2 EGURAMB Wife Female Nil AGRICULT 701774538609
ADA URE
KONDAM LABOUR
MA(45) /Nil
3 EGURAMB Son Male Nil Nil/Nil 752287038240
ADA
KRISHNA(2
3)
4 EGURAMB Daughter Female Nil Nil/Nil 432509583750
ADA
ANUSHA(1
1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319575/002

Household Verification Format Door No:2-78,LATTUPALI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband MOHABOOB ALI Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MOHAMM Self Male Nil DRIVERS/N 375099256544
ED il
SULTHAN(
42)
2 MOHAMM Wife Female Nil OTHERS(P 729348611747
ED ROVIDE
RUKSANA DETAILS)/
BEGAUM(3 Nil
6)
3 MOHAMM Son Male Nil Nil/Nil
ED
EMRAN(14)
4 MOHAMM Daughter Female Nil Nil/Nil 686498090840
ED
ASMA(19)
5 MOHAMM Daughter Female Nil Nil/Nil 940913876885
ED
RESHMA(1
6)
6 MOHAMM Daughter Female Nil Nil/Nil
ED
SANIYA(11
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319576/001

Household Verification Format Door No:2-80,LATTUPALI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband MOULANASAYAB Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MOHAMM Self Male Nil AGRICULT 636003888697
ED URE
NIRANJAN( LABOUR
54) /Nil
2 MOHAMM Wife Female Nil AGRICULT 343782816530
ED URE
ABEDABE LABOUR
GAUMQ(48 /Nil
)
3 MOHAMM Daughter Female Nil Nil/Nil 491968135510
ED
ASIYABEG
AUMQ(19)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319577/001

Household Verification Format Door No:99,LATTUPALI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NIRANJAN Gas YES/HP/619045/6299
Name Connection(Y/N)/Agen./ 06
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MOHAMM Self Male Nil Nil/Nil 748532742795
ED
JAHNGIR(3
3)
2 MOHAMM Wife Female Nil Nil/Nil
ED
GASIYABE
GAUM(24)
3 MOHAMM Wife Female Nil Nil/Nil 515862420224
ED SHAHIN
BEGAUM(2
9)
4 MOHAMM Son Male Nil Nil/Nil
ED
NAVAAZ(1
)
5 MOHAMM Son Male Nil Nil/Nil
ED MD
KHAJAMY
ANUDDIN(
27)
6 MOHAMM Son Male Nil Nil/Nil 312510655606
ED
JUNID(4)
7 MOHAMM Daughter Female Nil Nil/Nil 352008477820
ED
SHAMMA
HUSEN(7)
8 MOHAMM Daughter Male Nil Nil/Nil
ED
DILKASH(3
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319578/002

Household Verification Format Door No:2-83,LATTUPALI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAJANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BATHULA Self Male Nil OWN 315013180277
KRISHNAI AGRICULT
AH(48) URE
/Nil
2 BATHULA Wife Female Nil OWN 549091852747
CHENNEM AGRICULT
MA(43) URE
/Nil
3 BATHULA Wife Female Nil Nil/Nil 216208495588
LAXMI(23)

4 BATHULA Son Male Nil Nil/Nil 332207771838

MAHESH(3
)
5 BATHULA Son Male Nil OWN 294511714662
SRINU(28) AGRICULT
URE
/Nil
6 BATHULA Son Male Nil Nil/Nil
LOKESH(1)
7 BATHULA Son Male Nil Nil/Nil 569134964597
RAJESH(13)

8 BATHULA Mother Male Nil Nil/Nil 365592647025

BUDDAMM
A(73)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0.62/DRY:7.7 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319579/002

Household Verification Format Door No:2-81,LATTUPALI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BUCHANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VARLA Self Male Nil OWN
VENKATAI AGRICULT
AH(52) URE
/Nil
2 VARLA Wife Female Nil OWN 288912688475
PADMA(29) AGRICULT
URE
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.48 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319580/001

Household Verification Format Door No:2-82,LATTUPALI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BUCHANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VARLA Self Male Nil OWN 721180391602
THIRUPAT AGRICULT
AIAH(43) URE
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.48 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0319581/001

Household Verification Format Door No:2-84,LATTUPALE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHENNAPPA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDDAM Self Male Nil OWN 767054869190
ANJANEYU AGRICULT
LU(47) URE
/Nil
2 MUDDAM Wife Female Nil OWN 915056325014
PADMA(42) AGRICULT
URE
/Nil
3 MUDDAM Son Male Nil OWN 697249952084
CHENNAIA AGRICULT
H(23) URE
/Nil
4 MUDDAM Daughter Female Nil Nil/Nil
NAGALAX
MI(16)
5 MUDDAM Daughter Female Nil Nil/Nil 960581444612
BOGURAM
MA(18)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.98 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319582/002

Household Verification Format Door No:2-85,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDDAM Self Female Nil OWN 456045518950
RAMULAM AGRICULT
MA(36) URE
/Nil
2 MUDDAM Son Male Nil Nil/Nil 838164238191
MAHESH(1
2)
3 MUDDAM Son Male Nil Nil/Nil 866672022872
NARESH(10
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.95 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319583/002

Household Verification Format Door No:2-86,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALNAGAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDOLK Self Male Nil OWN 874596900353
OPULA AGRICULT
GANGAPU URE
RI(29) /Nil
2 GADDOLK Wife Female Nil OWN 989743142907
OPULA AGRICULT
ALIVELU(2 URE
7) /Nil
3 GADDOLK Daughter Female Nil Nil/Nil 345244198637
OPULA
NANDINI(6
)
4 GADDOLK Daughter Female Nil Nil/Nil 233967624213
OPULA
DIVYA(2)
5 GADDOLK Daughter Female Nil Nil/Nil 789206778724
OPULA
GIRIJA(9)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.15 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319584/002

Household Verification Format Door No:2-87,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDIKOP Self Male Nil OWN 382339329383
ULA AGRICULT
RAJU(39) URE
/Nil
2 GADDIKOP Wife Female Nil OWN 683447247014
ULA AGRICULT
CHANDRA URE
KALAMMA /Nil
(33)
3 GADDIKOP Son Male Nil Nil/Nil
ULA
RAMCHAR
ANTEJA(6)
4 GADDIKOP Daughter Female Nil Nil/Nil
ULA
GEETHA(10
)
5 GADDIKOP Daughter Female Nil Nil/Nil 894202710010
ULA
PRAVALIK
A(8)
6 GADDIKOP Daughter Female Nil Nil/Nil 599574822822
ULA
SUNITHA(1
3)
7 GADDIKOP Daughter Female Nil Nil/Nil 333163115146
ULA
NAGALAX
MI(15)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:6.72 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319585/002

Household Verification Format Door No:3-26,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARAYANA Gas YES/HP/606580
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAROJU Self Male GOLDSMIT Nil/Nil 271730320408
BRAHMAI H
AH(53)
2 MAROJU Wife Female Nil Nil/Nil 697972728165
KRISHNAM
MA(43)
3 MAROJU Son Male GOLDSMIT Nil/Nil
RAGHAVE H
NDRA
CHARY(22)
4 MAROJU Son Male GOLDSMIT Nil/Nil 941140735322
YUGENDE H
R
CHARY(24)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319586/002

Household Verification Format Door No:3-27,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband NAGALINGAM Gas YES/HP/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 AKULA Self Male Nil OWN 911140853369
SAMBAYY AGRICULT
A(65) URE
/Nil
2 AKULA Wife Female Nil HOUSE 509219426725
SUMALAT WIFE/Nil
HA(28)
3 AKULA Wife Female Nil OWN 259649616364
LALITHAM AGRICULT
MA(63) URE
/Nil
4 AKULA A Son Male FISHER Nil/Nil 754093375351
NAGALING MAN
AM(35)
5 AKULA Daughter Female Nil Nil/Nil 698501542056
LAXMIKR
UTHIKA(4)
6 AKULA Daughter Female Nil Nil/Nil 690896710544
NAGALAX
MI(33)PWD
:Y&
Sadaran
No:1418939
0140113042
7 AKULA Son in Law Male Nil Nil/Nil 818984116127
VENKATES
H(36)
8 AKULA Grand Son Male Nil Nil/Nil 973631491751
SANTOSH(
5)
9 AKULA Grand Son Male Nil Nil/Nil 485901972896
PAVANKU
MAR(10)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:6.18 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319587/001

Household Verification Format Door No:3-28,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband NAGALINGAM Gas YES/HP/631499
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 AKULA Self Male Nil OWN 535669634767
SRISAILA AGRICULT
M(49) URE
/Nil
2 AKULA Husband Female Nil Nil/Nil 866475964679
JAYAMMA
(42)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:6.15 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319588/001

Household Verification Format Door No:2-88,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHENAPPA Gas YES/Indane/312265
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MADDIGA Self Male Nil OWN 288834022932
TLA AGRICULT
CHANDRAI URE
AH(69) /Nil
2 MADDIGA Wife Female Nil OWN 808821192133
TLA AGRICULT
NAGAMM URE
A(63) /Nil
3 MADDIGA Son Male Nil OWN
TLA AGRICULT
KESHAVU URE
LU(25) /Nil
4 MADDIGA Son Male Nil AGRICULT 748102372221
TLA URE
RAJU(35) LABOUR
/Nil
5 MADDIGA Son Male Nil OWN 436356262690
TLA AGRICULT
GOUTHAM URE
(29) /Nil
6 MADDIGA Daughter in Female Nil HOUSE 846326530484
TLA Law WIFE/Nil
VIJAY(23)
7 MADDIGA Grand Son Male Nil Nil/Nil 734427392243
TLA
HARISH(3)
8 MADDIGA Grand Son Male Nil Nil/Nil 971921929373
TLA
SANJAY(5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.75 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319589/002

Household Verification Format Door No:2-90,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NAGAIAH Gas YES/HP/637306
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDIKOP Self Male Nil OWN 452699529696
ULA AGRICULT
RAMULU(6 URE
8) /Nil
2 GADDIKOP Wife Female Nil HOUSE 798259698140
ULA WIFE/Nil
RAMANJA
NAMMA(63
)
3 GADDIKOP Son Male Nil BEGGERS/ 442987044113
ULA Nil
CHETAN(3
0)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:4/DRY:7 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319590/002

Household Verification Format Door No:99,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband HANMANTHREDD Gas YES/HP/637622
Name Y Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUJJU Self Male Nil OWN 712900974134
VENKATR AGRICULT
EDDY(26) URE
/Nil
2 GUJJU Husband Female Nil HOUSE 847805203257
LAXMI(23) WIFE/Nil

3 GUJJU Son Male Nil Nil/Nil

GOPALRED
DY(1)
4 GUJJU Son Male Nil Nil/Nil 445104281685
SHASHAN
KREDDY(3)
5 GUJJU Father Male Nil Nil/Nil 758636158032
HANMANT
HREDDY(6
8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:7.98 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319591/001

Household Verification Format Door No:2-89,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDI Self Male Nil OWN 548745842892
KOPULA AGRICULT
BALA URE
NAGAIAH( /Nil
63)
2 GADDI Wife Female Nil AGRICULT 282742945316
KOPULA URE
ALIVELA(5 LABOUR
8) /Nil
3 GADDI Son Male Nil DO 925195164569
KOPULA NOTHING/
SRINIVASU Nil
LU(24)
4 GADDI Son Male Nil DAILY 441112370718
KOPULA WAGES
SEKHAR(27 LABOUR/N
) il
5 GADDI Daughter in Female Nil DO 646494861775
KOPULA Law NOTHING/
LAXMI(19) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:2/DRY:2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319592/002

Household Verification Format Door No:2-91,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDI Self Male Nil OWN 512641136543
KOPULA AGRICULT
SRINIVASU URE
LU(42) /Nil
2 GADDI Wife Female Nil OWN 246835648278
KOPULA AGRICULT
CHITTEMM URE
A(35) /Nil
3 GADDI Son Male Nil DO 442161947885
KOPULA NOTHING/
MAHESH(1 Nil
9)
4 GADDI Son Male Nil DO 441483090467
KOPULA NOTHING/
SIVAPRAS Nil
AD(17)
5 GADDI Mother Female Nil DO 513735486566
KOPULA NOTHING/
VENKATA Nil
MMA(78)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:5.95/DRY:5.95 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319593/001

Household Verification Format Door No:2-92,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband PEDDA NAGAIAH Gas YES/HP/645981
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDI Self Male Nil MIGRATED 525674376088
GOPULA LABOUR/N
KRISHNAI il
AH(34)
2 GADDI Wife Female Nil MIGRATED 896293821586
GOPULA LABOUR/N
LAXMI(26) il
3 GADDI Son Male Nil Nil/Nil
GOPULA
UMESHM
KUMAR(2)
4 GADDI Son Male Nil Nil/Nil 409828151490
GOPULA
SANTOOSH
KUMAR(10
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319594/001

Household Verification Format Door No:2-96,2

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARAYANA Gas YES/HP/617320
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PEDDABU Self Male Nil OWN 842861894771
DI AGRICULT
ANJANEYU URE
LU(52) /Nil
2 PEDDABU Wife Female Nil OWN 223089640872
DI AGRICULT
THIRUPAT URE
HAMMA(46 /Nil
)
3 PEDDABU Son Male Nil DO 644143218455
DI MANOJ NOTHING/
KUMAR(20 Nil
)
4 PEDDABU Son Male Nil DO 971927970071
DI NOTHING/
SRIKANTH Nil
(25)
5 PEDDABU Daughter Female Nil DO 439668323523
DI NOTHING/
SANDYAR Nil
ANI(24)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:5.4 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319595/002

Household Verification Format Door No:2-95,2

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARAYANA Gas YES/HP/615393
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PEDDABU Self Male Nil OWN 217964634493
DI AGRICULT
VASUDEV URE
UDU(49) /Nil
2 PEDDABU Wife Female Nil State Govt 953207345765
DI Project
VIJAYALA Employee
XMI(37) /Nil
3 PEDDABU Son Male Nil Nil/Nil 349713608264
DI
PRAVEEN
KUMAR(15
)
4 PEDDABU Daughter Female Nil Nil/Nil 319426544300
DI
ISWARAY
A(18)
5 PEDDABU Daughter Female Nil Nil/Nil 720054327805
DI
SUPRIYA(1
7)
6 PEDDABU Daughter Female Nil Nil/Nil 613302309746
DI
RANJITHA(
20)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:6.78 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319596/001

Household Verification Format Door No:2-93,2

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARAYANA Gas YES/HP/617308
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PEDDA Self Male Nil DO 616860627576
BUDI NOTHING/
BALAIAH(5 Nil
5)PWD: Y &
Sadaran
No:892182
2 PEDDA Wife Female Nil OWN 653279859770
BUDI AGRICULT
NIRMALA URE
MMA(53) /Nil
3 PEDDA Son Male Nil DO 317303535114
BUDI NOTHING/
RAMAKRIS Nil
HNA(31)
4 PEDDA Son Male Nil DO 299001326011
BUDI NOTHING/
SIVASHAN Nil
KAR(25)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:7.62 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319597/002

Household Verification Format Door No:2-94,2

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARAYANA Gas YES/HP/628380
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PEDDABU Self Male Nil OWN 297853573014
DI AGRICULT
SRISAILA URE
M(39) /Nil
2 PEDDABU Wife Female Nil Nil/Nil 328624076059
DI
RADHA(32)
3 PEDDABU Son Male Nil Nil/Nil 910526015476
DI NIDITH
NARAYAN
A(2)
4 PEDDABU Son Male Nil Nil/Nil 605193120706
DI
AADITHNA
RAYANA(4
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:5.82 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319598/001

Household Verification Format Door No:2-99,2

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BEESAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BEESAM Self Male Nil State 432322733343
ANJANEYU GovtEmploy
LU(56) ee/Nil
2 BEESAM Wife Female Nil AGRICULT 672081120711
USHAMMA URE
(55) LABOUR
/Nil
3 BEESAM Son Male Nil Nil/Nil 467807546169
SRISAILA
M(32)
4 BEESAM Son Male Nil Nil/Nil 624809105355
RAGHAVE
NDRA(29)
5 BEESAM Daughter in Female Nil AGRICULT 738281672248
MANJULA( Law URE
30) LABOUR
/Nil
6 BEESAM Daughter in Female Nil AGRICULT 636233922066
CHINAMM Law URE
A(27) LABOUR
/Nil
7 BEESAM Grand Son Male Nil Nil/Nil 376896388478
CHARAN
TEJA(6)
8 BEESAM Grand Female Nil Nil/Nil 901336914091
AKHILA(12 Daughter
)
9 BEESAM Grand Female Nil Nil/Nil 871259937403
SHIRISHA( Daughter
12)
10 BEESAM Grand Female Nil Nil/Nil 838292244651
LAVANYA( Daughter
7)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:1.5/DRY:1.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319599/001

Household Verification Format Door No:2-100,2

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas YES/HP/617313
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUNTI Self Female Nil DO 250926603443
ANJANAM NOTHING/
MA(65) Nil
2 GUNTI Son Male Nil DAILY 381063089393
SUDARSH WAGES
AN(36) LABOUR/N
il
3 GUNTI Son Male Nil DAILY 476704083895
CHANDRA WAGES
MOHAN(29 LABOUR/N
) il
4 GUNTI Son Male Nil DAILY 301677444117
SRINIVASU WAGES
LU(40) LABOUR/N
il
5 GUNTI Daughter Female Nil DO 523393262611
LALITHAM NOTHING/
MA(38) Nil
6 GUNTI Daughter in Female Nil State Govt 702909285110
LAXMI(33) Law Project
Employee
/Nil
7 GUNTI Daughter in Female Nil DAILY 693021918510
KRISHNAV Law WAGES
ENI(27) LABOUR/N
il
8 GUNTI Grand Son Male Nil DO 614041962827
KOUSIK NOTHING/
SAGAR(6) Nil
9 GUNTI Grand Son Male Nil Nil/Nil 646107100770
RAMCHAR
AN(11)
10 GUNTI Grand Son Male Nil DO 202816766261
LIKITHSAI( NOTHING/
4) Nil
11 GUNTI Grand Female Nil Nil/Nil 266358595217
SWETHA(9) Daughter

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:2.22/DRY:5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:
Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319600/002

Household Verification Format Door No:3-1,2

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NAKKA Self Male Nil DO 335748126003
THIRUPAR NOTHING/
HAIAH(80) Nil
2 NAKKA Wife Female Nil DO 838215886179
ANJANAM NOTHING/
MA(63)PW Nil
D: Y &
Sadaran No:
Nil
3 NAKKA Son Male Nil MILCH 834357073260
RAMULU(3 ANIMALS/
1) Nil
4 NAKKA Son Male Nil MILCH 384181951476
BUSHAIAH ANIMALS/
(38) Nil
5 NAKKA Daughter in Female Nil DAILY 996236549428
CHENNAM Law WAGES
MA(26) LABOUR/N
il
6 NAKKA Daughter in Female Nil DAILY 844549506180
JANAKAM Law WAGES
MA(34) LABOUR/N
il
7 NAKKA Grand Son Male Nil DO 766858972169
SATISH NOTHING/
KUMAR(12 Nil
)
8 NAKKA Grand Son Male Nil DO 610950827964
SIVAPRAS NOTHING/
AD(16) Nil
9 NAKKA Grand Female Nil DO
PARVATH Daughter NOTHING/
AMMA(3) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:6.55 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319601/001

Household Verification Format Door No:3-2,2

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NAKKA Self Male Nil DO 310577112193
NAGANNA NOTHING/
(70) Nil
2 NAKKA Wife Female Nil DO 201734796789
NAGAMM NOTHING/
A(65) Nil
3 NAKKA Son Male Nil DAILY 885224698735
MALLESH( WAGES
20) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.45 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319602/001

Household Verification Format Door No:3-2/1,2

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NAGANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NAKKA Self Male Nil OWN 278609619492
NAGARAJ AGRICULT
U(24) URE
/Nil
2 NAKKA Wife Female Nil AGRICULT 916496954974
JANAKAM URE
MA(19)PW LABOUR
D: Y & /Nil
Sadaran No:
Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:1.25 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319603/001

Household Verification Format Door No:3-3,2

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALRAM Gas YES/HP/617310
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NAKKA Self Male Nil OWN 291800578071
BALAIAH(4 AGRICULT
9) URE
/Nil
2 NAKKA Wife Female Nil AGRICULT 506911821909
ALIVELA(4 URE
8) LABOUR
/Nil
3 NAKKA Son Male Nil DAILY 536410083727
SRISAILA WAGES
M(26) LABOUR/N
il
4 NAKKA Daughter in Female Nil AGRICULT 694215491181
MANJULA( Law URE
23) LABOUR
/Nil
5 NAKKA Grand Son Male Nil DO 763259826016
SANNI(4) NOTHING/
Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.68 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319604/001

Household Verification Format Door No:3-6,2

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NAGANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NAKKA Self Male Nil DAILY 671837820950
RAMULU(3 WAGES
5) LABOUR/N
il
2 NAKKA Wife Female Nil DAILY 905620180477
KRISHNAI WAGES
AH(33) LABOUR/N
il
3 NAKKA Son Male Nil DO 399795953034
RAJ NOTHING/
KUMAR(12 Nil
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319605/001

Household Verification Format Door No:3-9,2

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHADROJI Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PANTHUL Self Male Nil AGRICULT 438501806143
A URE
NARAYAN LABOUR
A(48) /Nil
2 PANTHUL Wife Female Nil Nil/Nil 893851819548
A
PADMA(33)
3 PANTHUL Daughter Female Nil Nil/Nil 509084844026
A
SHIRISHA(
16)
4 PANTHUL Brother Male Nil Nil/Nil 280996131319
A
NAGESH(1
4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319606/001

Household Verification Format Door No:3-7,2

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHINAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KUMARI Self Male Nil AGRICULT 267667460279
MASAIAH( URE
73) LABOUR
/Nil
2 KUMARI Wife Female Nil Nil/Nil 545743827477
BALAKIST
AMMA(58)
3 KUMARI Son Male Nil Nil/Nil 539259925273
SRISAILA
M(28)
4 KUMARI Daughter in Female Nil Nil/Nil 333956203876
LAVANYA( Law
20)
5 KUMARI Grand Female Nil Nil/Nil 483818969114
KRISHNAV Daughter
ENI(20)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:1.35 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319607/002

Household Verification Format Door No:3-6/1,2

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHINNA NAGANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NAKKA Self Male Nil Nil/Nil 309805868691
CHINAIAH(
35)
2 NAKKA Wife Female Nil Nil/Nil 610411946315
RENUKA(3
0)
3 NAKKA Son Male Nil Nil/Nil 912037796395
BHASKAR(
7)
4 NAKKA Daughter Female Nil Nil/Nil 514989028898
UMADEVI(
8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:1.4 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319608/001

Household Verification Format Door No:3-5,2

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARAYANA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BOKKI Self Male Nil Nil/Nil 554414131745
RAMASWA
MY(45)
2 BOKKI Wife Female Nil Nil/Nil 728094505145
LALITHAM
MA(40)
3 BOKKI Son Male Nil Nil/Nil 344741151110
SATYA
NARAYAN
A(18)
4 BOKKI Daughter Female Nil Nil/Nil 610538056381
VIJAYALA
XMI(13)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319609/001

Household Verification Format Door No:2-97,2

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BEESAIAH Gas YES/HP/617321
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BEESAM Self Male Nil Nil/Nil 601948797994
RAVINDAR
(40)
2 BEESAM Wife Female Nil AGRICULT 880414338466
CHANDRA URE
KALA(33) LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:5.6 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319610/001

Household Verification Format Door No:3-18,2

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PALAMURI Self Female Nil AGRICULT 668584167999
MANEMM URE
A(50) LABOUR
/Nil
2 PALAMURI Son Male Nil Nil/Nil 684577040964
SIVA(11)

3 PALAMURI Son Male Nil Nil/Nil 226573099861

SURESH(19
)
4 PALAMURI Son Male Nil Nil/Nil 759022769065
KRISHNAI
AH(45)
5 PALAMURI Daughter in Female Nil Nil/Nil 815792331194
REVATHI(3 Law
8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319611/002

Household Verification Format Door No:3-22,2

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHENAPPA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MADITLA Self Male Nil AGRICULT 796393077445
NARAYAN URE
A(65) LABOUR
/Nil
2 MADITLA Wife Female Nil Nil/Nil 924485875402
CHINAMM
A(55)
3 MADITLA Son Male Nil Nil/Nil
CHENNA
KESHAVU
LU(15)
4 MADITLA Daughter Female Nil Nil/Nil
PRAVALIK
A(13)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319612/002

Household Verification Format Door No:3-19,2

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GADDI Self Male Nil Nil/Nil 748820148679
KOPULA
PUROSHOT
HAM(45)
2 GADDI Wife Female Nil Nil/Nil 234839668510
KOPULA
NIRMALA(
38)
3 GADDI Son Male Nil Nil/Nil
KOPULA
BANU(5)
4 GADDI Daughter Female Nil Nil/Nil 282776131551
KOPULA
LAVANYA(
3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319613/001

Household Verification Format Door No:3-35,2

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NEELA Self Male Nil MIGRATED 421037442713
KOMALAI LABOUR/N
AH(48) il
2 NEELA Wife Female Nil MIGRATED 984830898528
ANJANAM LABOUR/N
MA(44) il
3 NEELA Son Male Nil MIGRATED 409382000930
SRISAILA LABOUR/N
M(28) il
4 NEELA Daughter in Male Nil MIGRATED 524295589239
BEEMAMM Law LABOUR/N
A(21) il
5 NEELA Grand Male Nil Nil/Nil
JANAKAM Daughter
MA(2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0.55/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319615/002

Household Verification Format Door No:3-11,2

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BAKKI Husband Female Nil DAILY 592685447233
BALAIAH(7 WAGES
0) LABOUR/N
il
2 BAKKI Wife Female Nil Nil/Nil 291480983120
SIVAMMA(
65)
3 BAKKI Son Male Nil Nil/Nil 832906004687
THIRUPAT
HI(28)
4 BAKKI Daughter in Female Nil Nil/Nil 388264816187
BARGAVI( Law
23)
5 BAKKI Grand Son Female Nil Nil/Nil
VAMSI
KRISHNA(2
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:2.42/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319616/001

Household Verification Format Door No:3-10,2

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SAILU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JAJULA Self Male Nil Nil/Nil 671152806398
VENKATES
H(45)
2 JAJULA Wife Female Nil Nil/Nil
MANEMM
A(47)
3 JAJULA Son Male Nil Nil/Nil 281822755286
MAHESH(2
1)
4 JAJULA Son Male Nil Nil/Nil 915000674910
VISHNU(16
)
5 JAJULA Son Male Nil Nil/Nil 443596869402
ESWAR(16)

6 JAJULA Daughter Female Nil Nil/Nil 843476769972

JYOTHI(20)

7 JAJULA Daughter Female Nil Nil/Nil 240807552477

MADHAVI(
18)
8 JAJULA Brother Male Nil Nil/Nil 353756044351
SRISAILA
M(28)
9 JAJULA Brother Male Nil Nil/Nil 471111926247
THIRUPAT
HAIAH(45)
10 JAJULA Brother Male Nil Nil/Nil 733642866226
KASI(28)

11 JAJULA Sister in Law Female Nil Nil/Nil 881897934368

USHAMMA
(27)
12 JAJULA Sister in Law Female Nil Nil/Nil 559159115575
PENTAMM
A(38)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:
Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319616/002

Household Verification Format Door No:3-10,2

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SAILU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JAJALA Self Male Nil Nil/Nil 671152806398
VENKATES
H(48)
2 JAJALA Wife Female Nil Nil/Nil
MANEMM
A(40)
3 JAJALA Son Male Nil Nil/Nil 733642866226
KASI(30)

4 JAJALA Son Male Nil Nil/Nil 443596869402

ESWAR(16)

5 JAJALA Son Male Nil Nil/Nil 353756044351

SRISAILA
M(28)
6 JAJALA Son Male Nil Nil/Nil 281822755286
MAHESH(2
1)
7 JAJALA Son Male Nil Nil/Nil 915000674910
VISHNU(16
)
8 JAJALA Daughter Female Nil Nil/Nil 240807552477
MADHAVI(
18)
9 JAJALA Daughter Female Nil Nil/Nil 881897934368
USHAMMA
(27)
10 JAJALA Daughter Female Nil Nil/Nil 843476769972
JYOTHI(20)

11 JAJALA Brother Male Nil Nil/Nil 471111926247

THIRUPAT
HAIAH(45)
12 JAJALA Sister in Law Female Nil Nil/Nil 559159115575
PENTAMM
A(38)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:
Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319623/001

Household Verification Format Door No:3-32,lattupally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband raseed Gas YES/HP/05
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mahamood Self Male Nil OTHERS(P 482713454846
ajid(31) ROVIDE
DETAILS)/
Nil
2 mahamood Wife Female Nil HOUSE 499538109825
jareena WIFE/Nil
begum(27)
3 mahamood Son Male Nil STUDENT/ 824246924063
sofeyan(1) Nil

4 mahamood Daughter Female Nil STUDENT/ 233133763162

mizmamaha Nil
n(3)
5 mahamood Mother Female Nil OTHERS(P
muharambi( ROVIDE
58) DETAILS)/
Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319624/001

Household Verification Format Door No:3-31,lattupally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband raseed Gas YES/HP/05
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mahamood Self Male Nil DRIVERS/N 448083906262
rahaman(45) il

2 mahamood Wife Female Nil HOUSE 905397000410

syelab WIFE/Nil
begum(35)
3 mahamood Son Male Nil STUDENT/ 567373178744
abdul Nil
kadar(19)
4 mahamood Son Male Nil STUDENT/ 645495419812
shaik Nil
khaja(15)
5 mahamood Daughter Female Nil STUDENT/ 745043666155
rasida Nil
begam(13)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319625/002

Household Verification Format Door No:3-30,lattupally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband rahaman Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mahamood Self Female Nil HOUSE 629447632185
mahaboobhi( WIFE/Nil
63)
2 mahamood Son Male Nil OTHERS(P 696877133695
mahamood(2 ROVIDE
4) DETAILS)/
Nil
3 mahamood Son Male Nil Nil/Nil 661330888080
razzak
pasha(24)
4 mahamood Daughter in Female Nil OTHERS(P 328443406616
sameena Law ROVIDE
begam(24) DETAILS)/
Nil
5 mahamood Grand Female Nil Nil/Nil
faima(0) Daughter
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319626/002

Household Verification Format Door No:3-25,lattupelly

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband manohar Gas YES/HP/04
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 siddamshetty Self Female Nil OTHER 545095794889
suluchanam SKILLED
ma(46) WORKERS/
Nil
2 siddamshetty Son Male Nil Nil/Nil
ragavendar(2
9)
3 siddamshetty Daughter in Female Nil HOUSE
swetha(27) Law WIFE/Nil
4 siddamshetty Grand Female Nil Nil/Nil
shanvi(1) Daughter
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319628/001

Household Verification Format Door No:4-20,lattupally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband prabhakar Gas YES/HP/03
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 gummadivell Self Female Nil HOUSE 390457952876
i WIFE/Nil
nilamma(53)
2 gummadivell Son Male Nil HOUSE 905596564169
i WIFE/Nil
ramakrishna(
33)
3 gummadivell Son Male Nil HOUSE 506474695703
i naresh WIFE/Nil
kumar(26)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:10.18 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319629/001

Household Verification Format Door No:4-18,lattupaiiy

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband narayana Gas YES/HP/2
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 gummadivell Self Male Nil OWN 786365657729
i ramulu(58) AGRICULT
URE
/Nil
2 gummadivell Wife Female Nil HOUSE 970349602105
i WIFE/Nil
padmamma(
53)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:10.18 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319630/001

Household Verification Format Door No:3-24,lattupally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband emamasab Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mahamood Self Male Nil DAILY 807011421977
pasha(40) WAGES
LABOUR/N
il
2 mahamood Wife Female Nil DAILY 643324842092
raheema(29) WAGES
LABOUR/N
il
3 mahamood Son Male Nil DAILY 338756876733
hussain(18) WAGES
LABOUR/N
il
4 mahamood Daughter Female Nil DAILY 757993343925
farveen(17) WAGES
LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319631/002

Household Verification Format Door No:3-33,lattupally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband bapuji Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 panthula Self Male Nil MIGRATED 417899101696
chandruji(68 LABOUR/N
) il
2 panthula Wife Female Nil DAILY 948386291813
gangamma(6 WAGES
3) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:9.92 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319632/001

Household Verification Format Door No:3-23,lattupally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband gousemiya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 sayed Self Male Nil Nil/Nil 599774339786
hussain(33)

2 sayed Wife Female Nil Nil/Nil 576472607515

mahammad
begam(28)
3 sayed Son Male Nil Nil/Nil 327863965207
sohail(7)

4 sayed Daughter Female Nil Nil/Nil 795262303624

amren(4)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:343/DRY:2.3 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319633/002

Household Verification Format Door No:3-34,lattupally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas YES/HP/7
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 panthula Self Male Nil AGRICULT 576557024575
yellowji(68) URE
LABOUR
/Nil
2 panthula Wife Female Nil AGRICULT 206945637391
ushavamma( URE
57) LABOUR
/Nil
3 panthula Son Male Nil AGRICULT 211180983025
niranjan(53) URE
LABOUR
/Nil
4 panthula Daughter in Female Nil AGRICULT 980728121940
vanaja(43) Law URE
LABOUR
/Nil
5 panthula Grand Son Male Nil DO 844767483368
naresh(24) NOTHING/
Nil
6 panthula Grand Son Male Nil DO 799288026367
suresh(18) NOTHING/
Nil
7 panthula Grand Son Male Nil DO 656429723830
mahesh(21) NOTHING/
Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319634/002

Household Verification Format Door No:3-37,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband eshwarayya Gas YES/HP/6
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 kukkala Self Male Nil DO 558354595901
lingayya(68) NOTHING/
Nil
2 kukkala Wife Female Nil HOUSE 889231315823
anusuyamma WIFE/Nil
(63)
3 kukkala Son Male Nil SMALL 246756356568
eshwarayya( BUSINESS
45) /Nil
4 kukkala Daughter in Female Nil HOUSE 909729063871
sujatha(43) Law WIFE/Nil

5 kukkala Grand Son Male Nil Nil/Nil 542074545546

chandrakant
h(18)
6 kukkala Grand Female Nil Nil/Nil 973417053982
supraja(22) Daughter

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319635/001

Household Verification Format Door No:3-39,gandhinagar

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband laxmayya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 bokki Self Female Nil LEASE 316109381383
kasamma(51 AGRICULT
) URE /Nil
2 bokki Son Male Nil LEASE 308544927648
maibu(33) AGRICULT
URE /Nil
3 bokki Son Male Nil MIGRATED 645163474649
manyam(29) LABOUR/N
il
4 bokki Daughter in Female Nil DAILY 434383906545
sharadha(27) Law WAGES
LABOUR/N
il
5 bokki Daughter in Female Nil DAILY 359650593333
madhavi(18) Law WAGES
LABOUR/N
il
6 bokki Grand Son Male Nil Nil/Nil 255798497549
ramcharan(7
)
7 bokki Grand Female Nil Nil/Nil 461151648628
sirisha(6) Daughter

8 bokki Grand Female Nil Nil/Nil

thulasi(0) Daughter
9 bokki Grand Female Nil Nil/Nil 937609024876
laxmikala(10 Daughter
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.35 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319636/002

Household Verification Format Door No:3-86,gandhinagar

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband pullayya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 yelugu Self Male Nil DAILY 809691924517
venkatayya( WAGES
42) LABOUR/N
il
2 yelugu Wife Female Nil DAILY 870797105142
alivelu(40) WAGES
LABOUR/N
il
3 yelugu Son Male Nil DAILY 593968393096
pulendhar(13 WAGES
) LABOUR/N
il
4 yelugu Daughter Female Nil Nil/Nil 486985431302
kavitha(16)

5 yelugu Daughter Female Nil MIGRATED 335754789977

bhavani(12) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319637/002

Household Verification Format Door No:3-42,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband balesau Gas YES/HP/8
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 karnekota Self Male Nil AGRICULT 761882523089
gangugi(58) URE
LABOUR
/Nil
2 karnekota Wife Female Nil AGRICULT 572241002935
indiramma(5 URE
1) LABOUR
/Nil
3 karnekota Son Male Nil AGRICULT 240885209434
mahesh(28) URE
LABOUR
/Nil
4 karnekota Son Male Nil AGRICULT
shivaji(23) URE
LABOUR
/Nil
5 karnekota Daughter in Female Nil AGRICULT 799372811323
sharadha(23) Law URE
LABOUR
/Nil
6 karnekota Daughter in Female Nil AGRICULT
rani(19) Law URE
LABOUR
/Nil
7 karnekota Mother Male Nil STUDENT/
nandini(1) Nil
8 karnekota Grand Female Nil STUDENT/
indraja(0) Daughter Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319638/002

Household Verification Format Door No:3-42/1,gandinagar

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband ganguji Gas YES/HP/4
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 karnekota Self Male Nil DAILY 650654635056
sathish(38) WAGES
LABOUR/N
il
2 karnekota Wife Female Nil DAILY
swapna(29) WAGES
LABOUR/N
il
3 karnekota Daughter Female Nil Nil/Nil 741245681523
ramadevi(10
)
4 karnekota Daughter Female Nil Nil/Nil
nikhitha(12)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319639/002

Household Verification Format Door No:3-41,lattupally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband ranganna Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 palamuru Self Male Nil DAILY 348011322200
venkatayya( WAGES
43) LABOUR/N
il
2 palamuru Wife Female Nil DAILY 879770955398
nagamani(34 WAGES
) LABOUR/N
il
3 palamuru Wife Female Nil Nil/Nil 842812460656
balakistham
ma(73)
4 palamuru Son Male Nil Nil/Nil 902071241623
narasimha(2
1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.32 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319640/002

Household Verification Format Door No:3-44,lattupalli

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband ramulu Gas YES/HP/4
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 gaddikapula Self Male Nil OTHERS(P 392363199659
balaraju(43) ROVIDE
DETAILS)/
Nil
2 gaddikapula Wife Female Nil Nil/Nil 679330220069
nirmala(30)

3 gaddikapula Son Male Nil Nil/Nil 944768513057

srihari(12)

4 gaddikapula Son Male Nil Nil/Nil 734726999550

rajesh(10)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319641/001

Household Verification Format Door No:3-46,lattupally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband krishnayya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 vandanam Self Female Nil DAILY 470604971277
sayamma(74 WAGES
) LABOUR/N
il
2 vandanam Wife Female Nil Nil/Nil 948449052966
anitha(30)

3 vandanam Son Male Nil DAILY 550032640215

ramulu(28) WAGES
LABOUR/N
il
4 vandanam Son Male Nil Nil/Nil
tharun(4)
5 vandanam Son Male Nil Nil/Nil 944725952746
srinivasulu(3
1)
6 vandanam Son Male Nil DAILY 524465492705
laxmayya(34 WAGES
) LABOUR/N
il
7 vandanam Daughter Female Nil Nil/Nil
vaishnavi(7)
8 vandanam Daughter in Female Nil DAILY 861836241922
renuka(24) Law WAGES
LABOUR/N
il
9 vandanam Grand Female Nil DAILY 466585542774
samantha(2) Daughter WAGES
LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.35 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319642/002

Household Verification Format Door No:3-45,lattupally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband balayya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 vandanam Self Female Nil Nil/Nil 312327886011
balanagamm
a(56)
2 vandanam Son Male Nil Nil/Nil 875452996335
venkatayya(
38)
3 vandanam Son Male Nil Nil/Nil 608978323452
ramulu(39)

4 vandanam Daughter in Female Nil Nil/Nil 553708436192

kalamma(28) Law

5 vandanam Daughter in Female Nil Nil/Nil 726762043318

yadamma(35 Law
)
6 vandanam Mother Female Nil Nil/Nil 708072513759
nandini(15)

7 vandanam Grand Son Male Nil Nil/Nil 721714049689

bharath
kumar(11)
8 vandanam Grand Female Nil Nil/Nil
pravalika(15 Daughter
)
9 vandanam Grand Female Nil Nil/Nil 977734200932
navya(13) Daughter

10 vandanam Grand Female Nil Nil/Nil 918211012476

mounika(14) Daughter

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.35 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319643/001

Household Verification Format Door No:3-47,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband LAXMAYYA Gas YES/HP/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BAJARU Self Male Nil Nil/Nil 400853502696
BHASKAR(
36)
2 BAJARU Wife Female Nil Nil/Nil 637608375957
PUSPPA(28)

3 BAJARU Son Male Nil Nil/Nil

PAVAN(2)
4 BAJARU Daughter Female Nil Nil/Nil 423912074737
KAVYA(4)

5 BAJARU Mother Female Nil Nil/Nil 387072490166

RAMULAM
MA(61)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319644/002

Household Verification Format Door No:3-48,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KARRENNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MANGAMP Self Male Nil Nil/Nil 865661453787
ETA
THIRUPAT
HAYYA(44)
2 MANGAMP Wife Female Nil Nil/Nil 861210754194
ETA
SHANTHA
MMA(35)
3 MANGAMP Son Male Nil Nil/Nil 465554156495
ETA
KALENDH
AR(20)
4 MANGAMP Son Male Nil Nil/Nil 657377436337
ETA
MAHESH(1
8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.98 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319645/001

Household Verification Format Door No:3-49,GANDHINAGAR

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband LAXMAYYA Gas YES/HP/03
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 UMMUNA Self Male Nil Nil/Nil 940430434243
MOONI
KRISHNAY
YA(44)
2 UMMUNA Wife Female Nil Nil/Nil 946768795010
MOONI
LAXMI(35)
3 UMMUNA Son Male Nil Nil/Nil 419522497587
MOONI
SHIVSHAN
KAR(14)
4 UMMUNA Daughter Female Nil Nil/Nil
MOONI
HINDHU(3)
5 UMMUNA Brother Male Nil Nil/Nil 760383034996
MOONI
THIRUPAT
HAYYA(29)
6 UMMUNA Sister in Law Female Nil Nil/Nil 265329950449
MOONI
CHITTEMM
A(23)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.95 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319646/001

Household Verification Format Door No:3-52,gandhinagar

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband karrena Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 kummari Self Male Nil Nil/Nil 227376148058
usanna(70)

2 kummari Wife Female Nil Nil/Nil 860216317445

sathayya(60)

3 kummari Son Male Nil Nil/Nil 542123416867

bhusayya(38
)
4 kummari Daughter in Female Nil Nil/Nil 642813097728
chandrakala Law
mma(32)
5 kummari Mother Female Nil Nil/Nil 558139353565
mythri(5)

6 kummari Grand Female Nil Nil/Nil

sruthi(1) Daughter
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.35 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319647/002

Household Verification Format Door No:3-53,gandhinagar

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband chinna girranna Gas YES/Indane/3
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mangampeta Self Male Nil DO 543226424951
sathyam(45) NOTHING/
PWD: Y & Nil
Sadaran
No:1418939
0140113016
2 mangampeta Wife Female Nil DAILY 620309649162
girijamma(3 WAGES
6) LABOUR/N
il
3 mangampeta Son Male Nil STUDENT/ 559289028241
shivaprasad( Nil
21)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319652/000

Household Verification Format Door No:3-56,3VA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHINNA PAPANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MANGGA Self Male Nil DO 636228532164
M PETTA NOTHING/
MANGGA Nil
MPETTA
NAGAYAN
A(54)PWD:
Y & Sadaran
No:AR1418
9390140113
058
2 MANGGA Husband Female Nil DO 800683754329
M PETTA NOTHING/
MANGGA Nil
MPETTA
NAGGAMA
(48)PWD: Y
& Sadaran
No:1418939
0140113073
3 MANGGA Son Male Nil Nil/Nil 279213280638
M PETTA
MANGGA
MPETTA
SHIVA(14)
4 MANGGA Daughter Female Nil Nil/Nil 415143273477
M PETTA
MANGGA
MPETTA
RENUKA(1
8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319653/000

Household Verification Format Door No:3-57,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband M NAGAYANA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MANGGA Husband Female Nil MIGRATED 782085019764
MPETTA LABOUR/N
MANGGA il
MPETTA
TIRUPATA
YANA(1)
2 MANGGA Wife Female Nil MIGRATED 207926009320
MPETTA M LABOUR/N
SRILAXMI( il
23)
3 MANGGA Daughter Female Nil Nil/Nil 800027695396
MPETTA M
KIRTHANA
(3)
4 MANGGA Daughter Female Nil Nil/Nil 775592972024
MPETTA M
NAGACHAI
TANYA(1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319654/000

Household Verification Format Door No:3-56,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband M NAGAYANA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MANGGA Self Male Nil MIGRATED 481910103146
MPETTA LABOUR/N
MANGGA il
MPETTA
PARASHUR
AMULU(22)
2 MANGGA Wife Female Nil MIGRATED 277918178408
MPETTA LABOUR/N
MANGGA il
MPRTTA
NIRMALA(
20)
3 MANGGA Daughter Female Nil Nil/Nil 951078966009
MPETTA
MANGGAP
ETTA
SUPRAJA(0
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319655/000

Household Verification Format Door No:3-58,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARAYANA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MANGGA Self Female Nil AGRICULT 846905834589
MPETTA URE
MANGGA LABOUR
MPETTA /Nil
LAXMMA(
45)
2 MANGGA Son Male Nil AGRICULT 945523305513
MPETTA URE
MANGGA LABOUR
MPETTA /Nil
SRISAILA
M(29)
3 MANGGA Daughter Female Nil Nil/Nil 820975717487
MPETTA
MANGGA
MPETTA
MALESH(1
9)PWD: Y &
Sadaran
No:1418939
0140113033
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:0.72 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319656/000

Household Verification Format Door No:3-59,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NAGALINGAYANA Gas YES/HP/617324
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 AAKULA Self Male Nil OWN 947605344059
AAKULA AGRICULT
SIDESHVA URE
RAYA(49) /Nil
2 AAKULA Wife Female Nil HOUSE 719967729195
AAKULA WIFE/Nil
RAMESHV
ARAMMA(
38)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319657/000

Household Verification Format Door No:3-59,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband A Gas YES/HP/637151
Name SIDESHVARAYANA Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 AAKULA Self Male Nil OTHER 390627505964
AAKULA SKILLED
GANGADA WORKERS/
R(44) Nil
2 AAKULA Wife Female Nil HOUSE 328187410312
AAKULA WIFE/Nil
SAILAJA(4
2)
3 AAKULA Son Male Nil STUDENT/ 491288003111
AAKULA Nil
SAIKIRAN(
17)
4 AAKULA Daughter Female Nil STUDENT/ 803238395839
AAKULA Nil
PRIYANKA
(17)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:6.52 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319658/000

Household Verification Format Door No:3-62,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband N VENKANA Gas YES/HP/637621
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NNUTANA Self Male Nil DO 587313431243
GANTI N NOTHING/
CHANDRA Nil
YANA(45)
2 NNUTANA Wife Female Nil AGRICULT 511590867258
GANTI N URE
PADMA(35) LABOUR
/Nil
3 NNUTANA Son Male Nil DAILY 535019384386
GANTI N WAGES
PRASHANT LABOUR/N
H(17) il
4 NNUTANA Daughter Female Nil Nil/Nil 249306155015
GANTI N
KAVITHA(
14)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319659/000

Household Verification Format Door No:3-63,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAYANA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GAURAAR Self Male Nil AGRICULT 580955927265
MG URE
GANGAPU LABOUR
RI(53) /Nil
2 GAURAAR Wife Female Nil Nil/Nil 395501524485
MG
TIRUPATH
AMMA(34)
3 GAURAAR Wife Female Nil AGRICULT 737264626688
MG URE
SHANTAM LABOUR
MA(39) /Nil
4 GAURAAR Daughter Male Nil MIGRATED 317275932274
MG LABOUR/N
GOPAL(25) il
5 GAURAAR Daughter Male Nil Nil/Nil 973198814486
MG
SUJATHA(1
3)
6 GAURAAR Daughter in Female Nil MIGRATED 283503280524
MG Law LABOUR/N
KAMESHV il
ARE(22)
7 GAURAAR Father Male Nil Nil/Nil 812394673837
M
GAERARA
MUSHAYA
(45)
8 GAURAAR Grand Son Male Nil OTHERS(P 844882216805
MG ROVIDE
SURESH(3) DETAILS)/
Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319660/000

Household Verification Format Door No:3-64,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband V GOKARAYAA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VANDANA Self Male Nil OWN 438562944536
M AGRICULT
VANDANA URE
M /Nil
NARSIMHA
(36)
2 VANDANA Wife Female Nil HOUSE 530921480116
MV WIFE/Nil
HEMALAT
HA(30)
3 VANDANA Son Female Nil STUDENT/ 217891428900
MV Nil
GOVARDA
N(14)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0.15/DRY:0.95 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319661/000

Household Verification Format Door No:3-67,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband GOPANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAVELLA Self Male Nil Nil/Nil 563537132150
MAVELLA
NAGANNA
(58)
2 MAVELLA Wife Female Nil Nil/Nil 654934639767
MAVELLA
ANJANAM
MA(53)
3 MAVELLA Wife Female Nil Nil/Nil 390583506086
M
SAUJANYA
(22)
4 MAVELLA Son Male Nil Nil/Nil 518780771172
M
JHANGIR(2
1)
5 MAVELLA Daughter Female Nil Nil/Nil 469114274633
M
ANITHA(23
)
6 MAVELLA Brother Male Nil Nil/Nil 242645303641
M
RAMULU(3
1)PWD: Y &
Sadaran
No:1418939
0140113027
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0.9 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319662/000

Household Verification Format Door No:3-67,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NAGANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAVELLA Self Male Nil DAILY 505176362663
M WAGES
VENKATA LABOUR/N
SWAMY(33 il
)
2 MAVELLA Wife Female Nil Nil/Nil 911153687814
M
NIRMALA(
28)
3 MAVELLA Son Female Nil Nil/Nil
M
JAGADEES
HVAR(0)
4 MAVELLA Daughter Male Nil Nil/Nil 634008230491
M
PUJITHA(5)
5 MAVELLA Daughter Male Nil Nil/Nil 470934638797
M
HIMSIMMT
HA(4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319663/000

Household Verification Format Door No:3-68,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband M CHINAGOPANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAVELLA Self Male Nil MIGRATED 479070043029
M LABOUR/N
CHINAYAN il
A(38)
2 MAVELLA Wife Female Nil AGRICULT 629856900770
M URE
DARAMMA LABOUR
(32) /Nil
3 MAVELLA Son Male Nil Nil/Nil 257417098103
M
SHIVA(14)
4 MAVELLA Son Male Nil Nil/Nil 820420070729
M
SURESH(17
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0.9 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319664/000

Household Verification Format Door No:3-69,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband M CHINAGOPANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAVELLA Self Male Nil DO 239088556942
M NOTHING/
VENKATA Nil
YANA(39)P
WD: Y &
Sadaran
No:1418939
0140113001
2 MAVELLA Wife Female Nil AGRICULT 368619004554
M URE
LAXMMA( LABOUR
35) /Nil
3 MAVELLA Son Male Nil DO 899970637339
M NOTHING/
ANJANAIL Nil
U(10)
4 MAVELLA Daughter Female Nil DO 694122762378
M NOTHING/
SHANTHA Nil
MMA(15)
5 MAVELLA Daughter Female Nil DO 859717172637
M NOTHING/
YADHAM Nil
MA(12)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0.9 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319665/000

Household Verification Format Door No:3-71,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband RAJANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 YERUKAL Self Male Nil OTHER 859970849832
E SKILLED
YELLAYA WORKERS/
NA(60) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:5.6 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0319666/000

Household Verification Format Door No:3-65,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHAINAYANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SAMDA S Self Male Nil MIGRATED 847055172725
VENKATA LABOUR/N
YA(34) il
2 SAMDA S Wife Female Nil MIGRATED 459704547633
MANJULA( LABOUR/N
27) il
3 SAMDA S Son Male Nil Nil/Nil
CHANDU(1
)
4 SAMDA S Daughter Female Nil Nil/Nil 507770683066
NANDINI(7
)
5 SAMDA S Daughter Female Nil Nil/Nil 454491836309
BARGAVE(
9)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319668/000

Household Verification Format Door No:3-73,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SHAKARAYANA Gas YES/HP/617328
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 AAKULA A Self Male Nil SMALL 995335511745
SRISAILA BUSINESS
M(50) /Nil
2 AAKULA A Wife Female Nil HOUSE 222037805440
SHANTJI(4 WIFE/Nil
8)
3 AAKULA A Son Male Nil STUDENT/ 850344401329
SHIVAPRA Nil
SAD(20)
4 AAKULA A Mother Female Nil Nil/Nil 868860929708
SHANTHA
MMA(75)
5 AAKULA A Mother Female Nil Nil/Nil 553940970770
BUCHAMM
A(78)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319669/000

Household Verification Format Door No:3-73,LATTUAPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband A SRISAILAM Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 AAKULA A Self Male Nil Nil/Nil 416686896801
MALLIKAR
JUN(24)
2 AAKULA A Wife Female Nil Nil/Nil 398323039558
DEEPIKA(2
4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319670/000

Household Verification Format Door No:3-74,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHINNA GIRANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MANGAMP Self Male Nil AGRICULT 662597211335
ETA M URE
CHINNA LABOUR
NARAYAN /Nil
A(65)
2 MANGAMP Wife Female Nil DO 990220636093
ETA M NOTHING/
ANJANAM Nil
MA(60)
3 MANGAMP Son Male Nil AGRICULT 740494843428
ETA M URE
RAMULU(3 LABOUR
4) /Nil
4 MANGAMP Son Male FISHER Nil/Nil 591634854843
ETA M MAN
SRINIVASU
LU(35)
5 MANGAMP Daughter in Female Nil AGRICULT 253997299317
ETA M Law URE
LAVANYA( LABOUR
28) /Nil
6 MANGAMP Daughter in Female Nil State Govt 482355023306
ETA M Law Project
KRISNAVE Employee
NI(32) /Nil
7 MANGAMP Grand Son Male Nil Nil/Nil 334915689634
ETA M
SURYATEJ
A(4)
8 MANGAMP Grand Son Male Nil Nil/Nil 367749568440
ETA M
MOHANA
MURALI(12
)
9 MANGAMP Grand Female Nil Nil/Nil
ETA M Daughter
BHAVYAS
REE(0)
10 MANGAMP Grand Female Nil Nil/Nil 969166633862
ETA M Daughter
NAVYASR
EE(7)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:
Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319671/000

Household Verification Format Door No:3-75,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAYANA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MADDEEG Self Male Nil OWN
ATLLA M AGRICULT
BURAAN(4 URE
0) /Nil
2 MADDEEG Wife Female Nil AGRICULT
ATLLA M URE
CHITEMM LABOUR
A(35) /Nil
3 MADDEEG Wife Female Nil AGRICULT 882293439273
ATLLA M URE
ANJANAM LABOUR
MA(25) /Nil
4 MADDEEG Son Male Nil MIGRATED 249638434971
ATLLA M LABOUR/N
KRISHNA(1 il
)
5 MADDEEG Daughter in Female Nil MIGRATED
ATLLA M Law LABOUR/N
PARVATH il
MMA(22)
6 MADDEEG Grand Son Male Nil Nil/Nil 490249608489
ATLLA M
CHANDU(6
)
7 MADDEEG Grand Female Nil Nil/Nil
ATLLA M Daughter
SHARAVA
NI(2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.78 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319672/000

Household Verification Format Door No:3-79,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband HANUMANTH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BAYANA Self Male Nil DO 237861311180
BAYA NOTHING/
BUCHANN Nil
A(60)
2 BAYANA Wife Female Nil DO 711190888157
SITHAMM NOTHING/
A(55) Nil
3 BAYANA B Son Male Nil AGRICULT 995815885021
ANJANAIL URE
U(39) LABOUR
/Nil
4 BAYANA B Son Male Nil AGRICULT 670874252526
SRINIVASU URE
LU(22) LABOUR
/Nil
5 BAYANA B Daughter in Female Nil AGRICULT 603330992311
SUVARNA( Law URE
18) LABOUR
/Nil
6 BAYANA B Daughter in Female Nil AGRICULT 940895916770
SHAMALA( Law URE
30) LABOUR
/Nil
7 BAYANA B Grand Son Male Nil Nil/Nil
SRIKANTH
(0)
8 BAYANA B Grand Female Nil Nil/Nil 760620129710
GOWRAM Daughter
MA(4)
9 BAYANA B Grand Female Nil Nil/Nil
MOUNIKA( Daughter
6)
10 BAYANA B Grand Female Nil Nil/Nil 734711478822
NAGALAX Daughter
MMI(9)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:5.88 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319673/000

Household Verification Format Door No:3-80,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM J Self Male Nil AGRICULT 764651848290
MASAYAN URE
A(60) LABOUR
/Cntral Govt
Pension
2 JANGAM J Wife Female Nil AGRICULT 979812549933
VENKATA URE
MMA(45) LABOUR
/Nil
3 JANGAM J Son Male Nil Nil/Nil 526503399818
ASHOK(12)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319674/000

Household Verification Format Door No:3-83,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband VENKATAYANA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 TAATEKO Self Male Nil MIGRATED 563626603695
NDA T LABOUR/N
BALAYAN il
A(38)
2 TAATEKO Wife Female Nil MIGRATED 757415696432
NDA T LABOUR/N
MANJAEM il
MA(32)
3 TAATEKO Son Male Nil STUDENT/ 667763375741
NDA T Nil
CHANDRA
SHEKAR(9)
4 TAATEKO Daughter Female Nil STUDENT/ 292311466855
NDA T Nil
VIJAYALA
XMI(14)
5 TAATEKO Mother Female Nil DO 743636067863
NDA T NOTHING/
BALAKIST Nil
AMMA(66)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.95 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319675/000

Household Verification Format Door No:3-84,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAYANA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MADARAM Self Male Nil DO 305837013701
ONE M NOTHING/
ANJAYAN Nil
A(56)
2 MADARAM Wife Female Nil Nil/Nil 814350436032
ONE M
MANEMAA
(20)
3 MADARAM Wife Female Nil DO 460911808815
ONE M NOTHING/
CHENAMM Nil
A(52)
4 MADARAM Son Male Nil Nil/Nil 406326191564
ONE M
SAIKIRAN(
25)
5 MADARAM Son Male Nil Nil/Nil
ONE M
CHANDRA
MOHAN(8)
6 MADARAM Son Male Nil Nil/Nil 973022784642
ONE M
EESHVARA
MMA(1)
7 MADARAM Son Male Nil Nil/Nil
ONE M
BALARAJU
(5)
8 MADARAM Daughter Female Nil Nil/Nil
ONE M
SHEVALEE
LA(11)
9 MADARAM Daughter Female Nil Nil/Nil 837436924397
ONE M
MENAKSHI
(3)
10 MADARAM Brother Male Nil Nil/Nil
ONE M
SRINU(36)
11 MADARAM Brother Male Nil Nil/Nil 384958680264
ONE M
SATHYAN
ARAYANA(
34)
12 MADARAM Sister in Law Female Nil Nil/Nil
ONE M
RAMULAM
MA(30)
13 MADARAM Sister in Law Female Nil Nil/Nil 449225162802
ONE M
RENUKA(3
0)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319676/000

Household Verification Format Door No:3-87,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas YES/HP/634883
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 EENGURA Self Male Nil MILCH 452670692529
MBADDA E ANIMALS/
SRINIVASU Nil
LU(36)
2 EENGURA Wife Female Nil DAILY 663207034601
MBADDA E WAGES
LALITHA(2 LABOUR/N
9) il
3 EENGURA Son Male Nil Nil/Nil 624208281696
MBADDA E
RAMKUMA
R
GANDHI(5)
4 EENGURA Son Male Nil Nil/Nil 574191603826
MBADDA E
SHIVARAM
(8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319677/000

Household Verification Format Door No:3-88,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BODAELLI Self Male Nil DO 554870310576
B NOTHING/
BALAYAN Nil
A(60)
2 BODAELLI Wife Female Nil Nil/Nil 809700264980
B
BALAMMA
(50)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319678/000

Household Verification Format Door No:4-17/1,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband GOKARAYANA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VANDANA Self Male Nil OWN 710268291203
MV AGRICULT
ANJANAIL URE
U(48) /Nil
2 VANDANA Wife Female Nil AGRICULT 323565237560
MN URE
NAGALAX LABOUR
MI(34) /Nil
3 VANDANA Son Male Nil Nil/Nil 410511513810
MV
UDAYTEJA
(11)
4 VANDANA Daughter Female Nil Nil/Nil 546238434504
MV
DEVIKUM
ARI(19)
5 VANDANA Daughter Female Nil Nil/Nil 950027094505
MV
SUMALAT
HA(18)
6 VANDANA Mother Female Nil Nil/Nil 272273953718
MV
MASAMM
A(64)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:1.1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319681/000

Household Verification Format Door No:3-70,telugu vada

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC SC Father/Mother/husband JAGAN Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PONAKAN Self Female Nil MIGRATED
TI P LABOUR/N
SHAMALA( il
41)
2 PONAKAN Son Male Nil OTHERS(P
TI ROVIDE
MAHESH(1 DETAILS)/
8) Nil
3 PONAKAN Son Male Nil OTHER
TI SKILLED
ESWAR(21) WORKERS/
Nil
4 PONAKAN Daughter in Female Nil OTHERS(P 615127872721
TI Law ROVIDE
ANITHA(19 DETAILS)/
) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319682/000

Household Verification Format Door No:5-19,TELUGU VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARSIMHULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ANAMONI Self Female Nil DAILY 946611513654
NARAMMA WAGES
(58) LABOUR/N
il
2 ANAMONI Grand Son Male Nil DO 922380716468
SRIKANTH NOTHING/
(13) Nil
3 ANAMONI Grand Female Nil STUDENT/ 850908517708
MADAVI(1 Daughter Nil
2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:5.78 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319683/000

Household Verification Format Door No:5-20,TELUGU VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHENNAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PITTELA P Self Female Nil OWN 323483383014
NAGAMM AGRICULT
A(38) URE
/Nil
2 PITTELA Husband Male Nil AGRICULT 590051536048
CHENNAIA URE
H(41) LABOUR
/Nil
3 PITTELA Son Male Nil DO 400464284715
SAVESWA NOTHING/
RI(20) Nil
4 PITTELA Son Male Nil DO 819723946200
NARASIMH NOTHING/
A(22) Nil
5 PITTELA Daughter in Female Nil AGRICULT
LAVANYA( Law URE
18) LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:5.02 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319684/000

Household Verification Format Door No:5-17,TELUGU VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 INGURAM Self Male Nil OTHERS(P 603300037385
BADA ROVIDE
VENKAT DETAILS)/
SWAMI(38) Nil
2 INGURAM Wife Female Nil DAILY 647535774515
BADA WAGES
PADMA(28) LABOUR/N
il
3 INGURAM Daughter Female Nil STUDENT/ 653391726067
BADA Nil
NAVYA
SRI(7)
4 INGURAM Daughter Female Nil STUDENT/ 211033702594
BADA Nil
VAISHNAV
I(5)
5 INGURAM Mother Female Nil DO 268797642974
BADA NOTHING/
NARAMMA Nil
(64)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.92 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319685/000

Household Verification Format Door No:5-16,TELUGU VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SAYANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ANAMONI Self Male Nil AGRICULT 572224018010
NAGAIAH( URE
43) LABOUR
/Nil
2 ANAMONI Wife Female Nil AGRICULT 254791825767
MANGAM URE
MA(38) LABOUR
/Nil
3 ANAMONI Son Male Nil DO 423141101427
SRISAILA NOTHING/
M(20) Nil
4 ANAMONI Daughter Female Nil STUDENT/ 392479622168
SRAVANT Nil
HI(19)
5 ANAMONI Mother Female Nil DO 793121004928
MASAMM NOTHING/
A(73) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.52 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319686/000

Household Verification Format Door No:5-15,TELUGU VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband VENKATAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KAMPILLA Self Female Nil DO 694755583068
NAGAMM NOTHING/
A(60) Nil
2 KAMPILLA Son Male Nil DAILY 381149498378
SRISAILA WAGES
M(33) LABOUR/N
il
3 KAMPILLA Daughter in Female Nil DAILY 891600278796
KALAMMA Law WAGES
(25) LABOUR/N
il
4 KAMPILLA Brother Male Nil DAILY 352772890180
NAGANNA WAGES
(60) LABOUR/N
il
5 KAMPILLA Grand Son Male Nil STUDENT/ 689991486628
SHIVA Nil
CHERAN(5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319687/000

Household Verification Format Door No:3-93,TELUGU VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband LAXMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BOKKI Self Male Nil AGRICULT 947776405522
ANJANEYU URE
LU(48) LABOUR
/Nil
2 BOKKI Wife Female Nil DAILY 784037569057
RENUKA(3 WAGES
8) LABOUR/N
il
3 BOKKI Son Male Nil STUDENT/ 771028843490
SURESH(16 Nil
)
4 BOKKI Son Male Nil STUDENT/ 402610352147
SHIVA Nil
KUMAR(21
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.78 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319688/000

Household Verification Format Door No:3-94,TELUGU VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband PEDDA NARSIMNA Gas YES/HP/617466
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NEELLA Self Male Nil DO 235641191404
BHAKKAN NOTHING/
NA(68) Nil
2 NEELLA Wife Female Nil HOUSE 349862148414
VENKATA WIFE/Nil
MMA(58)
3 NEELLA Son Male Nil DAILY 865662155343
SRINIVASU WAGES
LU(26) LABOUR/N
il
4 NEELLA Son Male Nil DRIVERS/N 539601451967
NARASIMH il
A(32)
5 NEELLA Daughter in Female Nil HOUSE 815042876320
MANJULA( Law WIFE/Nil
20)
6 NEELLA Daughter in Female Nil HOUSE 907477952370
REKHA(26) Law WIFE/Nil

7 NEELLA Grand Son Male Nil DO 356753107307

KARTHIK(1 NOTHING/
) Nil
8 NEELLA N Grand Son Male Nil STUDENT/ 618941115041
VISHNU Nil
MANOHAR
(4)
9 NEELLA Grand Female Nil STUDENT/ 962044374907
NILA Daughter Nil
JAYANTHI(
6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.55 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319689/000

Household Verification Format Door No:5-15/1,TELUGU VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KASHANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ATHINARA Self Male Nil DO 385218198902
PU NOTHING/
SATYANA Nil
RAYANA(5
3)
2 ATHINARA Wife Female Nil AGRICULT 378002101337
PU URE
PADMAM LABOUR
MA(48) /Nil
3 ATHINARA Son Male Nil STUDENT/ 328311441144
PU Nil
HARISHEN
KAR(21)
4 ATHINARA Son Male Nil STUDENT/ 756669667567
PU Nil
KRUSHNA
KUMAR(13
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319690/000

Household Verification Format Door No:3-96,TELUGU VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband VENKATAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BOYINI B Self Female Nil DAILY 625854542676
INDHIRAM WAGES
MA(33) LABOUR/N
il
2 BOYINI B Son Male Nil STUDENT/ 577070143116
SHIVA Nil
KUMAR(10
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0.48/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319691/000

Household Verification Format Door No:3-95,TELUGU VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband PENTAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NARLA Self Female Nil DO 730837138136
PURAM N NOTHING/
PARVATH Nil
AMMA(73)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0319692/000

Household Verification Format Door No:3-97,TELUGU VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ALUGU Self Female Nil DO 757713447996
SAVARAM NOTHING/
MA(63) Nil
2 ALUGU Daughter Female Nil HOUSE 945109986202
ANSUYAM WIFE/Nil
MA(43)
3 ALUGU Son in Law Male Nil AGRICULT 839952120217
VENKATAI URE
AH(51) LABOUR
/Nil
4 ALUGU Grand Son Female Nil DO 254137087550
SHIVA NOTHING/
KUMAR(25 Nil
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319693/000

Household Verification Format Door No:3-98,TELUGU VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband PIRAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ALUGU Self Male Nil DAILY 716501553921
VENKATAI WAGES
AH(46) LABOUR/N
il
2 ALUGU Wife Female Nil DAILY 556026902707
THIRUPAT WAGES
HAIAH(37) LABOUR/N
il
3 ALUGU Daughter in Female Nil STUDENT/ 433369742384
AKHILA(13 Law Nil
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.05 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319694/000

Household Verification Format Door No:3-99,TELUGU VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 THATIKON Self Male Nil DO 811421465223
DA NOTHING/
LAXMAIA Nil
H(63)
2 THATIKON Wife Female Nil DO 401553545802
DA NOTHING/
SANJAMM Nil
A(61)
3 THATIKON Son Male Nil DAILY 516928484649
DA WAGES
KURMURT LABOUR/N
HI(34) il
4 THATIKON Daughter in Female Nil DAILY 702887442547
DA Law WAGES
KALYANI( LABOUR/N
28) il
5 THATIKON Grand Female Nil STUDENT/ 555613253980
DA Daughter Nil
SANDYAR
ANI(10)
6 THATIKON Grand Female Nil STUDENT/ 455453318730
DA Daughter Nil
SWARUPA
RANI(4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319695/000

Household Verification Format Door No:4-1,TELUGU VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas YES/HP/632002
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 THATI Self Female Nil DAILY 385012036028
KONDA WAGES
ALIVELA(4 LABOUR/N
9) il
2 THATI Son Male Nil DAILY 718163444467
KONDA WAGES
VENKATA LABOUR/N
SWAMI(18) il
3 THATI Son Male Nil DAILY 495761293016
KONDA WAGES
THIRUPAT LABOUR/N
HI(27) il
4 THATI Daughter Female Nil STUDENT/ 251213539840
KONDA Nil
SIRISHA(13
)
5 THATI Daughter Female Nil STUDENT/ 513096681291
KONDA Nil
SHAMALA(
16)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0.38/DRY:0.25 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319696/000

Household Verification Format Door No:4-2,TELUGU VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KURUMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 THATIKON Self Male Nil DO 524715144504
DA T NOTHING/
VENKATAI Nil
AH(78)
2 THATIKON Wife Female Nil DO 897741310214
DA NOTHING/
RAMULAM Nil
MA(60)
3 THATIKON Son Male Nil DRIVERS/N 311215517982
DA il
KRUSHNAI
AH(36)
4 THATIKON Daughter in Female Nil HOUSE 830770863140
DA Law WIFE/Nil
PRAMILA(2
7)
5 THATIKON Grand Female Nil STUDENT/ 503511051538
DA Daughter Nil
SRIJA(6)
6 THATIKON Grand Female Nil STUDENT/ 252906441188
DA T Daughter Nil
MEGHANA
(7)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0.58/DRY:3.32 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319697/000

Household Verification Format Door No:4-3,TELUGU VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KURUMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 THATI Self Male Nil DAILY 406145812412
KONDA T WAGES
NARAYAN LABOUR/N
A(53) il
2 THATI Wife Female Nil DAILY 286216220892
KONDA WAGES
VENKATA LABOUR/N
MMA(48) il
3 THATI Son Male Nil DAILY 937647888050
KONDA WAGES
KURUMUR LABOUR/N
THI(22) il
4 THATI Son Male Nil DAILY 516191200941
KONDA WAGES
SRINIVASU LABOUR/N
LU(27) il
5 THATI Daughter in Female Nil DAILY 917694069500
KONDA Law WAGES
SRAVANI(1 LABOUR/N
7) il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.48 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319698/000

Household Verification Format Door No:4-4,TELUGU VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband VENKATAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM J Self Female Nil DAILY 314772423663
LAXMI(40) WAGES
LABOUR/N
il
2 JANGAM Daughter Female Nil DAILY 740396529851
SIRISHA(13 WAGES
) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319699/000

Household Verification Format Door No:4-4/1,TELUGU VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SRINIVASULU Gas YES/HP/617456
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VAKITI V Self Female Nil DAILY 705585966844
KALYANI( WAGES
45) LABOUR/N
il
2 VAKITI Son Male Nil DO 612677118798
SHIVAKU NOTHING/
MAR(28) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319700/000

Household Verification Format Door No:5-14,TELUGU VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMCHRNDRAIAH Gas YES/HP/632835
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM J Self Male Nil OWN 560932742979
ESWARAIA AGRICULT
H(40) URE
/Nil
2 JANGAM Wife Female Nil Nil/Nil 285659294583
SRIDEVI(32
)
3 JANGAM Son Male Nil STUDENT/ 684167231006
CHENDU(9) Nil

4 JANGAM Daughter Female Nil STUDENT/ 422546992124

SARITHA(7 Nil
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0.12/DRY:1.68 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319701/000

Household Verification Format Door No:5-13,TELUGU VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMCHEDRAIAH Gas YES/HP/656789
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM Self Male Nil PSU 561420211653
PANDU(35) Employee/Ni
l
2 JANGAM Wife Female Nil STUDENT/ 924648160093
NIRMALA( Nil
27)
3 JANGAM Son Male Nil STUDENT/ 825857719005
SAIJESWA Nil
TH(7)
4 JANGAM Son Male Nil STUDENT/ 384151316559
SAIMURAL Nil
I(9)
5 JANGAM Mother Female Nil DO 400199737671
NILAMMA( NOTHING/
65) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0.25/DRY:1.95 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319702/000

Household Verification Format Door No:5-12,TELUGU VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARAYANA Gas YES/HP/670724
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM Self Male Nil AGRICULT 257334788526
MADAN(37 URE
) LABOUR
/Nil
2 JANGAM Wife Female Nil AGRICULT 637745449762
LAXMAM URE
MA(33) LABOUR
/Nil
3 JANGAM Daughter Female Nil STUDENT/ 847620769330
VANAJA(17 Nil
)
4 JANGAM Son in Law Male Nil STUDENT/ 426959399817
RAVI(13) Nil

5 JANGAM Mother Female Nil DO 977015980537

VENKATA NOTHING/
MMA(63) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.12 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319703/000

Household Verification Format Door No:4-6,TELUGU VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHENNAPPA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM J Self Male Nil AGRICULT 919259695570
CHINNA URE
NAGULU(6 LABOUR
3) /Nil
2 JANGAM Wife Female Nil AGRICULT 287284165526
MANGAM URE
MA(53) LABOUR
/Nil
3 JANGAM Son Male Nil DAILY 433369589333
RAMULU(3 WAGES
3) LABOUR/N
il
4 JANGAM Son Female Nil AGRICULT 483425395197
NAGARAJ URE
U(22)PWD: LABOUR
Y & Sadaran /Nil
No:000
5 JANGAM Son Male Nil AGRICULT 591920214731
CHENNAIA URE
H(32) LABOUR
/Nil
6 JANGAM Daughter in Female Nil DAILY 938917696867
CHENNAM Law WAGES
MA(30) LABOUR/N
il
7 JANGAM Daughter in Female Nil AGRICULT 407460451000
SHARADH Law URE
A(23) LABOUR
/Nil
8 JANGAM Grand Son Male Nil DO 342886753595
NAVEEN(3) NOTHING/
Nil
9 JANGAM Grand Female Nil DO
MOUNIKA( Daughter NOTHING/
1) Nil
10 JANGAM Grand Female Nil DO
NAMITHA( Daughter NOTHING/
0) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0.08 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:
Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319704/000

Household Verification Format Door No:4-8,TELUGU VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 THATI Self Male Nil DAILY 605082548402
KONDA T WAGES
THIRUPAT LABOUR/N
HAIAH(48) il
2 THATI Wife Female Nil DAILY 965273883619
KONDA WAGES
LAXMI(38) LABOUR/N
il
3 THATI Son Female Nil STUDENT/ 920811687189
KONDA Nil
SRINU(16)
4 THATI Daughter Female Nil DO 530759405147
KONDA NOTHING/
LAVANYA( Nil
18)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319705/000

Household Verification Format Door No:4-9,TELUGU VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband GOPANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MANILLA Self Male Nil DAILY 642905163433
KRUSHNAI WAGES
AH(38) LABOUR/N
il
2 MANILLA Wife Female Nil DAILY 910743301267
THIRUPAT WAGES
HAMMA(29 LABOUR/N
) il
3 MANILLA Son Female Nil STUDENT/ 290530020838
RAJINI Nil
KANTH(10)
4 MANILLA Son Female Nil STUDENT/ 932967249830
GOPANNA( Nil
9)
5 MANILLA Son Female Nil DAILY
VIJAI WAGES
KUMAR(15 LABOUR/N
) il
6 MANILLA Son Female Nil AGRICULT 696330887965
NAGESH(1 URE
8) LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319706/000

Household Verification Format Door No:5-11,TYELUGU VADA

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband MASAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GORLA Self Female Nil DAILY 264088092654
LALITHAM WAGES
MA(48) LABOUR/N
il
2 GORLA Son Male Nil DAILY 846667486735
SRISAILA WAGES
M(23) LABOUR/N
il
3 GORLA Daughter Female Nil DAILY 761121767753
SIRISHA(16 WAGES
) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319711/000

Household Verification Format Door No:5-9/1,lattupally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband mannem Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 sanda Self Male Nil AGRICULT
mahesh(32) URE
LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0319712/000

Household Verification Format Door No:5-10,lattupally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband narayana Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 kotha Self Male Nil OWN 326331148503
shravaiah(49 AGRICULT
) URE
/Nil
2 kotha Wife Female Nil HOUSE 266061362013
laxmamama( WIFE/Nil
45)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.4 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319713/000

Household Verification Format Door No:5-10,lattupally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband shravaiah Gas YES/HP/625091
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 kotha Self Male Nil Nil/Nil 569439983515
chendarashe
kar(42)
2 kotha Wife Female Nil Nil/Nil 698941926061
kirthi(32)

3 kotha Son Male Nil Nil/Nil 306570480506

saikumar(13)

4 kotha Daughter Female Nil Nil/Nil 239841963026

vina(11)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.92 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319714/000

Household Verification Format Door No:4-12,lattupally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband enkanna Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 elugu Self Male Nil OWN 626353448299
srinivasulu(6 AGRICULT
2) URE
/Nil
2 elugu Wife Female Nil OWN 642027394378
ramulamma( AGRICULT
53) URE
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.08 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319715/000

Household Verification Format Door No:4-12/1,lattupally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband ramaswami Gas YES/HP/659932
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 elugu Self Male Nil AGRICULT 215709101875
anjanulu(46) URE
LABOUR
/Nil
2 elugu Wife Female Nil AGRICULT 596257299956
kalamma(34) URE
LABOUR
/Nil
3 elugu Son Male Nil Nil/Nil 245741044812
mahesh(15)

4 elugu Daughter Female Nil Nil/Nil 734361156199

akhila(12)

5 elugu Daughter Female Nil Nil/Nil 484843061937

shivajothi(16
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0.38 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319716/000

Household Verification Format Door No:4-16,lattupally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband chinnagattu Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 elugu Self Male Nil OWN 336483122807
venkatraiah( AGRICULT
46) URE
/Nil
2 elugu Wife Female Nil AGRICULT 411493561790
padama(42) URE
LABOUR
/Nil
3 elugu Son Male Nil Nil/Nil
shiva(18)
4 elugu Mother Female Nil AGRICULT 832336613838
kondamma(7 URE
2) LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:7 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319717/000

Household Verification Format Door No:4-16/1,lattupally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband venkataiah Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 elugu Self Male Nil MIGRATED 684087121187
srinu(34) LABOUR/N
il
2 elugu Wife Female Nil Nil/Nil 419678157752
bimamma(29
)
3 elugu Son Male Nil Nil/Nil
chendrashek
ar(1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319718/000

Household Verification Format Door No:4-16/2,lattupally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband venkaiah Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 elugu Self Male Nil AGRICULT 904327030592
ramulu(42) URE
LABOUR
/Nil
2 elugu Wife Female Nil Nil/Nil 778148651839
manjula(23)

3 elugu Son Male Nil Nil/Nil 300306598830

sathish(5)

4 elugu Son Male Nil Nil/Nil

srikanth(2)
5 elugu Son Male Nil Nil/Nil 538440454017
ganesh(6)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319719/000

Household Verification Format Door No:4-17,lattupally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband anthaiah Gas YES/HP/617462
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 vemula Self Male Nil Nil/Nil 437482787749
saibaba(52)

2 vemula Wife Female Nil Nil/Nil 991515992720

arunaa(46)

3 vemula Son Male Nil SMALL 439751367969

shubhash(26 BUSINESS
) /Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319720/000

Household Verification Format Door No:4-77,lattupally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband sailu Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 gwararam Self Female TAILOR Nil/Nil 579453227909
balamma(56)

2 gwararam Son Male Nil Nil/Nil 999088188866

kurumurthi(1
2)
3 gwararam Daughter Female Nil Nil/Nil 995385332963
thirupatham
ma(14)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319721/000

Household Verification Format Door No:4-78,lattupally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband ramulu Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 elugu Self Female Nil DAILY 476113260375
buddamma(7 WAGES
2) LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.82 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0319722/000

Household Verification Format Door No:4-74,lattupally

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband chinnabalaiahchary Gas YES/HP/617465
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 kammari Self Female Nil AGRICULT 394887126719
kalavathi(51) URE
LABOUR
/Nil
2 kammari Son Male BLACKSMI Nil/Nil
ragavendra(2 TH
9)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0.25/DRY:3.25 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319723/000

Household Verification Format Door No:4-75,lattupaly

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband elloji Gas YES/HP/6336213
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 katike Self Female Nil Nil/Nil 787116916677
narsamma(6
5)
2 katike Son Male Nil AGRICULT 519057791629
krupaji(34) URE
LABOUR
/Nil
3 katike Daughter in Female Nil Nil/Nil
LAXMI(34) Law
4 katike Grand Son Male Nil Nil/Nil 623871359821
SHIVANAR
AYANA(3)
5 katike Grand Son Male Nil Nil/Nil 420314094073
VISHNUPR
ASAD(5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319724/000

Household Verification Format Door No:4-76,LATTUPALLY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband ELLOJI Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KATIKE Self Male Nil AGRICULT 307275421689
PRAKASH( URE
52) LABOUR
/Nil
2 KATIKE Wife Female Nil AGRICULT 844793765415
LALITHAM URE
MA(42) LABOUR
/Nil
3 KATIKE Son Male Nil Nil/Nil 355406092463
SHIVAJI(16
)
4 KATIKE Son Male Nil Nil/Nil 488846630895
BALRAJ(14
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:1.52 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319725/000

Household Verification Format Door No:4-21,LATTUPALLY

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband NARAYANAREDDY Gas YES/HP/617455
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUJJA Self Male Nil Nil/Nil 909207864048
VENKATR
EDDY(62)
2 GUJJA Wife Female Nil DO 583965871522
YSHODAM NOTHING/
MA(50) Nil
3 GUJJA Son Male Nil Nil/Nil 449520736846
RAGAVEN
DARREDD
Y(24)
4 GUJJA Son Male Nil Nil/Nil 551903747363
RAJENDAR
REDDY(21)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:7.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319728/000

Household Verification Format Door No:4-24,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARAYANA Gas NIL/-/
Name CHARY Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAROJU Self Male Nil Nil/Nil 666061193207
RAMULU(4
6)
2 MAROJU Wife Female Nil HOUSE 201989488220
NAVANITH WIFE/Nil
A(22)
3 MAROJU Daughter Female Nil Nil/Nil 459023149360
HARSHITH
A(7)
4 MAROJU Daughter Female Nil Nil/Nil
TEJASWAI
NI(1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319729/000

Household Verification Format Door No:4-26,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband LAXAMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KAKOJU Self Male CARPENTE Nil/Nil 523345611664
NARESH(22 R
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0319730/000

Household Verification Format Door No:4-25/2,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband RAMARAO Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SAMBARAJ Self Male Nil OWN 566775271089
U AGRICULT
BALAKISH URE
ANRAO(65) /Cntral Govt
Pension
2 SAMBARAJ Wife Female Nil HOUSE 692110809812
U LILA(60) WIFE/Nil

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:3.6/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319731/000

Household Verification Format Door No:4-25/1,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband RAMARAO Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SAMBHAR Self Male Nil OWN 345400306736
AJU AGRICULT
PANDURA URE
NGARAO(7 /Nil
4)
2 SAMBHAR Wife Female Nil HOUSE 931030693918
AJU WIFE/Nil
JAYAPRAD
HA(64)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:5.6/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319732/000

Household Verification Format Door No:4-25/3,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband SUNDARRAO Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SAMBARAJ Self Male Nil OWN 856939973327
U AGRICULT
RAVINDAR URE
RAO(52) /Nil
2 SAMBARAJ Wife Female Nil Nil/Nil 423025450211
U
MANJULA(
41)
3 SAMBARAJ Son Male Nil Nil/Nil 692933179395
U
SAISHIRIS
H(16)
4 SAMBARAJ Son Male Nil Nil/Nil 359826189199
U
VAMSHIKR
ISHANA(19
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319733/000

Household Verification Format Door No:4-25,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband RAMARAO Gas YES/HP/614525
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SAMBHAR Self Male Nil OWN 488954419125
AJU AGRICULT
MANOHAR URE
ARAO(65) /Nil
2 SAMBHAR Wife Female Nil HOUSE 690795892785
AJU WIFE/Nil
ANTHALA
XMI(60)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319734/000

Household Verification Format Door No:4-40,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARAYANA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MEGGA Self Male Nil AGRICULT 847530495424
NAGANNA URE
(46) LABOUR
/Nil
2 MEGGA Wife Female Nil Nil/Nil 595266518455
PADAMA(3
6)
3 MEGGA Son Male Nil Nil/Nil 330078600299
SAINATH(1
3)
4 MEGGA Son Male Nil Nil/Nil
DIKSHTH(1
)
5 MEGGA Daughter Female Nil Nil/Nil 358281495791
DEPTHI(3)

6 MEGGA Mother Female Nil Nil/Nil 312320543732

SHUNDAR
AMMA(72)
7 MEGGA Brother Male Nil Nil/Nil 309186392709
BEEMAIAH
(36)
8 MEGGA Brother Male Nil Nil/Nil 476819521724
CHENNAIA
H(45)
9 MEGGA Sister in Law Female Nil Nil/Nil
SWANDAR
YA(20)
10 MEGGA Sister in Law Male Nil Nil/Nil 330109383022
SWATHI(22
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319735/000

Household Verification Format Door No:4-31,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MOGGA Self Male Nil AGRICULT 454387467214
KRISHAIA URE
H(56) LABOUR
/Nil
2 MOGGA Wife Female Nil Nil/Nil 747952148337
NIRMALA(
51)
3 MOGGA Daughter Female Nil Nil/Nil 412059506908
CHETHAN
YA(10)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319736/000

Household Verification Format Door No:4-40/1,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas YES/HP/631451
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MOGGA Self Male Nil AGRICULT 629027847752
ANJANULU URE
(42) LABOUR
/Nil
2 MOGGA Wife Female Nil Nil/Nil 768080102383
PARIJATH
A(36)
3 MOGGA Mother Female Nil DO 539499113330
LAXAMMA NOTHING/
(72) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319737/000

Household Verification Format Door No:4-38,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SWAMI Gas YES/HP/635722
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MOGGA V Self Female Nil AGRICULT 780658241264
ENKATAM URE
MA(46) LABOUR
/Nil
2 MOGGA Husband Male Nil Nil/Nil 395922235331
SWAMI(56)

3 MOGGA Son Male Nil STUDENT/ 758992626345

NARESH(19 Nil
)
4 MOGGA Son Male Nil Nil/Nil 472721282283
MAHESH(2
3)
5 MOGGA Son Male Nil Nil/Nil 978229440345
SHURESH(
15)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.05 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319738/000

Household Verification Format Door No:4-46,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband DEVAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BOYINI Self Male Nil AGRICULT 788802469843
RAMURTHI URE
(56) LABOUR
/Nil
2 BOYINI Wife Female Nil Nil/Nil 691798992995
SARALA(46
)
3 BOYINI Son Male Nil Nil/Nil 860929242096
DERAJ
KUMAR(9)
4 BOYINI Daughter Female Nil Nil/Nil 446915598487
PRAVALIK
A(14)
5 BOYINI Mother Female Nil Nil/Nil 534928099737
LAXMIDEV
AMMA(72)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319741/001

Household Verification Format Door No:4-43,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband m anjanreddy Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 maepalle m Self Female Nil AGRICULT 797727224431
lalithamma(6 URE
5) LABOUR
/Nil
2 maepalle m Son Male Nil AGRICULT 302207209537
nagireddy(45 URE
) LABOUR
/Nil
3 maepalle m Daughter in Female Nil AGRICULT 725882587261
chandrakala( Law URE
40) LABOUR
/Nil
4 maepalle Grand Son Male Nil Nil/Nil 63044733272
mharshavard
han reddy(7)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:5/DRY:14 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319742/001

Household Verification Format Door No:4-44,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband ramulu Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 nalagonda n Self Female Nil AGRICULT 211901887969
ramulamma( URE
55) LABOUR
/Nil
2 nalagonda Son Male Nil Nil/Nil 955699960338
srinuvas(28)

3 nalagonda Son Male Nil Nil/Nil 429429320112

nagaraju(43)

4 nalagonda Daughter in Female Nil Nil/Nil 736831010811

chandrakhala Law
(20)
5 nalagonda Daughter in Female Nil Nil/Nil 799883099078
bharathamm Law
a(27)
6 nalagonda Grand Son Male Nil Nil/Nil 219142658246
vegnesh(6)

7 nalagonda Grand Female Nil Nil/Nil 631852296273

dhiksha(2) Daughter

8 nalagonda Grand Female Nil Nil/Nil 837859962268

lokeswari(9) Daughter

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319743/001

Household Verification Format Door No:4-47,latupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband kisanji Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 karenekota Self Male Nil OWN 474025128492
krupaji(52) AGRICULT
URE
/Nil
2 karenekota k Wife Female Nil Nil/Nil 382094549681
balubai(43)

3 karenekota k Son Male Nil Nil/Nil 984403363820

ragavendherj
i(24)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.08 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319744/002

Household Verification Format Door No:4-47,latupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband k khishanji Gas YES/HP/629896
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 karnekota k Self Male Nil OWN 421900735725
jiyaji(43) AGRICULT
URE
/Nil
2 karnekota Husband Female Nil Nil/Nil 493605061587
klaxmibai(40
)
3 karnekota k Son Male Nil Nil/Nil 200980759035
vamshikuma
r(5)
4 karnekota k Son Male Nil Nil/Nil 508417655431
saikumar(8)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:8.15 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319746/002

Household Verification Format Door No:4-49,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband buddoji Gas YES/Others/637152
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 karnekota k Self Male Nil OTHERS(P 546149493401
jangoji(35) ROVIDE
DETAILS)/
Nil
2 karnekota k Husband Female Nil Nil/Nil 769147444360
padmmabai(
25)
3 karnekota k Son Male Nil Nil/Nil 653320015955
karthik(4)

4 karnekota k Son Male Nil Nil/Nil 383074678583

shivaji(8)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319747/001

Household Verification Format Door No:4-50,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband buddoji Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 karnekota Self Female Nil Nil/Nil 340743827315
sakubai(70)

2 karnekota Daughter Female Nil Nil/Nil

shamalabai(3
0)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319748/002

Household Verification Format Door No:4-51,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband chandraih Gas YES/HP/636078
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 marepalle Self Male Nil AGRICULT 380872373179
srinuvasulu( URE
65) LABOUR
/Nil
2 marepalle m Son Male Nil Nil/Nil 219793391437
chandra
goud(28)
3 marepalle Daughter in Female Nil Nil/Nil 760429037970
shivalila(20) Law

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319748/003

Household Verification Format Door No:4-45,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband sakru Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath m Self Male Nil OWN 509673580946
pandu(57) AGRICULT
URE
/Nil
2 mudavath Wife Female Nil Nil/Nil 988331637462
rajamma(53)

3 mudavath Son Male Nil Nil/Nil

srinuvasulu(
28)
4 mudavath Daughter in Female Nil Nil/Nil 580564145889
lalitha(19) Law

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:9.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319750/001

Household Verification Format Door No:4-52,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband ballayagoud Gas YES/HP/618290
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 marepalle m Self Male Nil OWN 737720561101
laxmaya AGRICULT
goud(43) URE
/Nil
2 marepalle Wife Female Nil Nil/Nil 230902483802
sathyamma(
38)
3 marepalle Son Male Nil Nil/Nil 522517608491
suresh
goud(21)
4 marepalle Daughter in Male Nil Nil/Nil 529370473883
nagalaxmi(2 Law
4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.98 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319750/003

Household Verification Format Door No:4-54,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband nagannagoud Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 yedhula Self Male Nil AGRICULT 331757306368
laxmaiah URE
goud(49) LABOUR
/Nil
2 yedhula Wife Female Nil AGRICULT 918791052925
maneemma( URE
45) LABOUR
/Nil
3 yedhula Son Male Nil Nil/Nil 962363886582
shiva(22)

4 yedhula Son Male Nil AGRICULT 504144353806

chandra URE
goud(25) LABOUR
/Nil
5 yedhula Son Male Nil AGRICULT
raju(29) URE
LABOUR
/Nil
6 yedhula Daughter in Female Nil AGRICULT 934488822615
swaitha(21) Law URE
LABOUR
/Nil
7 yedhula Daughter in Female Nil AGRICULT
srilatha(25) Law URE
LABOUR
/Nil
8 yedhula Grand Son Male Nil Nil/Nil
karthik(5)
9 yedhula Grand Son Male Nil Nil/Nil 701208075979
navin(6)

10 yedhula Grand Son Male Nil Nil/Nil 299604732744

nanni(1)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319752/002

Household Verification Format Door No:4-56,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband nagannagoud Gas YES/HP/616851
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 yadhula Self Male Nil AGRICULT 420301448171
narayana URE
goud(48) LABOUR
/Nil
2 yadhula Wife Female Nil Nil/Nil 783469660978
bharathamm
a(36)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319753/001

Household Verification Format Door No:4-57,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband naganna goud Gas YES/HP/618293
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 suri s Self Male TODDY Nil/Nil 503633764227
devaiah TOPPERS
goud(65)
2 suri laxmi Wife Female Nil Nil/Nil 383272221342
devamma(55
)
3 suri Son Male Nil Nil/Nil
sudhakhar
goud(25)
4 suri Daughter Female Nil Nil/Nil 787640465365
vedhulatha(2
8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:11.78 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319754/001

Household Verification Format Door No:287,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband devaiah goud Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 suri Self Male Nil AGRICULT 658616719124
jagadeswar URE
goud(30) LABOUR
/Nil
2 suri Wife Female Nil Nil/Nil 709128008352
lavanya(25)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319755/002

Household Verification Format Door No:4-58,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband buchanna Gas YES/HP/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 marepeli Self Female Nil AGRICULT 727862853972
ramulamma( URE
65)PWD: Y LABOUR
& Sadaran /Nil
No:126/09
2 marepeli Son Male Nil Nil/Nil 436284200139
jangaiah
goud(32)
3 marepeli Daughter Female Nil Nil/Nil 535903895555
lavanya(27)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:10.78 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319756/002

Household Verification Format Door No:289/12,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband ballaya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 dokur Self Male Nil AGRICULT 397247997314
shanthaya(43 URE
) LABOUR
/Nil
2 dokur Wife Female Nil Nil/Nil 703587882134
maneemma(
35)
3 dokur Son Male Nil Nil/Nil 485596646411
shivakumar(
13)
4 dokur Daughter Female Nil Nil/Nil 640070990841
padmamma(
11)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319757/002

Household Verification Format Door No:4-61,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband ramchadraya Gas YES/HP/629325
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 gumudaveli Self Male Nil Nil/Nil 365796496276
eswaraya(81
)
2 gumudaveli Wife Female Nil Nil/Nil 560645482781
maneemma(
74)
3 gumudaveli Son Male Nil SMALL 960209091657
ramesh(54) BUSINESS
/Nil
4 gumudaveli Daughter in Female Nil Nil/Nil 272639339507
chandrakhala Law
(45)
5 gumudaveli Grand Female Nil Nil/Nil 237167239217
sowjanya(21 Daughter
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319758/002

Household Verification Format Door No:290/1,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband eswaraya Gas YES/HP/640880
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 gumadaveli Self Male Nil OTHERS(P 463544783743
shamsundhar ROVIDE
(40) DETAILS)/
Nil
2 gumadaveli Wife Female Nil Nil/Nil 433496435596
latha(36)

3 gumadaveli Son Male Nil Nil/Nil 264093526973

sampathkum
ar(3)
4 gumadaveli Daughter Female Nil Nil/Nil
buvanasri(1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319759/002

Household Verification Format Door No:4-60,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband shanthaya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mandla m Self Female Nil AGRICULT 788122769787
balakistamm URE
a(53) LABOUR
/Nil
2 mandla Son Male Nil Nil/Nil
balaswami(3
2)
3 mandla Daughter in Female Nil Nil/Nil 370503847385
anitha(28) Law

4 mandla Grand Female Nil Nil/Nil 689856246003

vanni(7) Daughter

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319760/002

Household Verification Format Door No:4-34,lattupale

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband chandramoile Gas YES/HP/604413
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 bimma b Self Male Nil AGRICULT 271889430611
venu URE
gopal(62) LABOUR
/Nil
2 bimma Wife Female Nil Nil/Nil 247554381941
yadhamma(5
6)
3 bimma Mother Female Nil Nil/Nil
bagyamma(7
9)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.55 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319761/002

Household Verification Format Door No:292/1,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband venugopal Gas YES/HP/629142
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 bimma Self Male Nil SMALL 907768437015
venkatesh(37 BUSINESS
) /Nil
2 bimma Wife Female Nil Nil/Nil 527387702820
haritha(32)

3 bimma Son Male Nil Nil/Nil 370861044057

chandrakiran
(11)PWD: Y
& Sadaran
No:1418939
0140113068
4 bimma Son Male Nil Nil/Nil 615801175178
sumanthu(8)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319763/001

Household Verification Format Door No:4-32,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband krishnaya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 nalagonda Self Male Nil AGRICULT 994507731618
shailu(38) URE
LABOUR
/Nil
2 nalagonda Wife Female Nil Nil/Nil 625046430334
indiramma(3
6)
3 nalagonda Daughter Female Nil Nil/Nil 710988426631
krishanaveni
(17)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319764/001

Household Verification Format Door No:4-30,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband cvhinna sayanna Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 nalagonda Self Male Nil AGRICULT 424338465310
laxmmaya(6 URE
5) LABOUR
/Nil
2 nalagonda Wife Female Nil Nil/Nil 784208167843
kondamma(5
5)
3 nalagonda Son Male Nil Nil/Nil 926356812406
shivakumar(
27)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.45 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319765/001

Household Verification Format Door No:4-30,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband chjna shayanna Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 nalagonda Self Male Nil AGRICULT 573943543381
krushnaya(6 URE
2) LABOUR
/Nil
2 nalagonda Wife Female Nil Nil/Nil 586958453897
edhamma(48
)
3 nalagonda Son Male Nil Nil/Nil 367667977572
rajavardhan(
18)
4 nalagonda Son Male Nil Nil/Nil 461180421992
purushotham
(20)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.48 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319766/000

Household Verification Format Door No:4-27,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband gattaya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 yalugu Self Male Nil AGRICULT 577986195604
srinivasulu(6 URE
5) LABOUR
/Nil
2 yalugu Wife Female Nil Nil/Nil 561004979919
lalithamma(6
0)
3 yalugu Son Male Nil Nil/Nil 793794179641
raju(20)

4 yalugu Son Male Nil Nil/Nil 726413198706

sikindher(25
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:9 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319767/000

Household Verification Format Door No:4-27,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband channaya Gas YES/HP/617453
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 kavali k Self Female Nil AGRICULT 700096824367
chitemma(50 URE
) LABOUR
/Nil
2 kavali Son Male Nil Nil/Nil 805437379082
nagesh(15)

3 kavali Daughter Female Nil Nil/Nil 752223434288

nandini(12)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319768/000

Household Verification Format Door No:4-70,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband narayana Gas YES/HP/617454
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 kasoji Self Female BLACKSMI Nil/Nil 311396417908
ballaya(64) TH

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.92 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0319769/000

Household Verification Format Door No:298/1,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband ballaya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 kasoji k Self Male Nil DRIVERS/N 891557922367
chandrashek il
har(31)
2 kasoji k Wife Female Nil Nil/Nil 993054325307
laxmi(24)

3 kasoji k Son Male Nil Nil/Nil 226209692763

akhil(6)

4 kasoji k Son Male Nil Nil/Nil 656319014794

swathik(4)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319770/000

Household Verification Format Door No:298/2,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KRISHNACHARY Gas YES/HP/617457
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KASOJU K Self Male BLACKSMI Nil/Nil 368380610211
BALASWA TH
MY(41)
2 KASOJU Wife Female Nil Nil/Nil 928272006892
SHARADA(
37)
3 KASOJU Son Male Nil Nil/Nil 254819268443
SHIVA
KUMAR(12
)
4 KASOJU Daughter Female Nil Nil/Nil 816259544537
PRASANN
A
LAXMI(18)
5 KASOJU Daughter Female Nil Nil/Nil 962647959339
PRATHYUS
HA(15)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0.25/DRY:4.6 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319771/001

Household Verification Format Door No:4-65,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband pentareddy Gas YES/HP/617323
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 subbireddy Self Male Nil OWN 558885635836
subbireddy AGRICULT
srinivas URE
reddy(64) /Nil
2 subbireddy Wife Female Nil OWN 774434999370
subbireddy AGRICULT
laxmamma(6 URE
0) /Nil
3 subbireddy Son Male Nil STUDENT/ 231476857527
subbireddy Nil
chandhuredd
y(23)
4 subbireddy Daughter Female Nil STUDENT/ 404459831664
subbireddy Nil
geethanjali(2
1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319771/002

Household Verification Format Door No:4-65,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband PENTAREDDY Gas YES/HP/317323
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SUBBIRED Self Male Nil OWN 55885635836
DY AGRICULT
SUBBIRED URE
DY /Nil
SRINIVAS
REDDY(64)
2 SUBBIRED Wife Female Nil OWN 774434999370
DY AGRICULT
SUBBIRED URE
DY /Nil
LAXMAM
MA(60)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319772/000

Household Verification Format Door No:4-65,LATPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband VENKATAREMIRE Gas NIL/-/
Name DDY Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 subbireddy Self Male Nil DO 901969353906
subbireddy NOTHING/
PENTARED Nil
DY(75)
2 subbireddy Wife Female Nil DO 784459471310
subbireddy NOTHING/
BALAMMA Nil
(65)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319773/000

Household Verification Format Door No:4-63,LATPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAVINDHARGOUD Gas YES/HP/612605
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 VINTAPUR Self Male Nil OWN 437085267892
AM V AGRICULT
SURYAKA URE
LA(45) /Nil
2 VINTAPUR Husband Female Nil OWN 879445475397
AM V AGRICULT
RAVINDHA URE
RGOUD(50) /Nil
3 VINTAPUR Son Female Nil STUDENT/ 317225436143
AM V Nil
PAVANKU
MAR(22)
4 VINTAPUR Daughter Male Nil STUDENT/ 877983528153
AM V Nil
SWAROOP
A(26)
5 VINTAPUR Daughter Male Nil STUDENT/ 388781365953
AM V Nil
SAMYUKT
HA(27)
6 VINTAPUR Mother Male Nil DO 744072966052
AM V NOTHING/
SUGUNAM Nil
MA(50)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:6.75/DRY:56.78 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319774/000

Household Verification Format Door No:4-63/1,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband VENKATIAAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ANEMONI Self Female Nil MIGRATED 824748859746
ANEMONI LABOUR/N
RAMULU(2 il
9)
2 ANEMONI Wife Male Nil MIGRATED 688459456502
LAXMI(25) LABOUR/N
il
3 ANEMONI Son Female Nil STUDENT/ 953628828563
SAIKUMAR Nil
(8)
4 ANEMONI Son Female Nil Nil/Nil 869128980932
SRINATH(3
)
5 ANEMONI Son Female Nil STUDENT/ 547452732637
SHASHI Nil
KUMAR(5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0.75 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319775/000

Household Verification Format Door No:4-87,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KRISHNAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ANEMONI Self Male Nil AGRICULT 476293628122
SHANKAR URE
AMMA(62) LABOUR
/Nil
2 ANEMONI Son Female Nil AGRICULT 959937262344
BALAIAHA URE
(46) LABOUR
/Nil
3 ANEMONI Daughter in Male Nil AGRICULT 916130380575
ANASUYA( Law URE
39) LABOUR
/Nil
4 ANEMONI Grand Son Female Nil STUDENT/ 528932407163
TEJA(8) Nil

5 ANEMONI Grand Male Nil STUDENT/ 501377026118

SHOBHA(1 Daughter Nil
4)
6 ANEMONI Grand Male Nil STUDENT/ 320714800811
HARIKA(16 Daughter Nil
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319776/000

Household Verification Format Door No:4-87/1,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KRISHNAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ANEMONI Self Male Nil MIGRATED 266775449050
ANEMONI LABOUR/N
SRINU(38) il
2 ANEMONI Wife Female Nil MIGRATED 570238470392
ANEMONI LABOUR/N
LAXMI(30) il
3 ANEMONI Daughter Female Nil STUDENT/ 830501553555
ANEMONI Nil
NANDHINI(
9)
4 ANEMONI Daughter Female Nil STUDENT/ 353290387723
VKRISHNA Nil
VENI(15)
5 ANEMONI Daughter Female Nil STUDENT/ 969593024541
ANEMONI Nil
KAVITHA(
11)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319777/000

Household Verification Format Door No:4-88,LaTTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KRISHNAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ANEMONI Self Male Nil DRIVERS/N 307239466076
ANEMONI il
NARAYAN
A(35)
2 ANEMONI Wife Female Nil HOUSE 663454954330
ANEMONI WIFE/Nil
SWAPNA(2
9)
3 ANEMONI Son Male Nil STUDENT/ 299508409640
ANEMONI Nil
RUGVESH(
4)
4 ANEMONI Son Male Nil STUDENT/
ANEMONI Nil
RUSHIKES
H(0)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319778/000

Household Verification Format Door No:4-85,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARAYANA Gas YES/HP/610868
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PANTHUL Self Male Nil DAILY 929710672923
AP WAGES
PEROZI(53) LABOUR/N
il
2 PANTHUL Wife Female Nil HOUSE 323570563335
AP WIFE/Nil
SYAMALA(
43)
3 PANTHUL Son Male Nil STUDENT/ 557649576972
AP Nil
VIKAS(13)
4 PANTHUL Daughter Female Nil STUDENT/ 279308450425
AP Nil
NIHARIKA(
14)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.32 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319779/000

Household Verification Format Door No:4-86,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PANTHUL Self Female Nil DO 522664949576
AP NOTHING/
BALAMAN State Govt
I(60) Pension
2 PANTHUL Son Male Nil State
AP GovtEmploy
NIRANJAN( ee/Nil
38)
3 PANTHUL Daughter in Female Nil HOUSE 899641566952
AP Law WIFE/Nil
SUNITHA(3
5)
4 PANTHUL Grand Son Male Nil STUDENT/ 759678971812
AP Nil
BHARATH(
5)
5 PANTHUL Grand Female Nil STUDENT/ 777572905413
AP Daughter Nil
JAHNAVI(9
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:6.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319780/000

Household Verification Format Door No:4-86/1,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BUDDOJI Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PANTHUL Self Male Nil DO 627782788601
AP NOTHING/
NARAYAN Nil
A(75)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.02 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0319781/000

Household Verification Format Door No:4-83,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NAGOJI Gas YES/HP/636504
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PANTHUL Self Male Nil OWN 219111758348
AP AGRICULT
BADHROJI( URE
65) /Nil
2 PANTHUL Wife Female Nil HOUSE 656053864319
AP WIFE/Nil
SUGUNAM
MA(60)
3 PANTHUL Wife Female Nil AGRICULT
AP URE
SWATHI(30 LABOUR
) /Nil
4 PANTHUL Son Male Nil ARTISTS/Ni 619286471167
AP l
MALLOJI(3
4)
5 PANTHUL Grand Female Nil Nil/Nil 596086007956
AP Daughter
RUSHIKA(2
)
6 PANTHUL Grand Female Nil Nil/Nil
AP Daughter
HEMA(1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:7.15 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319782/000

Household Verification Format Door No:4-83/1,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BADROJI Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PANTHUL Self Male Nil OWN 205706244468
AP AGRICULT
KRISHNAJI URE
(29) /Nil
2 PANTHUL Wife Female Nil AGRICULT 856060757536
AP URE
SHOBHA(2 LABOUR
0) /Nil
3 PANTHUL Daughter Female Nil Nil/Nil
AP
PRITHINIG
AM(1)
4 PANTHUL Daughter Female Nil Nil/Nil 871028184342
AP
VAISHNAV
I(4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319783/000

Household Verification Format Door No:4-81,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NAGAYYA Gas YES/HP/634712
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SIRANGI S Self Male Nil OWN 402287772707
VENKATAI AGRICULT
AH(49) URE
/Nil
2 SIRANGI S Wife Female Nil AGRICULT 379280676088
GIRAMMA( URE
40) LABOUR
/Nil
3 SIRANGI S Son Male Nil DAILY 406420480678
KRISHNA(1 WAGES
7) LABOUR/N
il
4 SIRANGI S Son Male Nil Nil/Nil 884108695868
BALRAJ(13
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.48 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319784/000

Household Verification Format Door No:4-80,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband GANGAPURI Gas YES/HP/634042
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SIRANGI S Self Male Nil AGRICULT 430888126438
SRISAILA URE
M(32) LABOUR
/Nil
2 SIRANGI S Wife Female Nil AGRICULT 499748964435
RENUKA(3 URE
0) LABOUR
/Nil
3 SIRANGI S Son Male Nil STUDENT/ 539140098571
CHANDHR Nil
ASEKHAR(
10)
4 SIRANGI S Daughter Female Nil STUDENT/ 476782235970
BHARGAVI Nil
(7)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319785/000

Household Verification Format Door No:4-79,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband LAXMAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM J Self Male Nil OWN 821929090704
KRISHNAI AGRICULT
AH(50) URE
/Nil
2 JANGAM J Wife Female Nil AGRICULT 604917744187
BALANAR URE
SAMMA(45 LABOUR
) /Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.7 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319786/000

Household Verification Format Door No:4-79,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband J KRISHNAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 jangam j Self Male Nil AGRICULT 565874282829
babu(29) URE
LABOUR
/Nil
2 jangam j Wife Female Nil AGRICULT 705423604565
chandhrakala URE
(26) LABOUR
/Nil
3 jangam j Daughter Female Nil Nil/Nil 839479555390
hemalatha(1)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319787/000

Household Verification Format Door No:4-79,lattupalli

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KRISHNAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM J Self Male Nil DRIVERS/N 298177101487
RAJU(23) il

2 JANGAM J Wife Female Nil AGRICULT 235556649466

NAGALAX URE
MI(20) LABOUR
/Nil
3 JANGAM J Son Male Nil Nil/Nil 822429476065
RAM
CHARAN(1
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319788/000

Household Verification Format Door No:4-79/1,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RANGANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM J Self Male Nil DO 782543483308
ANJANEYU NOTHING/
LU(58) Nil
2 JANGAM J Wife Female Nil STUDENT/ 770246424253
RUKKAMM Nil
A(53)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.58 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319789/000

Household Verification Format Door No:5-7,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SAYANNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM J Self Male Nil OWN 863731037755
VENKATAI AGRICULT
AH(40) URE
/Nil
2 JANGAM J Wife Female Nil AGRICULT 315877492428
ANJANAM URE
MA(35) LABOUR
/Nil
3 JANGAM J Son Male Nil OTHER 825817748796
MALLESH( SKILLED
22) WORKERS/
Nil
4 JANGAM J Mother Female Nil DO 263905999174
LAXMAM NOTHING/
MA(70) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.4 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319790/000

Household Verification Format Door No:5-6,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARAYANA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM J Self Male Nil DO 974637945494
SATYYYA( NOTHING/
66) Nil
2 JANGAM J Wife Female Nil STUDENT/ 382866698045
DEVAMMA Nil
(52)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:12.8 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319791/000

Household Verification Format Door No:5-6,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KRISHNAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KALVARA Self Male Nil OWN 758251848084
LA K AGRICULT
BALAIAH(4 URE
3) /Nil
2 KALVARA Wife Female Nil AGRICULT 711118611700
LA K URE
PARVATH LABOUR
AMMA(38) /Nil
3 KALVARA Son Male Nil STUDENT/ 795972113796
LA K Nil
PAVANKU
MAR(14)
4 KALVARA Daughter Female Nil STUDENT/ 577438953902
LA K Nil
KRISHNAV
ENI(9)
5 KALVARA Daughter Female Nil STUDENT/ 350028723044
LA K Nil
PAVANI(13
)
6 KALVARA Mother Female Nil DO 429549925964
LA K NOTHING/
MANIKYA Nil
MMA(68)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.68 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319792/000

Household Verification Format Door No:5-2,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHINNABALAIAH Gas YES/HP/639854
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KALVIRAL Self Female Nil DO 294644650716
AK NOTHING/
SUBADHR Nil
AMMA(65)
2 KALVIRAL Son Male Nil OWN 201009267952
AK AGRICULT
SHIVAIAH( URE
40) /Nil
3 KALVIRAL Son Male Nil STUDENT/ 225523031458
AK Nil
PARUSHAR
AMULU(32)
4 KALVIRAL Daughter in Female Nil OTHER 370004873135
AK Law SKILLED
CHITTEMM WORKERS/
A(28) Nil
5 KALVIRAL Daughter in Female Nil OWN 787717629963
AK Law AGRICULT
MANEMM URE
A(35) /Nil
6 KALVIRAL Grand Son Male Nil STUDENT/
AK Nil
NIKHIL(2)
7 KALVIRAL Grand Son Female Nil STUDENT/ 225523031458
AK Nil
YASWANT
H(8)
8 KALVIRAL Grand Son Male Nil OWN
AK AGRICULT
NARESH(6) URE
/Nil
9 KALVIRAL Grand Male Nil STUDENT/ 335691845207
AK Daughter Nil
SWAPNA(1
1)
10 KALVIRAL Grand Male Nil STUDENT/ 487678636809
AK Daughter Nil
SHIRISHA(
13)
11 KALVIRAL Grand Female Nil Nil/Nil
AK Daughter
YOGESWA
R(0)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0.4/DRY:4.68 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:
Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319793/000

Household Verification Format Door No:5-1,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHENNAPPA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JANGAM J Self Male Nil DO 878331875786
PEDHAMA NOTHING/
LLAYYA(7 Nil
0)PWD: Y &
Sadaran No:
Nil
2 JANGAM J Wife Female Nil HOUSE 702454445813
SANTHAM WIFE/Nil
MA(63)
3 JANGAM J Son Male Nil OTHER 534543524200
MAHESH(2 SKILLED
1) WORKERS/
Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319794/000

Household Verification Format Door No:4-100,LAttupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MADHIGA Self Female Nil DO 844720931907
TLA M NOTHING/
RAMULU(6 Nil
5)
2 MADHIGA Wife Female Nil DAILY 743589488800
TLA M WAGES
CHANDRA LABOUR/N
MMA(38) il
3 MADHIGA Son Female Nil DAILY 727527126561
TLA M WAGES
UTTHAYY LABOUR/N
A(45) il
4 MADHIGA Grand Son Female Nil OTHER 880884123381
TLA M SKILLED
SAIKUMAR WORKERS/
(18) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.58 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319795/000

Household Verification Format Door No:4-100,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SATHYYYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ANEMONI Self Female Nil DO 720134697414
ANEMONI NOTHING/
NAGAMM State Govt
A(62) Pension
2 ANEMONI Son Male Nil AGRICULT 224234436618
ANEMONI URE
RAVINDHA LABOUR
R (34) /Nil
3 ANEMONI Daughter in Female Nil AGRICULT 224234436618
ANEMONI Law URE
SUJATHA(3 LABOUR
2) /Nil
4 ANEMONI Grand Son Male Nil STUDENT/ 987229605142
ANEMONI Nil
BHARATH
KUMAR(18
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.95 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319796/000

Household Verification Format Door No:4-99,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NIRANJAN Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUDLA G Self Female Nil DO 862383756239
JAYAMMA NOTHING/
(45)PWD: Y Nil
& Sadaran
No:1418939
0140113047
2 GUDLA G Son Male Nil Nil/Nil 693980227510
NARESH(25
)
3 GUDLA G Daughter Female Nil Nil/Nil 390963930519
NARMADH
A(17)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed YES
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319797/000

Household Verification Format Door No:4-96,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SHEKAR Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GANJI Self Female Nil AGRICULT 719538484080
GANJI URE
SHANKAR LABOUR
AMMA(49) /Nil
2 GANJI Husband Male Nil AGRICULT 887879346429
GANJI URE
SHEKHAR( LABOUR
55) /Nil
3 GANJI Son Male Nil DRIVERS/N 856908834489
GANJI il
JAGADESH
KUMAR(32
)
4 GANJI Daughter in Female Nil AGRICULT 818825434151
GANJI Law URE
JAYALATH LABOUR
A(28) /Nil
5 GANJI Grand Female Nil STUDENT/
GANJI Daughter Nil
JNANESW
ARI(7)
6 GANJI Grand Female Nil STUDENT/ 420165210149
GANJI Daughter Nil
GAYATHRI
(4)
7 GANJI Grand Female Nil STUDENT/ 749060502961
GANJI Daughter Nil
BEBI(3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319798/000

Household Verification Format Door No:4-95,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARSIMHA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 PEDHAMU Self Male Nil OWN 485959516052
KKALA AGRICULT
BOYA URE
RAMULU(5 /Nil
8)
2 PEDHAMU Wife Female Nil AGRICULT 289599184078
KKALA URE
VUSENAM LABOUR
MA(42) /Nil
3 PEDHAMU Son Male Nil OWN 989388937104
KKALA AGRICULT
SHIVAIAH( URE
29) /Nil
4 PEDHAMU Son Male Nil OTHER 250766950109
KKALA SKILLED
MAHESH(2 WORKERS/
3) Nil
5 PEDHAMU Son Male Nil OTHER 284509316124
KKALA SKILLED
NARENDH WORKERS/
AR(24) Nil
6 PEDHAMU Son Female Nil OWN 500463144571
KKALA AGRICULT
SATHYAM( URE
32) /Nil
7 PEDHAMU Daughter in Female Nil AGRICULT 844390492044
KKALA Law URE
NAGAMM LABOUR
A(29) /Nil
8 PEDHAMU Daughter in Female Nil HOUSE
KKALA Law WIFE/Nil
SWAPNA(1
9)
9 PEDHAMU Daughter in Female Nil AGRICULT 944251502592
KKALA Law URE
THIRUPAT LABOUR
HAMMA(30 /Nil
)
10 PEDHAMU Father in Male Nil DO 514963391406
KKALA Law NOTHING/
MALLAIAH Nil
(81)
11 PEDHAMU Grand Son Male Nil STUDENT/
KKALA Nil
KARTHIK(9
)
12 PEDHAMU Grand Son Male Nil OTHER 903586681958
KKALA SKILLED
VENUCHA WORKERS/
NDHU(5) Nil
13 PEDHAMU Grand Female Nil OTHER 974902413915
KKALA Daughter SKILLED
LAXMI(3) WORKERS/
Nil
14 PEDHAMU Grand Female Nil SMALL 998880562743
KKALA Daughter BUSINESS
SHIRISHA( /Nil
3)
15 PEDHAMU Grand Female Nil STUDENT/ 835743943741
KKALA Daughter Nil
PRASHANT
HI(10)
16 PEDHAMU Grand Female Nil STUDENT/ 283898705490
KKALA Daughter Nil
AKHILA(7)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:11.38 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319799/000

Household Verification Format Door No:4-97,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BOYA Self Female Nil AGRICULT 627283628836
BOYA URE
BUDDAMA LABOUR
(60) /Nil
2 BOYA Son Male Nil OTHER 454371711963
BOYA SKILLED
RAMACHA WORKERS/
NDRIAH(20 Nil
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.52 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319800/000

Household Verification Format Door No:4-94,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHENNAPPA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BOYA Self Male Nil OWN 221429812507
BOYA AGRICULT
GANGAPU URE
RI(48) /Nil
2 BOYA Wife Female Nil AGRICULT 538727448070
BOYA URE
SAYAMMA LABOUR
(41) /Nil
3 BOYA Son Male Nil STUDENT/ 455540542205
BOYA Nil
CHENNAIA
H(18)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0334512/002

Household Verification Format Door No:1-40,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil
SHIVAIAH(
28)
2 Wife Female Nil Nil/Nil
PARWATH
AMMA(25)
3 Son Male Nil Nil/Nil
JNANESW
AR(2)
4 Daughter Female Nil Nil/Nil
GEETHANJ
ALI(6)
5 Daughter Female Nil Nil/Nil
SWATHI(14
)
6 Daughter Female Nil Nil/Nil
LOKESWA
RI(8)
7 LAXMI(4) Daughter Female Nil Nil/Nil
8 Daughter Female Nil Nil/Nil
SUNITHA(1
2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:3.88/DRY:7.75 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335111/000

Household Verification Format Door No:1,lpl

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband kodadaiah Gas YES/HP/604634
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 gummadavel Self Male Nil OWN 335515079924
ly AGRICULT
ramchandrai URE
ah(66) /Nil
2 gummadavel Wife Female Nil OWN 981504847468
ly surya AGRICULT
kala(58) URE
/Nil
3 gummadavel Sister Female Nil OWN 874883462256
ly AGRICULT
vimalamma( URE
43) /Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.22 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335112/000

Household Verification Format Door No:0,ltp

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband nagoji Gas YES/HP/618273
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 panthula Self Female Nil Nil/Nil 467003477590
janakiramulu
(59)
2 panthula Wife Female Nil Nil/Nil 934793558006
sulochanam
ma(45)
3 panthula Son Male Nil Nil/Nil
jangoji(35)
4 panthula Son Male Nil Nil/Nil
ravider(30)
5 panthula Daughter in Female Nil Nil/Nil 426548435354
sojanya(17) Law

6 panthula Daughter in Male Nil Nil/Nil

santhabai(27 Law
)
7 panthula Grand Male Nil Nil/Nil
keerthi(4) Daughter
8 panthula Grand Male Nil Nil/Nil
nagalaximi Daughter
prasanna(6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:7.18 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335113/000

Household Verification Format Door No:4,lp

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband anjaneyulu Gas YES/HP/621607
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 kasoji k Self Male Nil DAILY
chandrashek WAGES
ar(39) LABOUR/N
il
2 kasoji Wife Female Nil Nil/Nil 305338611933
govidamm(3
1)
3 kasoji Daughter Female Nil Nil/Nil
srija(10)
4 kasoji Daughter Female Nil Nil/Nil 473390576760
anitha(12)

5 kasoji Peternal Female Nil DAILY 745209685406

santhamma( Grand WAGES
70) Mother LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335114/000

Household Verification Format Door No:5,lp

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband anjaneyulu Gas YES/Bharath/623938
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 kasoji Self Male Nil Nil/Nil 634402727661
balaswami(3
3)
2 kasoji Wife Female Nil Nil/Nil 783600156729
suvarna(28)

3 kasoji Son Male Nil Nil/Nil 647710475772

anilkumar(1
0)
4 kasoji Daughter Female Nil Nil/Nil
sindu(6)
5 kasoji Mother Female Nil Nil/Nil
narayanamm
a(68)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335115/000

Household Verification Format Door No:6,lp

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband devaiah goud Gas YES/HP/618292
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 badepalli Self Male Nil OWN 680866534277
chennamma( AGRICULT
51) URE
/Nil
2 badepalli Husband Female Nil OWN 218093028421
devaiah AGRICULT
goud(58) URE
/Nil
3 badepalli Son Male Nil OWN
rajender AGRICULT
goud(39) URE
/Nil
4 badepalli Daughter Female Nil Nil/Nil 927079771995
ramya(26)

5 badepalli Daughter in Female Nil OWN 505379510833

varalaximi(2 Law AGRICULT
8) URE
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:5.98 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335116/000

Household Verification Format Door No:6,lp

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband sayanna Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 g Self Male Nil Nil/Nil
pentaiah(68)
2 g Son Male Nil Nil/Nil
krishnaiah(3
0)
3 g Son Male Nil Nil/Nil
badraiah(43)
4 g Daughter in Female Nil Nil/Nil
laximidevam Law
ma(38)
5 g ganesh(11) Grand Son Male Nil Nil/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335117/000

Household Verification Format Door No:9,lp

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband pentaiah Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 m Self Male Nil OTHER 929834203529
venkatiah(40 SKILLED
) WORKERS/
Nil
2 m Wife Female Nil OTHER 286605228818
laxmamma(3 SKILLED
8) WORKERS/
Nil
3 m Daughter Female Nil Nil/Nil 492068171556
vasantha(19)

4 m Daughter Female Nil Nil/Nil

videesha(11)
5 m Mother Female Nil Nil/Nil
sayamma(73
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335118/000

Household Verification Format Door No:5,lp

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband asi reddy Gas YES/HP/617481
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 kamatham k Self Male Nil Nil/Nil
venkatreddy(
75)
2 kamatham Wife Female Nil Nil/Nil 381152216511
narsigamma(
60)
3 kamatham k Daughter in Female Nil Nil/Nil 424958543502
aruna(19) Law

4 kamatham k Daughter in Female Nil Nil/Nil

shivaleela(40 Law
)
5 kamatham Grand Son Male Nil Nil/Nil
shivakumar
reddy(14)
6 kamatham Grand Female Nil Nil/Nil 930477403196
maneesha(39 Daughter
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.4 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335120/000

Household Verification Format Door No:0,lp

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband janardan reddy Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 m lokesh Self Female Nil Nil/Nil
waramma(52
)
2 m thirupath Son Male Nil Nil/Nil
reddy(30)
3 m santhosh Son Male Nil Nil/Nil
reddy(18)
4 m vamsider Son Male Nil Nil/Nil
reddy(25)
5 m vikram Son Male Nil Nil/Nil
reddy(21)
6 m Father in Female Nil Nil/Nil
papireddy(78 Law
)
7 m Sister Female Nil Nil/Nil
jayamma(42)
8 m m laxmi Brother in Male Nil Nil/Nil
reddy(46) Law
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335121/000

Household Verification Format Door No:0,lp

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband ayapureddy Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 tilati buchi Self Male Nil Nil/Nil 264404993264
reddy(55)

2 tilati Wife Female Nil Nil/Nil

barathamma(
50)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:17.62 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335122/000

Household Verification Format Door No:12,ltpl

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband anantharedy Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 m Self Male Nil OWN 226101887106
padmamma( AGRICULT
43) URE
/Nil
2 m Husband Female Nil OWN 537010350988
anantharedd AGRICULT
y(46) URE
/Nil
3 m Son Male Nil STUDENT/
shivakumare Nil
ddy(20)
4 m Daughter Female Nil Nil/Nil 324686665307
monika(19)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.78 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335123/000

Household Verification Format Door No:0,lp

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband mallareddy Gas YES/HP/618295
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 tilati Self Male Nil OWN 399419668517
chandraredd AGRICULT
y(52) URE
/Nil
2 tilati Wife Female Nil OWN
padmamma( AGRICULT
45) URE
/Nil
3 tilati arun Son Male Nil Nil/Nil
reddy(19)
4 tilati upender Son Male Nil Nil/Nil
reddy(24)
5 tilati Son Male Nil Nil/Nil 380089275070
govindaredd
y(26)
6 tilati Daughter Female Nil Nil/Nil 608919267809
abinaya(14)

7 tilati Brother Male Nil Nil/Nil

thirupathi
reddy(45)
8 tilati Sister in Law Female Nil Nil/Nil
laximi(38)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:13.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335124/000

Household Verification Format Door No:0,lpl

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband mallaredy Gas YES/HP/625905
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 t ravinder Self Male Nil OWN 634128777709
reddy(38) AGRICULT
URE
/Nil
2 t Wife Female Nil OWN 752873025062
sumithra(39) AGRICULT
URE
/Nil
3 t vijai Son Male Nil Nil/Nil
kumareddy(1
1)
4 t Daughter Female Nil Nil/Nil
soujanya(12)
5 t lavnya(16) Daughter Female Nil STUDENT/ 463503666978
Nil

6 t deepthi(12) Daughter Female Nil STUDENT/

Nil
7 t shekar Brother Male Nil Nil/Nil
reddy(39)
8 t suvarna(33) Sister in Law Female Nil Nil/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:11.15 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335125/000

Household Verification Format Door No:15,lp

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband usahlu Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudam Self Male Nil Nil/Nil 794009044933
venkataiah(4
4)
2 mudam Wife Female Nil Nil/Nil 626042724107
maneem(38)

3 mudam Son Male Nil Nil/Nil 960160534035

kurmaiah(22
)
4 mudam Son Male Nil Nil/Nil
shekar(20)
5 mudam Daughter in Female Nil Nil/Nil
reka(20) Law
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:7.92 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335126/000

Household Verification Format Door No:16,lp

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband kistaiah Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ganta Self Male Nil OWN 269641089095
venkataiah(5 AGRICULT
1) URE
/Nil
2 ganta Wife Female Nil OWN
amanamma( AGRICULT
44) URE
/Nil
3 ganta Son Male Nil OWN
chennaiah(3 AGRICULT
0) URE
/Nil
4 ganta Son Male Nil OWN
sagar(25) AGRICULT
URE
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:6.42 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335127/000

Household Verification Format Door No:17,lp

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband gopal Gas YES/Bharath/14997
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 g raju(33) Self Male Nil OWN
AGRICULT
URE
/Nil
2 g jyothi(26) Wife Female Nil OWN 837763572571
AGRICULT
URE
/Nil
3 g karthik(3) Son Male Nil Nil/Nil 427157686909

4 g Daughter Female Nil DO 873792313955

sarika(9)PW NOTHING/
D: Y & Nil
Sadaran
No:1418939
0140113097
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:8104/DRY:4.88 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335128/000

Household Verification Format Door No:18,lp

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband kistaiah Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 g gopal(58) Self Male Nil OWN 602332489694
AGRICULT
URE
/Nil
2 g Wife Female Nil OWN 539379138063
jayamma(48) AGRICULT
URE
/Nil
3 g Son Male Nil OWN 812642724966
kurmaiah(28 AGRICULT
) URE
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335129/000

Household Verification Format Door No:19,lp

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband hanmanthu reddy Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 k Self Male Nil OWN 252269559088
rangareddyy( AGRICULT
70) URE
/Nil
2 k Wife Female Nil OWN
sathyamma( AGRICULT
65) URE
/Nil
3 k Son Male Nil Nil/Nil
srnivsureddy
(32)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335130/000

Household Verification Format Door No:20,lp

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband laxmareddy Gas YES/HP/636011
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 kk Self Female Nil Nil/Nil 82963116606
manikyamm
a(68)
2 k srinivas Husband Male Nil Nil/Nil
reddy(26)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.75 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335131/000

Household Verification Format Door No:12,lp

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband p rangareddy Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 k srinivas Self Male Nil Nil/Nil 337697661978
reddy(45)

2 k Wife Female Nil Nil/Nil

nagamani(40
)
3 k sumanth Son Male Nil Nil/Nil
redyy(14)
4 k Daughter Female Nil Nil/Nil
supritha(19)
5 k Daughter Female Nil Nil/Nil
darsitha(20)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:14.18 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335132/000

Household Verification Format Door No:2,lp

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband p rangareddy Gas YES/HP/615954
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 k Self Male WEAVERS Nil/Nil 204377136348
anjanreddy(5
5)
2 k Wife Female Nil Nil/Nil
sugunamma(
48)
3 k yugander Son Male Nil Nil/Nil
reddy(25)
4 k narender Son Male Nil Nil/Nil
reddy(26)
5 k Mother Female Nil Nil/Nil
sarojamma(6
8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:16.22 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335133/000

Household Verification Format Door No:23,lp

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband p rangareddy Gas YES/HP/628838
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 k Self Male Nil OWN 461067004455
KVENKAT AGRICULT
REDDY(53) URE
/Nil
2 k Wife Male Nil OWN
JAYAMMA AGRICULT
(49) URE
/Nil
3 k Son Male Nil Nil/Nil 329027936058
RAVINDER
EREDDY(2
6)
4 k Son Male Nil Nil/Nil
SATHISRE
DDY(28)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:16.55 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335134/000

Household Verification Format Door No:22,LP

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband RAMREDDY Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 B Self Male Nil OWN 423378885216
VENKTRE AGRICULT
DDY(60) URE
/Nil
2 B Wife Female Nil OWN
CHITEMM AGRICULT
A(55) URE
/Nil
3 B Son Male Nil OWN
MADUSUD AGRICULT
ANREDDY( URE
19) /Nil
4 B Mother in Female Nil Nil/Nil
SANTHAM Law
MA(73)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.58 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335135/000

Household Verification Format Door No:25,LP

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband VEMAREDDY Gas YES/HP/618298
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 T Self Male Nil Nil/Nil
SUSILAMM
A(45)
2 T Wife Male Nil Nil/Nil
SRINVSRE
DDY(26)
3 T Son Male Nil Nil/Nil
NAVEENR
EDDY(30)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:8.55 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335136/000

Household Verification Format Door No:8,lp

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband pentaiah Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 g Self Male Nil Nil/Nil 828330159164
badraiah(39)

2 g Wife Female Nil Nil/Nil

manemma(3
8)
3 g barath(11) Son Male Nil Nil/Nil
4 g kaveri(19) Daughter Female Nil Nil/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335137/000

Household Verification Format Door No:2,lp

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband pentiah Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 g Self Male Nil Nil/Nil
anjaneyulu(3
8)
2 g Wife Female Nil Nil/Nil
mangamma(
31)
3 g ashok(10) Son Male Nil Nil/Nil
4 g sures(8) Son Male Nil Nil/Nil
5 g varun(1) Son Male Nil Nil/Nil
6 g Daughter Female Nil Nil/Nil
vijayalaximi(
3)
7 g Daughter in Female Nil Nil/Nil
savithri(23) Law
8 g shekar(26) Brother Male Nil Nil/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335138/000

Household Verification Format Door No:1,lp

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband asireddy Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 k bupal Self Male Nil Nil/Nil 395918022874
reddy(40)

2 k Wife Male Nil Nil/Nil 521179409368

suvarna(38)

3 k sharath Son Male Nil Nil/Nil 377909263812

chandra(10)

4 k adithya(10) Son Male Nil Nil/Nil

5 k Daughter Female Nil Nil/Nil 850781955077
akshara(11)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335141/000

Household Verification Format Door No:1-38,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SRINIVAS Self Male Nil Nil/Nil
REDDY(33)
2 sree Wife Female Nil Nil/Nil
devi(30)
3 anusha(6) Daughter Female Nil Nil/Nil
4 Daughter Female Nil Nil/Nil
DAKSHAY
ANI(1)
5 sravani(3) Daughter Female Nil Nil/Nil
6 Brother Male Nil Nil/Nil
narender(29)
7 madhavi(26) Sister in Law Female Nil Nil/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335143/000

Household Verification Format Door No:1-41,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil
LAVARED
DY(55)
2 Wife Transgender Nil Nil/Nil
ANJANAM
MA(50)
3 Son Male Nil Nil/Nil
RAGHAVA
REDDY(30)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335144/000

Household Verification Format Door No:1-41,LATTUPALLE1

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 BHASKAR Self Male Nil Nil/Nil
(32)
2 Wife Female Nil Nil/Nil
SHWETHA(
28)
3 Son Male Nil Nil/Nil
SUSMANT
H(4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335145/000

Household Verification Format Door No:1-41,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil
BALREDD
Y(58)
2 Wife Female Nil Nil/Nil
MANNEM
MA(48)
3 Sister Female Nil Nil/Nil
PULLAMM
A(60)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335146/000

Household Verification Format Door No:1-43,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil
KRISHNAR
EDDY(25)
2 Wife Female Nil Nil/Nil
CHITTAM
MA(22)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335147/000

Household Verification Format Door No:1-43,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC oc Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAM Self Male Nil Nil/Nil
REDDY(33)
2 Wife Female Nil Nil/Nil
RAJITHA(2
5)
3 PASANNA Daughter Female Nil Nil/Nil
LAXMI(6)
4 Daughter Female Nil Nil/Nil
PALLAVI(7
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335148/000

Household Verification Format Door No:1-45,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil
BUCHANN
A(60)
2 Wife Female Nil Nil/Nil
NAGAMM
A(50)
3 Son Female Nil Nil/Nil
NAGARAJ
U(15)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335149/000

Household Verification Format Door No:1-48,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil
YELLAIAH
(24)
2 LAXMI(22) Wife Female Nil Nil/Nil
3 Daughter Female Nil Nil/Nil
PRAVAVI(1
)
4 Daughter Female Nil Nil/Nil
VYSNAVI(3
)
5 Father Male Nil Nil/Nil
VENKATAI
AH(49)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335150/000

Household Verification Format Door No:1-44,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil
JAHARABI(
54)
2 Son Male Nil Nil/Nil
HABEEB(26
)
3 Son Male Nil Nil/Nil
KHADHEE
R(31)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335151/000

Household Verification Format Door No:1-44,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUFEED Self Male Nil Nil/Nil
MIA(40)
2 Wife Female Nil Nil/Nil
HEENABE
GUM(26)
3 YUSUF(1) Son Male Nil Nil/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335152/000

Household Verification Format Door No:1-44,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAFEE(34) Self Male Nil Nil/Nil
2 Wife Female Nil Nil/Nil
ZASMIN(25
)
3 Daughter Female Nil Nil/Nil
SADHIYA(1
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335153/000

Household Verification Format Door No:1-49,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Female Nil Nil/Nil
MANNEM
MA(53)
2 Daughter Female Nil Nil/Nil
MANJULA(
29)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335154/000

Household Verification Format Door No:1-50,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC NIL Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil
NARENDE
R(41)
2 Wife Female Nil Nil/Nil
SHIVAMM
A(35)
3 Daughter Female Nil Nil/Nil
SANJANA(
3)
4 Daughter Female Nil Nil/Nil
VENNELA(
1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335155/000

Household Verification Format Door No:99,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil
PARWATH
AIAH(38)
2 Wife Female Nil Nil/Nil
PARWATH
AMMA(33)
3 Son Male Nil Nil/Nil
MAHESH(1
2)
4 Son Male Nil Nil/Nil
SUDHAKA
R(15)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335156/000

Household Verification Format Door No:1-52,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC NIL Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil
USHANNA(
78)
2 Wife Female Nil Nil/Nil
MALLAMM
A(72)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335157/000

Household Verification Format Door No:1-52/1,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil
RAMULU(2
6)
2 Wife Female Nil Nil/Nil
LALITHA(2
1)
3 Son Male Nil Nil/Nil
JASWANT
H(1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335158/000

Household Verification Format Door No:1-55,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil
PARWATH
ALU(36)
2 Wife Female Nil Nil/Nil
SHYAMAL
AMMA(30)
3 AJAY(8) Son Male Nil Nil/Nil
4 SHIVA(10) Son Male Nil Nil/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335159/000

Household Verification Format Door No:1-56,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil
MALLAIAH
(53)
2 Wife Female Nil Nil/Nil
SATHYAM
MA(50)
3 Son Male Nil Nil/Nil
JASWANT
H(7)
4 Daughter Female Nil Nil/Nil
POOJITHA(
6)
5 Daughter Female Nil Nil/Nil
LAVANYA(
5)
6 Brother Male Nil Nil/Nil
KRISHNAI
AH(34)
7 Sister in Law Female Nil Nil/Nil
SHIVAMM
A(30)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335160/000

Household Verification Format Door No:1-59,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil
PARWATH
AIAH(38)
2 Wife Female Nil Nil/Nil
NAGAMM
A(33)
3 Son Male Nil Nil/Nil
SRINIVASU
LU(20)
4 Son Male Nil Nil/Nil
PARAMES
H(19)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335161/001

Household Verification Format Door No:1-59/1,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC NIL Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Female Nil Nil/Nil
KISTAMM
A(78)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0335161/002

Household Verification Format Door No:1-66,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil
VENKATAI
AH(41)
2 Wife Female Nil Nil/Nil
CHENNAM
MA(37)
3 NAVYA(7) Daughter Female Nil Nil/Nil
4 Daughter Female Nil Nil/Nil
NANDHINI(
10)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335162/000

Household Verification Format Door No:1-65,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil
BHUSHAN(
33)
2 Wife Female Nil Nil/Nil
LAXMAM
MA(28)
3 Son Male Nil Nil/Nil
MAHENDR
A(4)
4 Son Male Nil Nil/Nil
SHIVAKU
MAR(7)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335163/000

Household Verification Format Door No:1-62,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil
KONDAIA
H(72)
2 Wife Female Nil Nil/Nil
BALAKIST
AMMA(62)
3 Son Male Nil Nil/Nil
BALAPEER
U(31)
4 Daughter in Female Nil Nil/Nil
KAVITHA( Law
29)
5 Grand Son Male Nil Nil/Nil
BHARATH(
1)
6 Grand Son Male Nil Nil/Nil
SRIKANTH
(8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335164/000

Household Verification Format Door No:1-68,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil
CHANDRAI
AH(60)
2 Wife Female Nil Nil/Nil
ANANTHA
MMA(55)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335165/000

Household Verification Format Door No:1-67,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC NIL Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil
KRISHNAI
AH(33)
2 Wife Female Nil Nil/Nil
CHINNAM
MA(30)
3 Son Male Nil Nil/Nil
SHANKAR(
3)
4 Son Male Nil Nil/Nil
NAGESH(4)
5 Daughter Female Nil Nil/Nil
SHIVAMM
A(2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335166/000

Household Verification Format Door No:1-68/1,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil
RAMULU(4
3)
2 Wife Female Nil Nil/Nil
PADMA(40)
3 Son Male Nil Nil/Nil
MALLESH(
21)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335167/000

Household Verification Format Door No:1-69,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil
SRINIVASU
LU(24)
2 Wife Female Nil Nil/Nil
ANITHA(22
)
3 NIRAJ(1) Son Male Nil Nil/Nil
4 Brother Male Nil Nil/Nil
BALAPEER
U(20)
5 Sister in Law Female Nil Nil/Nil
RADHA(18)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335168/000

Household Verification Format Door No:1-72,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil
SRINIVASU
LU(36)
2 Wife Female Nil Nil/Nil
BBHARAT
HAMMA(34
)
3 Son Male Nil Nil/Nil
BHANUPR
ASAD(1)
4 SHIVA(8) Son Male Nil Nil/Nil
5 Daughter Female Nil Nil/Nil
GAYATHRI
(7)
6 Daughter Female Nil Nil/Nil
SRAVANI(7
)
7 HARIKA(3) Daughter Female Nil Nil/Nil
8 Mother Female Nil Nil/Nil
KONDAM
MA(56)
9 Brother Male Nil Nil/Nil
BALASWA
MY(47)
10 Sister in Law Female Nil Nil/Nil
DHANALA
XMI(42)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335169/000

Household Verification Format Door No:1-61,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RAJU(37) Self Male Nil Nil/Nil
2 Wife Female Nil Nil/Nil
NAGAMM
A(30)
3 Son Male Nil Nil/Nil
NARESH(6)
4 Daughter Female Nil Nil/Nil
SHIVANI(8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335170/000

Household Verification Format Door No:1-63,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 Self Male Nil Nil/Nil
BALAIAH(6
3)
2 Son Male Nil Nil/Nil
SHIVAIAH(
24)
3 Daughter Female Nil Nil/Nil
ANITHA(13
)
4 Daughter in Female Nil Nil/Nil
ANJANAM Law
MA(22)
5 RAMU(6) Grand Son Male Nil Nil/Nil
6 Grand Son Male Nil Nil/Nil
MOHANAK
RISHNA(2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335171/000

Household Verification Format Door No:1-62,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 CHATAMO Self Male Nil Nil/Nil 734992601759
NI
BAKKAIAH
(35)
2 CHATAMO Wife Female Nil Nil/Nil 628123939339
NI
PADMAM
MA(29)
3 CHATAMO Son Male Nil Nil/Nil
NI
YADAIAH(
7)
4 CHATAMO Daughter Female Nil Nil/Nil 641838467205
NI
MANASA(1
0)
5 CHATAMO Daughter Female Nil Nil/Nil
NI
KAVITHA(
4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.32 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335172/000

Household Verification Format Door No:1-95,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas YES/HP/638264
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MADDHA Self Male Nil Nil/Nil 542318233841
M
SRISAILA
M(48)
2 MADDHA Wife Female Nil Nil/Nil 559721990874
M
BOGURAM
MA(42)
3 MADDHA Son Male Nil Nil/Nil
M
KARTHIK(9
)
4 MADDHA Son Male Nil Nil/Nil 485249364119
M
RAMULU(1
6)
5 MADDHA Son Male Nil Nil/Nil 368694147004
M
MALLESH(
18)
6 MADDHA Daughter Female Nil Nil/Nil
M
SHERESA(1
4)
7 MADDHA Father in Female Nil Nil/Nil
M Law
MANEESA(
17)
8 MADDHA Brother Male Nil Nil/Nil 510734857558
M
VENKATAI
AH(45)
9 MADDHA Sister in Law Female Nil Nil/Nil 893580918063
M
NAGAMM
A(38)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.43 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335173/000

Household Verification Format Door No:1-93,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAH Gas YES/HP/638253
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MADDHA Self Male Nil Nil/Nil 866441139962
M
BALAIAH(4
1)
2 MADDHA Wife Female Nil Nil/Nil 611787556619
M
LAXMI(38)
3 MADDHA Son Male Nil Nil/Nil 252951976116
M
NARESH(16
)
4 MADDHA Daughter Female Nil Nil/Nil
M
AKILA(7)
5 MADDHA Daughter Female Nil Nil/Nil
M
AMMULU(
1)
6 MADDHA Daughter Female Nil Nil/Nil 306173227494
M
SRIDAVI(1
1)
7 MADDHA Daughter Female Nil Nil/Nil
M
BARGAVI(
4)
8 MADDHA Daughter Female Nil Nil/Nil 591001558755
M
MAHESHW
ARI(12)
9 MADDHA Daughter Female Nil Nil/Nil 909822722067
M
MAMATHA
(13)
10 MADDHA Brother Male Nil Nil/Nil 784954498335
M
PARVATAI
AH(31)
11 MADDHA Sister in Law Female Nil Nil/Nil
M
YADAIAH(
28)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:1.18/DRY:8.68 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:
Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335174/000

Household Verification Format Door No:1-97,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARAYANA Gas YES/HP/636729
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDDHA Self Male Nil Nil/Nil 256622762947
M
SRINIVASU
LU(35)
2 MUDDHA Wife Female Nil Nil/Nil 850573068415
M
EESHWAR
AMMA(31)
3 MUDDHA Son Male Nil Nil/Nil
M
GANESH(4)
4 MUDDHA Son Male Nil Nil/Nil
M
SHIVAKU
MAR(6)
5 MUDDHA Daughter Female Nil Nil/Nil 564575277876
M
SHAMALA(
13)
6 MUDDHA Daughter Female Nil Nil/Nil 239264905786
M
POOJA(7)
7 MUDDHA Daughter Female Nil Nil/Nil 947207557384
M
KALPANA(
14)
8 MUDDHA Daughter Female Nil Nil/Nil 633009851076
M
AKILA(8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:7.02 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335175/000

Household Verification Format Door No:1-96,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARAYANA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDDHA Self Male Nil DAILY 832324207516
M WAGES
RAMBABU LABOUR/N
(35) il
2 MUDDHA Wife Female Nil Nil/Nil 915216423035
M
LAXMI(32)
3 MUDDHA Son Male Nil Nil/Nil
M
SHIVAKU
MAR(1)
4 MUDDHA Daughter Female Nil Nil/Nil 785944573584
M
SHIVALEE
LA(7)
5 MUDDHA Daughter Female Nil Nil/Nil 571887098784
M
SWAPNA(5
)
6 MUDDHA Daughter Female Nil Nil/Nil 975145004481
M
MAHESHW
ARI(9)
7 MUDDHA Mother Female Nil Nil/Nil
M
YALLAMM
A(68)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:11.65 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335176/000

Household Verification Format Door No:1-98,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NAGAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDDHA Self Male Nil Nil/Nil 729728609216
M
VENKATAI
AH(42)
2 MUDDHA Wife Female Nil Nil/Nil 675671106148
M
ANJANAM
MA(37)
3 MUDDHA Son Male Nil Nil/Nil 573116514462
M
SHIVAIAH(
10)
4 MUDDHA Daughter Female Nil Nil/Nil 317384236823
M
KALPANA(
6)
5 MUDDHA Mother Female Nil Nil/Nil 922460603654
M
CHANDRA
MMA(65)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335177/000

Household Verification Format Door No:1-99,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NAGAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDDHA Self Male Nil Nil/Nil
M
MALLAIAH
(53)
2 MUDDHA Wife Female Nil Nil/Nil 824472167350
M
LAXMAM
MA(48)
3 MUDDHA Son Male Nil Nil/Nil 820518977322
M
USHAKAN
TH(15)
4 MUDDHA Daughter Female Nil Nil/Nil 246180642370
M
NEELAMM
A(18)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335178/000

Household Verification Format Door No:2-1,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband JANGEERSHAB Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAHAMO Self Male Nil Nil/Nil 284967480169
OD
MAHABOO
BALI(55)
2 MAHAMO Wife Female Nil Nil/Nil 568129836042
OD
SAHADBA
GAM(48)
3 MAHAMO Son Male Nil Nil/Nil 449966698345
OD
SHARIF(23)
4 MAHAMO Daughter Female Nil Nil/Nil 583854533104
OD
FARHANA
BAGAM(24
)
5 MAHAMO Daughter Female Nil Nil/Nil 731811973204
OD
TABUEHB
AGAM(16)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335179/000

Household Verification Format Door No:1-100,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband KAJASHAB Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAHAMA Self Male Nil Nil/Nil 857505561955
D GANI(63)

2 MAHAMA Wife Female Nil Nil/Nil 841349790904

D
MAHAMA
DKAJABE(
48)
3 MAHAMA Son Male Nil Nil/Nil
D
MAHAMA
DSAJEETH(
25)
4 MAHAMA Son Male Nil Nil/Nil 801172466934
D
JAHANGEE
R(29)
5 MAHAMA Daughter in Female Nil Nil/Nil
D Law
SAIJEETH(
22)
6 MAHAMA Daughter in Female Nil Nil/Nil 642314317055
D Law
JAKEER(24
)
7 MAHAMA Grand Son Male Nil Nil/Nil
D
SHAKSAL
MAN(3)
8 MAHAMA Grand Son Male Nil Nil/Nil
D
MAHAMD
AAHAMDA
(2)
9 MAHAMA Grand Son Male Nil Nil/Nil 897232456071
D SERAJ(7)

10 MAHAMA Grand Female Nil Nil/Nil

D Daughter
KAREESH
MA(5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:
Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335180/000

Household Verification Format Door No:2-2,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband MAHAMADKAJA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAHAMA Self Male Nil Nil/Nil 624663554107
D
GOUSEYA(
36)
2 MAHAMA Daughter Male Nil Nil/Nil 592206782783
D
MAHAMA
DAABADA(
12)
3 MAHAMA Daughter Male Nil Nil/Nil 943358928329
D
MAHAMA
DFAREDA(
15)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335181/000

Household Verification Format Door No:2-3,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband AAIAHNNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SHAREPAL Self Male Nil Nil/Nil 299470802138
LY
BALAIAH(2
8)
2 SHAREPAL Wife Female Nil Nil/Nil 833935335386
LY
MANAMM
A(26)
3 SHAREPAL Son Male Nil Nil/Nil
LY
ARAVEND
YADAV(1)
4 SHAREPAL Son Male Nil Nil/Nil 451606456288
LY
SHIVAKU
MAR(7)
5 SHAREPAL Daughter Female Nil Nil/Nil 776733550769
LY
SANGEETH
A(6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.82 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335182/000

Household Verification Format Door No:2-4,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband CHINNABALAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SHAREEPA Self Male Nil Nil/Nil 217882748539
LLE
VENKATAI
AH(48)
2 SHAREEPA Wife Female Nil Nil/Nil 845596172273
LLE
PADMAM
MA(34)
3 SHAREEPA Daughter Female Nil Nil/Nil
LLE
SUJATHA(1
4)
4 SHAREEPA Daughter Female Nil Nil/Nil 763942866851
LLE
MANJULA(
16)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.48 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335183/000

Household Verification Format Door No:2-7,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband GOPAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GANTA Self Male Nil Nil/Nil 438670744092
VENKATAI
AH(48)
2 GANTA Wife Female Nil Nil/Nil 490670804294
EENDIRAM
MA(38)
3 GANTA Son Male Nil Nil/Nil 210046722848
SHAKER(16
)
4 GANTA Son Male Nil Nil/Nil
RAVIKUM
AR(22)
5 GANTA Son Male Nil Nil/Nil
SURENDER
(14)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.08 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335184/000

Household Verification Format Door No:1-2,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband MASAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SHARUPAL Self Male Nil Nil/Nil 497503859574
LE
BUCHAIAH
(53)
2 SHARUPAL Wife Female Nil Nil/Nil 738702153318
LE
LAXMAM
MA(51)
3 SHARUPAL Son Male Nil Nil/Nil 358279299030
LE
SAILU(11)
4 SHARUPAL Son Male Nil Nil/Nil 836962267811
LE
MAHESH(1
5)
5 SHARUPAL Daughter Female Nil Nil/Nil 604505622423
LE
BALESHW
ARAMMA(
10)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0.5/DRY:2.32 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335185/000

Household Verification Format Door No:1-71,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NAGAIAH Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDDHA Self Male Nil Nil/Nil 507714828863
M
AASANNA(
53)
2 MUDDHA Wife Female Nil Nil/Nil 460922189402
M
LENGAMM
A(51)
3 MUDDHA Son Male Nil Nil/Nil 334727452775
M
SRINU(21)
4 MUDDHA Sister Female Nil Nil/Nil
M
NARAMMA
(63)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:4.4/DRY:9.08 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335186/000

Household Verification Format Door No:1-74,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARSAIAH Gas YES/HP/610130
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAROJA Self Male Nil Nil/Nil 947196615682
LAXMINA
RAYANA(7
3)
2 MAROJA Son Male Nil Nil/Nil 375991437775
MORALIKR
ISHNA(44)
3 MAROJA Son Male Nil Nil/Nil
YADAGIRI(
43)
4 MAROJA Daughter in Female Nil Nil/Nil
VISHNAVI( Law
27)
5 MAROJA Daughter in Female Nil Nil/Nil 553042619706
RADHIKA( Law
40)
6 MAROJA Grand Son Male Nil Nil/Nil
AKSHAI(4)
7 MAROJA Grand Female Nil Nil/Nil
VARSHINI( Daughter
2)
8 MAROJA Grand Female Nil Nil/Nil 376225350044
ANUSA(5) Daughter

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335188/000

Household Verification Format Door No:1-79,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband BALAIAHCHARY Gas YES/HP/46443
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MAROJA Self Male Nil Nil/Nil 272853058068
RAMMOHA
NACHARY(
42)
2 MAROJA Wife Female Nil Nil/Nil 211807262075
MANJULA(
37)
3 MAROJA Son Male Nil Nil/Nil 730484448679
ADITYABA
RDVJA(11)
4 MAROJA Daughter Female Nil Nil/Nil
SAIMAGA
NA(13)
5 MAROJA Mother Female Nil Nil/Nil
YASODAM
MA(68)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335189/000

Household Verification Format Door No:1-78,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARAYANA Gas YES/HP/632803
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KAKOJA Self Male Nil Nil/Nil 374801911439
RAMULU(5
4)
2 KAKOJA Wife Female Nil Nil/Nil 373832982317
KRISHNAM
MA(49)
3 KAKOJA Son Male Nil Nil/Nil 858118867049
CHANDRA
SHAKER(33
)
4 KAKOJA Son Male Nil Nil/Nil 429143114767
SRIKANTH
(26)
5 KAKOJA Daughter in Female Nil Nil/Nil 556266939117
BALESHW Law
ARAMMA(
28)
6 KAKOJA Daughter in Female Nil Nil/Nil
UMADAVI( Law
24)
7 KAKOJA Grand Son Male Nil Nil/Nil
LIKITHKU
MAR(11)
8 KAKOJA Grand Female Nil Nil/Nil
LAVANYA( Daughter
9)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:8 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335190/000

Household Verification Format Door No:1-79,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARAYANA Gas YES/HP/637478
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KAKOJI Self Male Nil Nil/Nil 678698859633
BRAMAIA
HCHARY(6
6)
2 KAKOJI Wife Female Nil Nil/Nil 719641390396
MANIKYA
MMA(61)
3 KAKOJI Son Male Nil Nil/Nil 618400590072
BALASWA
MY(36)
4 KAKOJI Son Male Nil Nil/Nil
SRINIVASA
CHARY(30)
5 KAKOJI Daughter in Female Nil Nil/Nil 454928946595
SUDHA(32) Law

6 KAKOJI Daughter in Female Nil Nil/Nil

ALIVALAM Law
MA(22)
7 KAKOJI Grand Son Male Nil Nil/Nil
KARTIKAY
ASAI(6)
8 KAKOJI Grand Female Nil Nil/Nil 995790525840
KIRTHANA Daughter
(10)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:3.45 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335191/000

Household Verification Format Door No:1-80,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMALAXMARED Gas YES/HP/628207
Name DY Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 NAGOLU Self Male Nil Nil/Nil
MANNAPU
REDDY(59)
2 NAGOLU Son Male Nil Nil/Nil 567734695114
TIRUPATHI
REDDY(28)
3 NAGOLU Son Male Nil Nil/Nil 850445125635
RAMREDD
Y(26)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:8.92 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335192/000

Household Verification Format Door No:1-81,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband RAMULU Gas YES/HP/610134
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 JAREPATI Self Male Nil Nil/Nil 784843380577
SRINIVASU
LU(47)
2 JAREPATI Wife Female Nil Nil/Nil
KONDAM
MA(49)
3 JAREPATI Son Male Nil Nil/Nil 810838838442
ROHITKU
MAR(22)
4 JAREPATI Son Male Nil Nil/Nil 600534843044
RAJASHAK
ER(23)
5 JAREPATI Mother Female Nil Nil/Nil 416641531992
MASAMM
A(65)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:1.9/DRY:2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335193/000

Household Verification Format Door No:1-82,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband SHASAIAH Gas YES/HP/613697
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 POODATT Self Male Nil Nil/Nil 638797663984
U
MADAVAI
AH(52)
2 POODATT Wife Female Nil Nil/Nil 983377131563
U
SUKADA(4
4)
3 POODATT Son Male Nil Nil/Nil 772332914202
U
SAIKRISHN
A(20)
4 POODATT Son Male Nil Nil/Nil 718518496437
U
VANUMAD
AV(22)
5 POODATT Daughter Female Nil Nil/Nil
U
PAVANI(19
)
6 POODATT Mother Female Nil Nil/Nil
U
LAXMIDA
VAMMA(79
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335194/000

Household Verification Format Door No:1-22,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband NARAYANA Gas YES/Bharath/7221
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 SANGAM Self Male Nil Nil/Nil 346144138235
BALANAR
SHIMMAS
WAMY(62)
2 SANGAM Wife Female Nil Nil/Nil 273692393802
PADMAVA
THI(58)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:1.92/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0335195/000

Household Verification Format Door No:1-91,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband HANMANTHURED Gas NIL/-/
Name DY Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 GUJJA Self Male Nil Nil/Nil 207865728607
RAMREDD
Y(38)
2 GUJJA Wife Female Nil Nil/Nil 251739650957
BAGYALA
XMI(33)
3 GUJJA Son Male Nil Nil/Nil 505302133438
MAHESH(1
1)
4 GUJJA Daughter Female Nil Nil/Nil 753208833312
SHERISHA(
14)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:4.38 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0361951/001

Household Verification Format Door No:2-17,gollageri

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC BC Father/Mother/husband krishanaiah Gas YES/Bharath/63420
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ganta g Self Male Nil OWN 731859976541
satyanarayan AGRICULT
a(48) URE
/Nil
2 ganta Husband Female Nil OWN 562245890647
yadamma(43 AGRICULT
) URE
/Nil
3 ganta udai Son Male Nil STUDENT/ 983902123279
kumar(22) Nil

4 ganta Son Male Nil STUDENT/

sivakumar(1 Nil
5)
5 ganta Daughter Female Nil STUDENT/
sreelatha(15) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:13.98 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0919493/001

Household Verification Format Door No:823/33,yerrakunta tanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation latpalle

alle
SC/ST/BC/OC ST Father/Mother/husband Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavat Self Female Nil Nil/Nil 547739258035
hrani(51)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0219608/000

Household Verification Format Door No:7-46,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband KANDYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ESHLAVAT Self Male Nil Nil/Nil
H
LAXMAN(5
3)
2 ESHLAVAT Wife Female Nil Nil/Nil
H
LAXMI(48)
3 ESHLAVAT Son Male Nil Nil/Nil
H
RAMESH(2
3)
4 ESHLAVAT Son Male Nil Nil/Nil
H
HANMYA(2
9)
5 ESHLAVAT Daughter in Female Nil Nil/Nil
H SITA(21) Law
6 ESHLAVAT Daughter in Male Nil Nil/Nil
H Law
ANJAMMA
(26)
7 ESHLAVAT Grand Son Male Nil Nil/Nil
H
RAKESH(1)
8 ESHLAVAT Grand Son Male Nil Nil/Nil
H
ROHITHKU
MAR(5)
9 ESHLAVAT Grand Son Male Nil Nil/Nil
H
PAVANKU
MAR(4)
10 ESHLAVAT Grand Son Male Nil Nil/Nil
H
NAVEENK
UMAR(2)
11 ESHLAVAT Grand Female Nil Nil/Nil
H Daughter
NIHARIKA(
8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:5.7 WET/ID:____/DRY____:
3 4 Wheeler owners YES
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:
Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319285/000

Household Verification Format Door No:7-174,LATPALI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband KRISTYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil Nil/Nil
H RAJU(33)
2 MUDAVAT Wife Female Nil Nil/Nil
H SALI(30)
3 MUDAVAT Daughter Female Nil Nil/Nil
H
NAVANEE
THA(6)
4 MUDAVAT Daughter Female Nil Nil/Nil
H
SRIVIDYA(
3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319286/000

Household Verification Format Door No:7-175,LATTPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband NARSINGHYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil Nil/Nil
H
DUBYA(63)
2 MUDAVAT Wife Female Nil Nil/Nil
H
BIBILIYA(4
8)
3 MUDAVAT Daughter in Female Nil Nil/Nil
H Law
LALITHA(2
3)
4 MUDAVAT Daughter in Female Nil Nil/Nil
H Law
SHANKAR(
22)
5 MUDAVAT Grand Female Nil Nil/Nil
H Daughter
LAVANYA(
1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:1.2/DRY:2.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319290/000

Household Verification Format Door No:7-170,LATTPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband BHANU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil Nil/Nil
H
SHANKAR(
28)
2 MUDAVAT Wife Female Nil Nil/Nil
H
SHANTHI(2
3)
3 MUDAVAT Son Male Nil Nil/Nil
H
JAGDEESH
(1)
4 MUDAVAT Son Male Nil Nil/Nil
H
BHARATH
KUMAR(4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319300/001

Household Verification Format Door No:7-23,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband HANMA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MADAVAT Self Male Nil AGRICULT 423239667775
H URE
RAYDYA(5 LABOUR
3) /Nil
2 MADAVAT Wife Female Nil AGRICULT 301700418217
H URE
MANEMM LABOUR
A(48) /Nil
3 MADAVAT Son Male Nil Nil/Nil 904723749125
H
SHANKAR(
20)
4 MADAVAT Son Male Nil Nil/Nil 758157919804
H
PEERU(28)
5 MADAVAT Son Male Nil DRIVERS/N 264315037873
H il
RAMESH(2
8)
6 MADAVAT Daughter in Female Nil HOUSE 768324715660
H Law WIFE/Nil
CHITTI(24)
7 MADAVAT Daughter in Female Nil Nil/Nil 300235349562
H Law
NEELA(23)
8 MADAVAT Grand Son Male Nil Nil/Nil 971792638850
H
CHARAN(5
)
9 MADAVAT Grand Female Nil Nil/Nil
H Daughter
RISHITHA(
2)
10 MADAVAT Grand Female Nil Nil/Nil 521733594421
H Daughter
NIKHITHA(
6)
11 MADAVAT Grand Female Nil Nil/Nil
H PUJA(2) Daughter
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:4.82 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:
Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319301/002

Household Verification Format Door No:7-19,sc

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband KAMDIRIYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAAVA Self Male Nil AGRICULT 560274488956
TH URE
PULUA(52) LABOUR
/Nil
2 MUDAAVA Wife Female Nil AGRICULT 691592999528
TH URE
MUTHYAL LABOUR
AMMA(49) /Nil
3 MUDAAVA Son Male Nil DRIVERS/N 658121681618
TH il
RAMESH(3
1)
4 MUDAAVA Daughter in Female Nil HOUSE
TH Law WIFE/Nil
VIJAYA(19)
5 MUDAAVA Grand Son Male Nil Nil/Nil 335893591743
TH
TIRUPATHI
(6)
6 MUDAAVA Grand Female Nil Nil/Nil 852926656424
TH Daughter
BINDU(7)
7 MUDAAVA Grand Female Nil Nil/Nil 462694477362
TH Daughter
BINDU(5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:5.32 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319302/001

Household Verification Format Door No:7-33,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband HANMYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAAVA Self Male Nil AGRICULT 630524696032
TH URE
RAMULU(3 LABOUR
8) /Nil
2 MUDAAVA Wife Female Nil AGRICULT 411320328202
TH URE
DEVI(33) LABOUR
/Nil
3 MUDAAVA Son Male Nil Nil/Nil 467004471568
TH
SANJU(13)
4 MUDAAVA Daughter Female Nil Nil/Nil 684470271556
TH
KAVITHA(
15)
5 MUDAAVA Daughter Female Nil Nil/Nil 723944798179
TH
SHANTHI(7
)
6 MUDAAVA Daughter Female Nil Nil/Nil 284143009564
TH
SUNITHA(1
8)
7 MUDAAVA Daughter Female Nil Nil/Nil 919039359887
TH
SHIRISHA(
6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.82 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319303/002

Household Verification Format Door No:5-27,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband DAYVLLA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil DRIVERS/N 612102704355
H il
LAKSHMA
N(41)
2 MUDAVAT Wife Female Nil DAILY 578905921064
H WAGES
HASLLI(33) LABOUR/N
il
3 MUDAVAT Son Male Nil Nil/Nil 590963055808
H
VIJAY(10)
4 MUDAVAT Son Male Nil Nil/Nil
H
KALAYND
HAR(10)
5 MUDAVAT Daughter Female Nil STUDENT/
H Nil
ANJALI(15)
6 MUDAVAT Mother Female Nil DO 648702953200
H NOTHING/
BIGNI(68) Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319304/001

Household Verification Format Door No:7-25,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband DAYVLLA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil AGRICULT 782965787785
H URE
KRSHNA(4 LABOUR
8) /Nil
2 MUDAVAT Wife Female Nil AGRICULT 841053880726
H URE
SHANTHI(3 LABOUR
8) /Nil
3 MUDAVAT Son Male Nil Nil/Nil 709750158616
H SHIVA(7)

4 MUDAVAT Daughter Female Nil Nil/Nil 372908131155

H
PARVATHI
(16)
5 MUDAVAT Daughter Female Nil Nil/Nil 555565525616
H
LAKSHMI(
9)
6 MUDAVAT Daughter Female Nil Nil/Nil 844867238004
H
ALIVELU(1
3)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.6 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319305/002

Household Verification Format Door No:7-26,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband DAYVLLA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil AGRICULT 626937094964
H URE
RAYDYA(4 LABOUR
8) /Nil
2 MUDAVAT Wife Female Nil AGRICULT
H URE
CHAVLLI(4 LABOUR
3) /Nil
3 MUDAVAT Son Male Nil STUDENT/ 363800566003
H Nil
SRINU(20)
4 MUDAVAT Son Male Nil DRIVERS/N 524680595192
H il
SHANKAR
A(28)
5 MUDAVAT Daughter Female Nil Nil/Nil
H
RAANI(14)
6 MUDAVAT Daughter in Female Nil HOUSE
H Law WIFE/Nil
CHITTEMM
A(24)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319306/002

Household Verification Format Door No:7-14,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband KASHNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAAVA Self Male Nil DAILY 346053888636
TH WAGES
RAMULU(3 LABOUR/N
8) il
2 MUDAAVA Wife Female Nil DAILY 687321360145
TH WAGES
MUTHYALI LABOUR/N
(33) il
3 MUDAAVA Son Male Nil Nil/Nil
TH
BHASHKA
R(9)
4 MUDAAVA Son Male Nil Nil/Nil 268530733385
TH
JAIPAL(11)
5 MUDAAVA Daughter Female Nil Nil/Nil
TH
LAKSHMI(
13)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319307/001

Household Verification Format Door No:7-14,sc

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband KASHNA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAAVA Self Male Nil DRIVERS/N 998782564996
TH il
PULYA(38)
2 MUDAAVA Wife Female Nil AGRICULT 999739019615
TH URE
BHAMINI(3 LABOUR
3) /Nil
3 MUDAAVA Son Female Nil Nil/Nil 990836828267
TH
SRINU(14)
4 MUDAAVA Son Female Nil Nil/Nil 327307543166
TH
EESHWAR(
11)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319308/002

Household Verification Format Door No:7-19,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband PULAYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAAVA Self Male Nil DRIVERS/N 711034404896
TH il
SRISHAILA
M(34)
2 MUDAAVA Wife Female Nil HOUSE 656307296208
TH WIFE/Nil
CHITTI(26)
3 MUDAAVA Son Male Nil STUDENT/ 224981581964
TH Nil
SRINADH(7
)
4 MUDAAVA Daughter Female Nil STUDENT/ 605931953445
TH Nil
SHIRISH(6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319309/001

Household Verification Format Door No:7-19,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband PULYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil AGRICULT 457360147132
H URE
HEERYA(3 LABOUR
5) /Nil
2 MUDAVAT Wife Female Nil AGRICULT 693471820678
H URE
SHANTHI(3 LABOUR
5) /Nil
3 MUDAVAT Son Male Nil STUDENT/ 415034849354
H Nil
SAYVUYA(
10)
4 MUDAVAT Daughter Female Nil STUDENT/ 495633026132
H Nil
SOUJANYA
(7)
5 MUDAVAT Daughter Female Nil STUDENT/
H Nil
SANDHYA
RANI(12)
6 MUDAVAT Daughter Female Nil STUDENT/ 922910362560
H Nil
SARITHA(1
6)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319310/002

Household Verification Format Door No:7-27,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband DAYVULLA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil AGRICULT 798280695441
H URE
jumpalya(48 LABOUR
) /Nil
2 MUDAVAT Wife Female Nil AGRICULT 332939767970
H masri(43) URE
LABOUR
/Nil
3 MUDAVAT Daughter Female Nil Nil/Nil
H
anusha(14)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319311/001

Household Verification Format Door No:7-28,sc

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband HOBLA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAAVA Self Male Nil AGRICULT 918261146477
TH URE
RAMULU(3 LABOUR
8) /Nil
2 MUDAAVA Wife Female Nil AGRICULT 650561381410
TH URE
LAKSHMI( LABOUR
33) /Nil
3 MUDAAVA Son Male Nil STUDENT/ 355803878272
TH Nil
VINOD(11)
4 MUDAAVA Son Male Nil STUDENT/ 999190496895
TH Nil
SHIVA(9)
5 MUDAAVA Mother Female Nil DO 265030420839
TH NOTHING/
MUTHYALI Nil
(65)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:6.85 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319312/001

Household Verification Format Door No:7-28,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband SAKRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Female Nil Nil/Nil 768766424349
H
BAKKAMM
A(32)
2 MUDAVAT Daughter Female Nil Nil/Nil 680689267478
H
ANJAMMA
(16)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319313/001

Household Verification Format Door No:7-14,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband KASHNA Gas YES/HP/638558
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil AGRICULT 237179386174
H URE
KRUSHNA( LABOUR
33) /Nil
2 MUDAVAT Wife Female Nil AGRICULT 293605068630
H URE
CHITTI(28) LABOUR
/Nil
3 MUDAVAT Son Male Nil STUDENT/ 275784624655
H Nil
TIRUPATHI
(5)
4 MUDAVAT Daughter Female Nil STUDENT/ 314251949034
H RAANI(7) Nil

5 MUDAVAT Daughter Female Nil STUDENT/ 636611084297

H Nil
ANITHA(9)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:2.82 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319314/001

Household Verification Format Door No:7-15,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband PARSHA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ROUTHLA Self Female Nil AGRICULT 265903595784
VATH URE
LAXMI(62) LABOUR
/Nil
2 ROUTHLA Son Male Nil AGRICULT 881509676543
VATH URE
SHEKHAR( LABOUR
33) /Nil
3 ROUTHLA Daughter in Female Nil AGRICULT 662477811517
VATH Law URE
PADMA(28) LABOUR
/Nil
4 ROUTHLA Grand Son Male Nil Nil/Nil
VATH
SHIVA(7)
5 ROUTHLA Grand Son Male Nil Nil/Nil
VATH
SANTHOSH
(7)
6 ROUTHLA Grand Son Male Nil Nil/Nil 370019730388
VATH
RAJU(13)
7 ROUTHLA Grand Female Nil Nil/Nil
VATH Daughter
RAMYA(13
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:2.42 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319315/001

Household Verification Format Door No:7-16,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband RAYKYA Gas YES/HP/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil AGRICULT 338125376973
H URE
MAANYA(3 LABOUR
8) /Nil
2 MUDAVAT Wife Female Nil AGRICULT 880841483496
H URE
BANNI(37) LABOUR
/Nil
3 MUDAVAT Son Male Nil STUDENT/ 919359895070
H Nil
NARESH(11
)
4 MUDAVAT Son Male Nil STUDENT/ 330897767506
H Nil
BAALU(15)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:1.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319316/002

Household Verification Format Door No:7-16,SC

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband RAYKHYA Gas YES/HP/1034284
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil AGRICULT 773559245687
H URE
RAAMU(38 LABOUR
) /Nil
2 MUDAVAT Wife Female Nil AGRICULT 227470506179
H DEVI(33) URE
LABOUR
/Nil
3 MUDAVAT Son Male Nil STUDENT/ 707686627418
H Nil
MALLESH(
12)
4 MUDAVAT Daughter Female Nil STUDENT/ 451043738422
H Nil
CHINNARI(
8)
5 MUDAVAT Daughter Female Nil STUDENT/ 884603104528
H SONI(10) Nil

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0.72 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319321/000

Household Verification Format Door No:7-17,badyatanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband banunayak Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath Self Male Nil Central Govt 896018263528
rekya(65) Employee/St
ate Govt
Pension
2 mudavath Wife Female Nil Nil/Nil 968322250828
jamli(62)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319322/002

Household Verification Format Door No:7-17,badyatanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband laxman Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath Self Female Nil DAILY 968693985726
chetti(30) WAGES
LABOUR/N
il
2 mudavath Daughter Female Nil Nil/Nil 364864688119
laxmi(3)

3 mudavath Daughter Female Nil Nil/Nil

rajitha(9)
4 mudavath Daughter Female Nil Nil/Nil 299943907577
lalitha(5)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319324/000

Household Verification Format Door No:8-3,badyatanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband parma Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath Self Male Nil OWN 931779886558
bimla(60) AGRICULT
URE
/Nil
2 mudavath Wife Female Nil DAILY 854164898549
gamli(55) WAGES
LABOUR/N
il
3 mudavath Son Male Nil DAILY 583500452288
srinu(23) WAGES
LABOUR/N
il
4 mudavath Daughter in Female Nil DAILY
maroni(20) Law WAGES
LABOUR/N
il
5 mudavath Grand Female Nil DAILY
pallavee(2) Daughter WAGES
LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319325/000

Household Verification Format Door No:8-4,badyathanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband gangaiah Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath Self Male Nil OWN 640445083582
balu(60) AGRICULT
URE
/Nil
2 mudavath Son Male Nil MIGRATED 908518602709
jaipal(30) LABOUR/N
il
3 mudavath Daughter in Female Nil HOUSE 548820621769
meri(26) Law WIFE/Nil

4 mudavath Grand Son Male Nil Nil/Nil 562536003156

srinu(12)

5 mudavath Grand Son Male Nil Nil/Nil 686442527492

anil(8)

6 mudavath Grand Female Nil Nil/Nil 725284233582

ragitha(6) Daughter

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319326/000

Household Verification Format Door No:8-5,badyatanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband dhenaiah Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath Self Male Nil DO 755856255524
sakram(75) NOTHING/
Nil
2 mudavath Wife Female Nil Nil/Nil 555760603246
ramulamma(
65)
3 mudavath Son Male Nil Nil/Nil 211501962484
bashya(23)

4 mudavath Daughter in Female Nil Nil/Nil 314250580710

shradha(20) Law

5 mudavath Grand Female Nil Nil/Nil

bhindhupriya Daughter
(1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:5.52/DRY:5.52 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319327/000

Household Verification Format Door No:8-5,badyatanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband sakram Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath Self Male Nil MIGRATED 990233144496
sevya(37) LABOUR/N
il
2 mudavath Husband Female Nil Nil/Nil 992251723696
subhdra(28)

3 mudavath Son Male Nil Nil/Nil 446039304830

hemanthkum
ar(12)
4 mudavath Son Male Nil Nil/Nil 444034728907
mukesh(10)

5 mudavath Daughter Female Nil Nil/Nil 310454026122

karthi(9)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319328/000

Household Verification Format Door No:8-5/1,badyatanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband sakru Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 nudavath Self Male Nil MIGRATED 260189269959
malya(33) LABOUR/N
il
2 nudavath Wife Female Nil MIGRATED 525112379037
bhuji(30) LABOUR/N
il
3 nudavath Son Male Nil Nil/Nil 726379883067
charan(6)

4 nudavath Daughter Female Nil Nil/Nil 655199173289

jyothi(11)

5 nudavath Daughter Female Nil Nil/Nil 804394376780

puja(4)

6 nudavath Daughter Female Nil Nil/Nil 777423458391

shirisha(8)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:1.15/DRY:1.15 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319329/000

Household Verification Format Door No:8-5,badyatanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband sakrum Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath Self Male Nil Central Govt 460077360653
pandu(27) Employee/St
ate Govt
Pension
2 mudavath Wife Female Nil Nil/Nil 665219830239
shradha(25)

3 mudavath Son Male Nil Nil/Nil

denesh(6)
4 mudavath Daughter Female Nil Nil/Nil
devya(8)
5 mudavath Daughter Female Nil Nil/Nil 348332205455
deksha(2)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319330/000

Household Verification Format Door No:8-6,badyatanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband parshi Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath Self Male Nil Nil/Nil 736048836197
kashnnna(50
)
2 mudavath Wife Female Nil Nil/Nil 313321646217
muthyali(45)

3 mudavath Son Male Nil Nil/Nil

chndhra(31)
4 mudavath Daughter Female Nil Nil/Nil 393358663773
anusha(17)

5 mudavath Daughter in Female Nil Nil/Nil

shanthi(27) Law
6 mudavath Grand Son Male Nil Nil/Nil
shivacharan(
1)
7 mudavath Grand Son Male Nil Nil/Nil 331968106632
saicharan(3)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:2/DRY:2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319331/000

Household Verification Format Door No:8-7,badyatanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband prsha Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 hansha Self Male Nil Nil/Nil 639782374104
hansha(57)

2 hansha Wife Female Nil Nil/Nil 920131391629

lakshmi(54)

3 hansha Son Male Nil Nil/Nil 545194840457

srishelam(26
)
4 hansha Son Male Nil Nil/Nil 845364882838
gopal(32)

5 hansha Daughter in Female Nil Nil/Nil 234387775820

saroja(25) Law

6 hansha Grand Son Male Nil Nil/Nil

sidhu(0)
7 hansha Grand Female Nil Nil/Nil
bhindhu(5) Daughter
8 hansha Grand Female Nil Nil/Nil
puja(7) Daughter
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:2.18/DRY:2.18 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319332/000

Household Verification Format Door No:8-9,badfyathanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband bindu Gas YES/HP/634768
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath Self Male Nil Central Govt 518017478244
tharu(35) Employee/St
ate Govt
Pension
2 mudavath Wife Female Nil Nil/Nil 813614670624
maroni(31)

3 mudavath Son Male Nil Nil/Nil

santhosh(13)
4 mudavath Son Male Nil Nil/Nil 742162893282
adhithya(5)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319333/000

Household Verification Format Door No:8-10,badyatanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband bendhu Gas YES/HP/645667
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath Self Male Nil Central Govt 332089551507
gopal(31) Employee/St
ate Govt
Pension
2 mudavath Wife Female Nil Nil/Nil 790882804247
laxmi(25)

3 mudavath Daughter Female Nil Nil/Nil

barathi(10)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319334/000

Household Verification Format Door No:8-11,badyatanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband gangya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath Self Male Nil Central Govt 705867788937
bendhu(35) Employee/St
ate Govt
Pension
2 mudavath Husband Female Nil MIGRATED 638922562472
laxmi(35) LABOUR/N
il
3 mudavath Son Male Nil Nil/Nil 759069670296
hanmanthu(1
9)
4 mudavath Daughter in Female Nil Nil/Nil
lalitha(17) Law
5 mudavath Grand Son Male Nil Nil/Nil
harseth(2)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319335/000

Household Verification Format Door No:8-12,badyatanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband dahas Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath Self Male Nil Central Govt 746045311923
ramji(38) Employee/St
ate Govt
Pension
2 mudavath Husband Female Nil Nil/Nil 805614367353
mangamma(
28)
3 mudavath Son Male Nil Nil/Nil
rahul(10)
4 mudavath Son Male Nil Nil/Nil 445504500411
purindhar(7)

5 mudavath Daughter Female Nil Nil/Nil 792670530588

shirisha(5)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319336/000

Household Verification Format Door No:8-13,badyatanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband dhas Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath Self Male Nil Central Govt 796093609861
govendh(38) Employee/St
ate Govt
Pension
2 mudavath Husband Female Nil Nil/Nil 665180189519
hasli(36)

3 mudavath Son Male Nil Nil/Nil 821188532924

srishelam(15
)
4 mudavath Daughter Female Nil Nil/Nil 698108091064
anitha(16)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319337/000

Household Verification Format Door No:8-14,badyatanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband bimla Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath Self Male Nil Central Govt
venkatesh(28 Employee/St
) ate Govt
Pension
2 mudavath Husband Female Nil Nil/Nil
manemma(2
3)
3 mudavath Son Male Nil Nil/Nil 351884335976
chran(4)

4 mudavath Daughter Female Nil Nil/Nil 487108453980

shirisha(4)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319338/000

Household Verification Format Door No:8-15,badyatanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband bimla Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath Self Male Nil Central Govt 587133392294
chandhra(29) Employee/St
ate Govt
Pension
2 mudavath Husband Female Nil Nil/Nil
sony(27)
3 mudavath Son Male Nil Nil/Nil 927441849740
rakesh(10)

4 mudavath Daughter Female Nil Nil/Nil 579118960180

ranitha(12)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319339/000

Household Verification Format Door No:8-16,badyatanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband sathru Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath Self Male Nil Nil/Nil
harshi(38)
2 mudavath Husband Female Nil Nil/Nil 765925707723
anji(35)

3 mudavath Son Male Nil Nil/Nil

ganesh(0)
4 mudavath Daughter Female Nil Nil/Nil 572511443349
saritha(13)

5 mudavath Daughter Female Nil Nil/Nil 812151828480

sunitha(4)

6 mudavath Daughter Female Nil Nil/Nil 758334157344

anusha(10)

7 mudavath Daughter Female Nil Nil/Nil 824830541973

savjanya(6)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319340/000

Household Verification Format Door No:8-18,badyatanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband nagya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath Self Male Nil Central Govt 369197733457
bashya(60) Employee/St
ate Govt
Pension
2 mudavath Husband Female Nil DAILY 919978604608
jimma(58) WAGES
LABOUR/N
il
3 mudavath Son Male Nil Nil/Nil
santhosh(21)
4 mudavath Son Male Nil OWN
raju(33) AGRICULT
URE
/Nil
5 mudavath Daughter in Female Nil Nil/Nil 742497239942
vejaiaa(19) Law

6 mudavath Daughter in Female Nil Nil/Nil 967375460330

goramma(30 Law
)
7 mudavath Grand Son Male Nil Nil/Nil
sidhu(6)
8 mudavath Grand Son Male Nil Nil/Nil 971112365559
naveen(7)

9 mudavath Grand Female Nil Nil/Nil 437478893572

manjula(9) Daughter

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319341/000

Household Verification Format Door No:7-14,badyathanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband valya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath Self Male Nil Nil/Nil
kashinya(62)
2 mudavath Husband Male Nil Nil/Nil
shiva(8)
3 mudavath Husband Female Nil Nil/Nil 979293497358
hanshi(60)

4 mudavath Son Male Nil Nil/Nil

ravee(28)
5 mudavath Son Male Nil Nil/Nil 714697939064
gopal(22)

6 mudavath Son Male Nil Nil/Nil 482570345350

shankar(20)

7 mudavath Daughter in Female Nil Nil/Nil 267059325452

kavetha(20) Law

8 mudavath Grand Son Male Nil Nil/Nil

koti(7)
9 mudavath Grand Female Nil Nil/Nil 235048798674
veeralaxmi(4 Daughter
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:

NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319342/000

Household Verification Format Door No:7-14,badyatanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband kashanya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath Self Male Nil Nil/Nil 337785084718
pandhu(28)

2 mudavath Husband Female Nil Nil/Nil 889020851572

kamalamma(
23)
3 mudavath Daughter Female Nil Nil/Nil 851944006763
kavshalya(7)

4 mudavath Daughter Female Nil Nil/Nil 515169625534

mavnika(11)

5 mudavath Daughter Female Nil Nil/Nil 622200430405

sritha(9)

6 mudavath Daughter Female Nil Nil/Nil

anusha(4)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319343/000

Household Verification Format Door No:8-20,badfyatanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband hansha Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath Self Male Nil Nil/Nil 228796846610
niru(28)

2 mudavath Husband Female Nil Nil/Nil

sakri(25)
3 mudavath Daughter Female Nil Nil/Nil 889044285410
shirisha(4)

4 mudavath Daughter Female Nil Nil/Nil

shradha(9)
5 mudavath Daughter Female Nil Nil/Nil 471235423474
tarun(9)

6 mudavath Mother Female Nil Nil/Nil 321578453170

lali(70)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319344/000

Household Verification Format Door No:8-21,badytanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband nrasingya Gas YES/HP/635777
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath Self Male Nil Central Govt 909216414717
thru(68) Employee/St
ate Govt
Pension
2 mudavath Husband Female Nil Nil/Nil 992586475559
sethamma(6
5)
3 mudavath Son Male Nil Nil/Nil 972880274422
raju(22)

4 mudavath Son Male Nil Nil/Nil 670387401599

ganesh(20)

5 mudavath Daughter in Female Nil Nil/Nil

barathi(19) Law
6 mudavath Grand Son Female Nil Nil/Nil 285538235973
shammala(1
1)
7 mudavath Grand Female Nil Nil/Nil 389562899701
manjula(10) Daughter

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319345/000

Household Verification Format Door No:69628,badyathanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband dubya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath Self Male Nil Nil/Nil 996156409125
govendha(38
)
2 mudavath Husband Female Nil Nil/Nil
sakri(37)
3 mudavath Son Male Nil Nil/Nil 574263715142
sunil(7)

4 mudavath Son Male Nil Nil/Nil 754201956179

depak(10)

5 mudavath Daughter Female Nil Nil/Nil 909254630228

anitha(11)

6 mudavath Daughter Female Nil Nil/Nil

sunitha(15)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319346/000

Household Verification Format Door No:7-30,bdyatanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband narsing Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath Self Male Nil Nil/Nil 610718964849
chndhru(65)

2 mudavath Wife Female Nil Nil/Nil 737237155498

gogili(60)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319347/000

Household Verification Format Door No:7-30,badyathanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband chandhru Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 mudavath Self Male Nil Nil/Nil 449697490603
laxman(30)

2 mudavath Wife Female Nil Nil/Nil 666865227812

saramma(28)

3 mudavath Son Male Nil Nil/Nil 766906224063

thirupathi(4)

4 mudavath Daughter Female Nil Nil/Nil 226873473432

savjanya(5)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319348/000

Household Verification Format Door No:7-88,badyatanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband bikya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ramdhath Self Female Nil Nil/Nil 317757038976
jamru(35)

2 ramdhath Son Male Nil Nil/Nil 250259645773

lokya(15)

3 ramdhath Son Male Nil Nil/Nil 744535002945

hanmanth(15
)
4 ramdhath Son Male Nil Nil/Nil 576791353276
laxman(20)

5 ramdhath Daughter in Female Nil Nil/Nil 922790831087

laxmi(24) Law

6 ramdhath Grand Son Male Nil Nil/Nil 843177013880

rahul(4)

7 ramdhath Grand Female Nil Nil/Nil

chinnari(1) Daughter
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319349/000

Household Verification Format Door No:7-88,badyatanda

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC ST Father/Mother/husband gimya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 ramdhath Self Male Nil Nil/Nil 982922227314
thukya(30)

2 ramdhath Wife Female Nil AGRICULT 416124383854

jamma(29) URE
LABOUR
/Nil
3 ramdhath Son Male Nil Nil/Nil 820013344461
ganesh(7)

4 ramdhath Daughter Female Nil Nil/Nil 578040980409

nirmala(4)

Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0319745/002

Household Verification Format Door No:4-48/1,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC BC Father/Mother/husband kishanji Gas YES/HP/610136
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 karnekota k Self Female Nil AGRICULT 838123082803
narshamma( URE
67) LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:4.12/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0319762/002

Household Verification Format Door No:4-33,lattupalle

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation badya tanda

alle
SC/ST/BC/OC BC Father/Mother/husband pedda yallaya Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 nalagonda n Self Female Nil AGRICULT 929774758083
anthamma(6 URE
8) LABOUR
/Nil
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0317701/000

Household Verification Format Door No:8-50,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation yerragunta tanda

alle
SC/ST/BC/OC ST Father/Mother/husband DARJA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil OWN 709757522778
H AGRICULT
SRINU(33) URE
/Nil
2 MUDAVAT Wife Female Nil AGRICULT
H URE
ANGURA(2 LABOUR
8) /Nil
3 MUDAVAT Son Male Nil STUDENT/ 693824147483
H Nil
SRIKANTH
(10)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:1.5 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317702/000

Household Verification Format Door No:8-37,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation yerragunta tanda

alle
SC/ST/BC/OC ST Father/Mother/husband DEVULA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil OWN 204065861491
H BALU(48) AGRICULT
URE
/Nil
2 MUDAVAT Wife Female Nil AGRICULT
H URE
PUTANI(46) LABOUR
/Nil
3 MUDAVAT Son Male Nil MIGRATED 817042702556
H LABOUR/N
PANDU(19) il
4 MUDAVAT Son Male Nil MIGRATED 844463153099
H LABOUR/N
JITHYA(32) il
5 MUDAVAT Daughter in Female Nil MIGRATED 261333779565
H Law LABOUR/N
SHANTHI(2 il
5)
6 MUDAVAT Grand Son Male Nil Nil/Nil 913399372018
H SHIVA(8)

7 MUDAVAT Grand Son Male Nil Nil/Nil 931760518226

H
SANTHU(1
0)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317703/000

Household Verification Format Door No:8-29,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation yerragunta tanda

alle
SC/ST/BC/OC ST Father/Mother/husband SHIRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil OWN 334032567971
H AGRICULT
CHENDU(4 URE
3) /Nil
2 MUDAVAT Husband Female Nil Nil/Nil 625070169750
H
CHENTI(16)
3 MUDAVAT Wife Female Nil AGRICULT 354260714224
H ANJI(40) URE
LABOUR
/Nil
4 MUDAVAT Son Male Nil Nil/Nil 561330272127
H
SRINU(15)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.73 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317704/000

Household Verification Format Door No:8-33,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation yerragunta tanda

alle
SC/ST/BC/OC ST Father/Mother/husband BADRA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAATH Self Male Nil DAILY 874690002525
A WAGES
RAMULU(4 LABOUR/N
4) il
2 MUDAATH Wife Female Nil DAILY 754784549557
A SONA(39) WAGES
LABOUR/N
il
3 MUDAATH Daughter Female Nil Nil/Nil 825466570159
A
SHIRISHA(
11)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317705/000

Household Verification Format Door No:8-33,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation yerragunta tanda

alle
SC/ST/BC/OC ST Father/Mother/husband BADRA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil DAILY 254148588584
H WAGES
LAXMAN(4 LABOUR/N
8) il
2 MUDAVAT Wife Female Nil DAILY 965423763893
H WAGES
MUNNI(38) LABOUR/N
il
3 MUDAVAT Daughter Female Nil Nil/Nil 283686982564
H
MOVNIKA(
11)
4 MUDAVAT Daughter Female Nil Nil/Nil
H
ANUSHA(5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0.7 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317706/000

Household Verification Format Door No:8-52,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation yerragunta tanda

alle
SC/ST/BC/OC ST Father/Mother/husband KAVSI Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil OWN 762833669643
H AGRICULT
HANMA(38 URE
) /Nil
2 MUDAVAT Wife Female Nil Nil/Nil 373596395794
H
MANNI(35)
3 MUDAVAT Daughter Female Nil Nil/Nil 880572935985
H
NANDINI(3
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0.1/DRY:1.9 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317707/000

Household Verification Format Door No:8-53,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation yerragunta tanda

alle
SC/ST/BC/OC ST Father/Mother/husband KESHYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil OWN
HA AGRICULT
SAKRU(45) URE
/Nil
2 MUDAVAT Wife Female Nil Nil/Nil
HA
ATHYALI(4
0)
3 MUDAVAT Son Male Nil Nil/Nil
HA
LAXMAN(1
6)
4 MUDAVAT Son Male Nil Nil/Nil
HA
SRINU(23)
5 MUDAVAT Daughter Female Nil Nil/Nil
HA
SARITHA(1
2)
6 MUDAVAT Daughter in Female Nil Nil/Nil
HA Law
LAXMI(21)
7 MUDAVAT Grand Female Nil Nil/Nil
HA Daughter
PRANITHA
(0)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2.55 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317708/000

Household Verification Format Door No:8-54,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation yerragunta tanda

alle
SC/ST/BC/OC ST Father/Mother/husband BADRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil OWN 584346755321
H AGRICULT
THULCHA( URE
41) /Nil
2 MUDAVAT Wife Female Nil AGRICULT 296120431318
H URE
JEMRU(39) LABOUR
/Nil
3 MUDAVAT Son Male Nil Nil/Nil 821234172987
H
SANTHOSH
(11)
4 MUDAVAT Son Male Nil Nil/Nil 216122715382
H
NARESH(10
)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:2 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317709/000

Household Verification Format Door No:99,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation yerragunta tanda

alle
SC/ST/BC/OC ST Father/Mother/husband GOPAL Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Female Nil MIGRATED
H PPD(43) LABOUR/N
il
2 MUDAVAT Son Male Nil MIGRATED
H LABOUR/N
GOVINDU( il
18)
3 MUDAVAT Son Male Nil MIGRATED
H RAVI(38) LABOUR/N
il
4 MUDAVAT Daughter Female Nil MIGRATED
H LABOUR/N
PADMA(16) il
5 MUDAVAT Daughter in Female Nil MIGRATED
H Law LABOUR/N
LALITHA(2 il
7)
6 MUDAVAT Grand Female Nil Nil/Nil
H Daughter
SANDYA(1)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
NONE ELIGIBLE [ ]
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:

NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317710/000

Household Verification Format Door No:8-56,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation yerragunta tanda

alle
SC/ST/BC/OC ST Father/Mother/husband BASHYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVTH Self Male Nil MIGRATED 304829744000
RAVI(32) LABOUR/N
il
2 MUDAVTH Wife Female Nil MIGRATED 461323890878
CHANDI(28 LABOUR/N
) il
3 MUDAVTH Son Male Nil Nil/Nil 256239462687
CHERAN(6)

4 MUDAVTH Daughter Female Nil Nil/Nil

NANDINI(1
)
5 MUDAVTH Mother Female Nil Nil/Nil
SONI(50)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:0.8 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317711/000

Household Verification Format Door No:8-56,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation yerragunta tanda

alle
SC/ST/BC/OC ST Father/Mother/husband BASHA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil MIGRATED 891566516828
H LABOUR/N
KRISHNA(3 il
7)
2 MUDAVAT Wife Female Nil MIGRATED 664763228452
H LABOUR/N
SHARADH il
A(1)
3 MUDAVAT Son Male Nil Nil/Nil
H
GANESH(7)
4 MUDAVAT Son Male Nil Nil/Nil 278134073594
H
SHIVA(11)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Plastic Roof
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317712/000

Household Verification Format Door No:8-56,LATTUPALLI

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation yerragunta tanda

alle
SC/ST/BC/OC ST Father/Mother/husband BASHA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil MIGRATED 759539038155
H LABOUR/N
LAXMAN(3 il
2)
2 MUDAVAT Wife Female Nil MIGRATED 768304402685
H LABOUR/N
HANMI(38) il
3 MUDAVAT Son Male Nil Nil/Nil 492251689531
H
CHERAN(6)
4 MUDAVAT Daughter Female Nil Nil/Nil 387411818506
H
MANISHA(
8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317713/000

Household Verification Format Door No:8-33,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation yerragunta tanda

alle
SC/ST/BC/OC ST Father/Mother/husband BADRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil OWN 317225282303
H AGRICULT
MANYA(48 URE
) /Nil
2 MUDAVAT Husband Female Nil Nil/Nil 595293566620
H SHIVA(2)

3 MUDAVAT Husband Female Nil Nil/Nil 978875881461

H MARI(43)

4 MUDAVAT Son Male Nil Nil/Nil

H PINA
NAYAK(17)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:3.1 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317714/000

Household Verification Format Door No:8-33,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation yerragunta tanda

alle
SC/ST/BC/OC ST Father/Mother/husband TAKRU Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 KODAVAL Self Male Nil DAILY 726726994472
KISTYA(72) WAGES
LABOUR/N
il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:0 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:
NONE ELIGIBLE [ ]
1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for
Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer:
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ] NONE ELIGIBLE [ ]
Name & Signature of the Tahsildar:
Date: Name & Signature of the MPDO/Municipal Commissioner
Date:
 SKS Survey Number:MB0317715/000

Household Verification Format Door No:8-52,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation yerragunta tanda

alle
SC/ST/BC/OC ST Father/Mother/husband KESYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 MUDAVAT Self Male Nil MIGRATED
H LABOUR/N
LASKAR(39 il
)
2 MUDAVAT Wife Female Nil MIGRATED
H VALI(32) LABOUR/N
il
3 MUDAVAT Son Male Nil Nil/Nil 861446218573
H
ANJANELU
(5)
4 MUDAVAT Daughter Female Nil Nil/Nil 460528891796
H
ANITHA(8)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:2.78 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317716/000

Household Verification Format Door No:8-62,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation yerragunta tanda

alle
SC/ST/BC/OC ST Father/Mother/husband CHINYA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATHNAV Self Female Nil DO 589990480574
AL NOTHING/
CHANDI(66 Nil
)
2 RATHNAV Son Male Nil STUDENT/ 432766877310
AL Nil
BASKAR(1
5)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) thatched
2 Total Land Holding(acres) WET/ID:0/DRY:13.88 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317717/000

Household Verification Format Door No:8-61,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation yerragunta tanda

alle
SC/ST/BC/OC ST Father/Mother/husband PARSHA Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATHNAV Self Male Nil OWN 68356141729
ALI AGRICULT
MANSING( URE
54) /Nil
2 RATHNAV Wife Female Nil Nil/Nil 975285234841
ALI
MANEMM
A(49)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) Tiled
2 Total Land Holding(acres) WET/ID:0/DRY:8.6 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ] NONE ELIGIBLE [ ]

Name & Signature of the Verification Officer:

Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar: NONE ELIGIBLE [ ]
Date:

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317718/000

Household Verification Format Door No:8-61/1,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation yerragunta tanda

alle
SC/ST/BC/OC ST Father/Mother/husband MANSING Gas NIL/-/
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATHNAV Self Male Nil MIGRATED 635527650415
ALI LABOUR/N
KEISHNA(3 il
2)
2 RATHNAV Husband Female Nil Nil/Nil
ALI
MANJULA(
8)
3 RATHNAV Wife Female Nil MIGRATED 807016147171
ALI LABOUR/N
ANJI(27) il
4 RATHNAV Sister Female Nil MIGRATED
ALI LABOUR/N
GORI(29) il
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:8.6 WET/ID:____/DRY____:
3 4 Wheeler owners NIL
4 IT Assessed NIL
5 Freedom Fighter Pensioners 0
6 Nomadic HouseHold(Y/N) NIL

Note:Combine the artificial households if any into one household and state the SKS numbers of split households:

Verification Officer Remarks:

Declaration:
It is certified that,I have personally visited the above household and Name of Benificiary Old Widow Disable Toddy Weaver
verified all the above details.I certify that the household above eligible for pensions Age d Topper
information is true and recommended one of the following:

1.Eligible for Antyodaya Food Security Card [ ] 2.Eligible for

Food Security Card [ ] 3.InEligible for Food Security Card [ ]
Name & Signature of the Verification Officer: NONE ELIGIBLE [ ]
Date of Visit:
It is certified that,after securitinizing the verification parameters with It is certified that,after securitinizing the verification parameters with
the eligibility criteria,I confirm the household as one of the following: the eligibility criteria,I confirm the following:
1.Issue for Antyodaya Food Security Card [ ] 2.Issue for Food Name of Benificiary Type of Pension
Security Card [ ] 3.Ineligible for Food Security Card [ ]
Name & Signature of the Tahsildar:
Date:
NONE ELIGIBLE [ ]

Name & Signature of the MPDO/Municipal Commissioner

Date:
 SKS Survey Number:MB0317719/000

Household Verification Format Door No:8-61/2,LATTUPALLE

District/Mandal mahabubnagar/bijinap GP lattupalle Habitation yerragunta tanda

alle
SC/ST/BC/OC ST Father/Mother/husband MANSANG Gas YES/Bharath/42546
Name Connection(Y/N)/Agen./
CNO
Family Details of Family Members
Land as 1B
S.No Name of the Relation ship Sex Register/Field Present Status of Aadhar Card Number Residing/Dea
Family with head of Verification Artisan Employment/ d/living Out
Member(age) HH Status Govt side
Pensioner
Details
1 RATHNAV Self Male Nil LARGE 254847056515
ALI MANU BUSINESS/
NAYAK(32) Nil
2 RATHNAV Wife Female Nil Nil/Nil 412618173617
ALI
ANJALI(29)
3 RATHNAV Son Male Nil Nil/Nil 440243441844
ALI RADA
KRISHNA(1
1)
4 RATHNAV Daughter Female Nil Nil/Nil 463363894523
ALI
MAVNIKA(
12)
Verification Parameters of the household to be verified

S.No Verfication Parameters Data As Per Samagra As Per Field Verfication

Kutumba Survey
1 Type of House(thatched/plastic roof/tiled/RCC) RCC
2 Total Land Holding(acres) WET/ID:0/DRY:8.6 W