YSR Navasakam

Social audit Survey format for Fee Reimbursement

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

Village/Ward Volunteer Details :

Name Mobile No. Volunteer Code Nomenclature & Ward No

District: Krishna Mandal: Gudivada (Urban) GP/Village: Gudivada (Urban)

Family Head Details:

Family Head Name:CHAVVALA KANAKA BHUSHANAM Caste:Kapu

Ration Card No.WAP061800900535 Family Income :0

Address :D.No.18/164,ramalayam street,Gudivada (Urban),Gudivada (Urban),Krishna, Pincode:521301

Student Details in the Family:

Sl Student Name Aadhaar/ Age/ College Course/

No Mobile Gender Course Year

1 CHAVVALA 680954431857/ 20/ F usha rama college of M.Tech (VLSI & Embedded System)/2
LATHASRI 9618211885 engineeringtechnology
telaprolu(ng),Krishna

Bank Account Details of Mother (Required) *:

Mother Name:CHAVVALA NAGALAKSHMI

Mother Bank Account Number: IFSC Code:

Details For Validation:

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

Details of Details Agree/Disagree

Four Wheeler Owned by family Member:

Land Holding By the Family:

Property(Commercial/Residential)
in urban Area

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

The above mentioned details are correct and certified by me

Signature of the Student/Parent

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

Signature of the volunteer