Form Number: BWM461711351 State: S01 - Andhra Pradesh District: 22 - Sri Sathya Sai AC: 158-Penukonda

Form 6 - Fresh Inclusion Part: 16 - PEDDA KODI PALLY

Form Type: Online Section No.: 3 - MAIN ROAD, PEDDA KODI PALLI.
Form Submission date : 12/04/2022  
11:49:21

Name : BOYA RAKESH BOYA / బొయ రాకేశ్ బొయ Gender : Male

Rln Name : B RAAMANJINAMMA / బీ రామంజినమ్మ RLN Type : Mother
DOB : 15/08/2000 Age : 22
Mobile No. : +916305712208 Email Id : NA
Street / Area : 2/43 pedda kodi palli / 2/43 పెద్ద కొడి పల్లి Village/ Town : pedda kodi palli / పెద్ద కొడి పల్లి
Post Office : roddam / రొడ్డం Pin Code : 515123

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Checklist for BLO Designated Officer

Field Verification Address   DOB/AGE   Photo as per Specification   [Y/N]
If age is greater than 21, has applicant given declaration     [Y/N]
On field visit Applicant is found Absent Shifted Dead No Such Person
No of Application already applied
BLO Comments   Applicant Details are Verified & Correct                       Data entry errors, if any   
Corrections, if any Name: _________________________________________ DOB/AGE:____________________ Gender:______
  Rln Name: _____________________________________ RLN Type:_________
House No.: __________________ Street / Area: _____________________________________________ Village/ Town:
 
_________________
  Post Office: ___________________________
  District: ___________________ Pin Code: ____________________
Remarks: ______________________________________________________________________________________________

Date: ____________________    
Place: ____________________ _________________   _________________
  Applicant's Signature  BLO Signature