Ur d- art SDwroacdso YSR Cheyutha 2023-2024 FIELD VERIFICATION FORM Secretariat Details Secretariat Name KODUR3, Volunteer Name CHITTIPUREDDY SIVAIAH Secretariat Code 4190711 Cluster ID) 1190111014 Application Basic D ‘Application ID Name, Date of Birth Father Name/ Husband] Name '$9202330004127572714 | Application Date 15-AUG-2023 TIRUPATI ADILAKAHMI ‘Aadhaar No. YOK KHKN 274 OF May-1971 Gender FEMALE, Income Certificate No. Caste Certificate No. Eligibility Criterion Category ‘As per System Validation. ‘As per Field Verification Rs Rs. Monthly Family Income Dry land holding of family (0 Acres Acres Wet Land holding of Family 0 Acres ‘Acres: Four-Wheeler in Family NO. Yes/No ‘Any person in the Family ie Neue working in Central/State Govt/PSU/Private etc. with IfYes: income more than 12000/- a“ Name of Organization Electricity consumption 718_Units Units Urban property 0 insaft Insaft Income tax payee in family NO. Yes No. Field Verifier Details WEA/WWDS Name | RV KISHORE KUMAR REDDY Employee ID. 14849036 Time and Date Recommendation Remarks | solemnly swear that the above-mentioned particulars are true to the best of my knowledge and belief, and it conceals nothing and that no part of it is false. In case if found in future that the declaration given above is false, | am liable for prosecution. Signature of the Applicant Signature of the WEA/WWDS 23/8/2023 @ 11:19:25