Your Complete Name (As mentioned on PAN card)

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Complete Permanent Address with Pin code

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Applicant Telephone/Mobile No
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Personal Mail ID
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OFFICE LANDLINE NO

Office Address with Pin code

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Reference 1 (Relative)
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Reference Complete Address with pin code

Reference 2 (Relative)
Reference Name
Reference Contact Number

Reference Complete Address with pin code

Bhupathiraju Pardhasaradhi Raju
AJWPR6771Q
Bhupathiraju Vakata Pallala Raju
Bhupathiraju Kumari
70-17/A31/2, Plot No 138, 4th Floor, Near V S Lakshmi College,
Shashikanth Nagar, Kakinada East Godavari, Andhra Pradesh
533003
Near V S Lakshmi College
Rented
70-17/A31/2, Plot No 138, 4th Floor, Near V S Lakshmi College,
Shashikanth Nagar, Kakinada East Godavari, Andhra Pradesh
533003
70-17/A31/2, Plot No 138, 4th Floor, Near V S Lakshmi College,
Shashikanth Nagar, Kakinada East Godavari, Andhra Pradesh
533003
9866556687
9866556687
bhpsraju@gmail.com
bhpsraju@ksplmail.com
0884 6601111
Kakinada Seaports Limited, 2nd Floor, Port Administrative
Building, Beach Road, Kakinada, East Godavari, Andhra Pradesh
533007.
Near Kumbhabhikshekam Temple
B.Tech
Married
Axis Bank
76010100163392
4/10/2006
4 years
20 years
2000000
96

Cousin Brother
A Ajay
8919012608
70-17A-5C Flat No - 55, Sasikanth Nagar, Kakinada, East Godavari,
Andhra Pradesh 533005

Brother
M Srihari
9100250099

69-6a-20, Chaitanya Nagar, Near Navabarat School, Back Side,

Gaigolpadu, Kakinada, East Godavari, Andhra Pradesh 533005.