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Form Number: OTO062982037 State: S01 - Andhra

Form 6 - Fresh Inclusion
Form Type: Online
Form Submission date :
07/23/2022 10:18:14
District: 10 - Kadapa AC: 133-Mydukur
Pradesh
Part: 69 - VISWANADHAPURAM H/O ONIPENTA
Section No.: 1 - GANGAVARAM 1ST STREET

: VAMSI BABU KOVVURI / వం� బ�బ�

Name Gender : Male
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: PEDDA PEERAIAH KOVVURI / ��ద�

Rln Name RLN Type : Father
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DOB : 22/06/2001 Age : 20
Mobile
: +917995325105 Email Id : NA
No.
Street / Village/ : GANGAVARAM /
: 3/102 GANGAVARAM / 3/102 గంగవరం
Area Town గంగవరం

Post : VISWANATHAPURAM / �శ���థప�రం Pin Code : 516173

Office

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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
Name: _________________________________________ DOB/AGE:____________________
Corrections, if any
Gender:______
Rln Name: _____________________________________ RLN Type:_________
House No.: __________________ Street / Area:
_____________________________________________ Village/ Town: _________________
Post Office: ___________________________
District: ___________________ Pin Code: ____________________
Remarks: ______________________________________________________________________________________________

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

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