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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: West Godavari Mandal: PENTAPADU GP/Village: PENTAPADU

Family Head Details:

Family Head Name:AMBATI HARI BABU Caste:Kapu

Ration Card No.WAP052700200127 Family Income :

Address :D.No.3/136-1A,NH 16 PRATHIPADU,PENTAPADU,PENTAPADU,West Godavari, Pincode:534146

Student Details in the Family:

Sl Student Name Aadhaar/ Age/ College Course/

No Mobile Gender Course Year

1 AMBATI DURGA 260019071855/ 20/ M swarnandhra college of BTECH (ECE)/3

RAMA KRISHNA 9398973736 engineeringtechnology swrn a2,West

Bank Account Details of Mother (Required) *:


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: A Dhana Lakshmi, AP37DC3023, Maruti

Suzuki India Ltd

Land Holding By the Family:

in urban Area

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

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