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

VANKA VENKATESH 7993734618 V05072019181832734618 CHILAMATHUR

District: Chittoor Mandal: VARADAIAHPALEM GP/Village: CHILAMATHUR

Family Head Details:

Family Head Name:GUMMA CHANDRAMOULI Caste:BC-D

Ration Card No. Family Income :0

Address :D.No.4/35A,CHOLA AGRAHARAM,CHILAMATHUR,VARADAIAHPALEM,Chittoor, Pincode:517541

Student Details in the Family:

Sl Student Name Aadhaar/ Age/ College Course/

No Mobile Gender Course Year

1 GUMMA MUNI ROSI 938204566770/ 20/ M Chadalawada Ramanamma Engineering MBA (Day)/2
7093886834 College Renigunta Road
TIRUPATI,Chittoor

Bank Account Details of Mother (Required) *:

Mother Name:GUMMA GUNA

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:

Land Holding By the Family:

Property(Commercial/Residential)
in urban Area

FOUR-WHEELER Please Family Land Holding Please

tick
Personal Vehicle still in the name of
applicant / family members.
Taxi vehicle still in the name of applicant /
family members
Vehicle was in the name of the applicant /
family member but sold to other person now
updated in the database.
Vehicle never belong to applicant and
database updated to applicant / family
members.
tick The above mentioned details are correct and
The extents of land details are correct. certified by me
The land details have been updated and
the total extent of the land is more than
10.00 Ac. Wet (or) 25 Ac. Dry or both
together 25 Ac.
The land details have been updated and
the total extent of the land is less than
10.00 Ac. Wet (or) 25 Ac. Dry or both
together 25 Ac.
Do not own any land on applicant and
family member's.

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