Insurance Application ID :

RPG-INS-2026-0015

Ravinder

First Name :

Surname :

Ganta

Mobile Number :

9550225595

Address :

H.no:4-69/23/C, Chandrapuri colony, theegalaguttapally,arepalle(rural),karminagar

pincode :

505001

Bank Account :

610002010001946

Nominee Name :

Manga

Nominee Surname :

Ganta

Nominee Relation :

Wife

Nominee Mobile Number :

9963087847

I hereby declare that the details furnished above are true and correct to the best of my knowledge. I agree to abide by the Bye-laws of RapidGrow Mutually Aided Cooperative Thrift and Credit Society Ltd. and accept the terms and conditions governing this insurance application. I authorize the Society to verify my Aadhaar and KYC details for processing this request.

Signature :
(Please sign it with BLUE INK PEN only)

Insurance Application ID :

RPG-INS-2026-0015

Ravinder

First Name :

Surname :

Ganta

Mobile Number :

9550225595

Address :

H.no:4-69/23/C, Chandrapuri colony, theegalaguttapally,arepalle(rural),karminagar

pincode :

505001

Bank Account :

610002010001946

Nominee Name :

Manga

Nominee Surname :

Ganta

Nominee Relation :

Wife

Nominee Mobile Number :

9963087847

Signature : (Please sign it with BLUE INK PEN only)

Signature :
(Please sign it with BLUE INK PEN only)