Insurance Application ID :

RPG-INS-2026-0022

Ravindhar

First Name :

Surname :

Madari

Mobile Number :

7396613435

Address :

Hno:6-6-825 shivaji nagar, karimnagar.

pincode :

505001

Bank Account :

073610100044922

Nominee Name :

Niraja rani

Nominee Surname :

Madari

Nominee Relation :

Wife

Nominee Mobile Number :

7993957994

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-2026-0022

Ravindhar

First Name :

Surname :

Madari

Mobile Number :

7396613435

Address :

Hno:6-6-825 shivaji nagar, karimnagar.

pincode :

505001

Bank Account :

073610100044922

Nominee Name :

Niraja rani

Nominee Surname :

Madari

Nominee Relation :

Wife

Nominee Mobile Number :

7993957994

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

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