Insurance Application ID :

RPG-INS-2026-0024

Padma

First Name :

Surname :

Malyala

Mobile Number :

9492195187

Address :

Hno:1-40,Village:Namiligundapalli,Mandal:Vemulawada,Dist:Rajanna Siricilla.

pincode :

505524

Bank Account :

100320021020222

Nominee Name :

Jithender

Nominee Surname :

Malyala

Nominee Relation :

Husband

Nominee Mobile Number :

9848139496

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-2026-0024

Padma

First Name :

Surname :

Malyala

Mobile Number :

9492195187

Address :

Hno:1-40,Village:Namiligundapalli,Mandal:Vemulawada,Dist:Rajanna Siricilla.

pincode :

505524

Bank Account :

100320021020222

Nominee Name :

Jithender

Nominee Surname :

Malyala

Nominee Relation :

Husband

Nominee Mobile Number :

9848139496

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

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