Insurance Application ID :

RPG-INS-2026-0034

Venkatesh

First Name :

Surname :

Guntuka

Mobile Number :

9676520904

Address :

Hno:13-77,kodimial,karimangar

pincode :

505501

Bank Account :

62363925433

Nominee Name :

Sampurna

Nominee Surname :

Guntuka

Nominee Relation :

Wife

Nominee Mobile Number :

9391501965

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-2026-0034

Venkatesh

First Name :

Surname :

Guntuka

Mobile Number :

9676520904

Address :

Hno:13-77,kodimial,karimangar

pincode :

505501

Bank Account :

62363925433

Nominee Name :

Sampurna

Nominee Surname :

Guntuka

Nominee Relation :

Wife

Nominee Mobile Number :

9391501965

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

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