Insurance Application ID :

RPG-INS-2026-0039

Raju

First Name :

Surname :

Mallepoola

Mobile Number :

8019585170

Address :

5-14,Manakondur mandal, Annaram,karimangar

pincode :

505469

Bank Account :

79053611161

Nominee Name :

Swapna

Nominee Surname :

Mallepoola

Nominee Relation :

Wife

Nominee Mobile Number :

9652524629

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-2026-0039

Raju

First Name :

Surname :

Mallepoola

Mobile Number :

8019585170

Address :

5-14,Manakondur mandal, Annaram,karimangar

pincode :

505469

Bank Account :

79053611161

Nominee Name :

Swapna

Nominee Surname :

Mallepoola

Nominee Relation :

Wife

Nominee Mobile Number :

9652524629

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

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