Insurance Application ID :

RPG-INS-2026-0040

Maneesh

First Name :

Surname :

Sangoju

Mobile Number :

9010050495

Address :

2-10-1350, Jyothinagar, Karimnagar, Telangana 505001, India

pincode :

505001

Bank Account :

20094363931

Nominee Name :

Mounika

Nominee Surname :

Mugala

Nominee Relation :

Wife

Nominee Mobile Number :

7013304654

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)