Insurance Application ID :

RPG-INS-2026-0045

Nirmal babu

First Name :

Surname :

Madipelli

Mobile Number :

7075845103

Address :

Hno:2-7-4,New sikhwadi,karimangar

pincode :

505001

Bank Account :

200122010090610

Nominee Name :

Sunitha

Nominee Surname :

Madipelli

Nominee Relation :

Wife

Nominee Mobile Number :

7981730509

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-2026-0045

Nirmal babu

First Name :

Surname :

Madipelli

Mobile Number :

7075845103

Address :

Hno:2-7-4,New sikhwadi,karimangar

pincode :

505001

Bank Account :

200122010090610

Nominee Name :

Sunitha

Nominee Surname :

Madipelli

Nominee Relation :

Wife

Nominee Mobile Number :

7981730509

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

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