Insurance Application ID :

RPG-INS-2026-0051

Rohini kumar

First Name :

Surname :

Vasamsetti

Mobile Number :

7013992888

Address :

Hno:8-360,Satyanandapuram vanapalli kothapet East Godavari,Andhra Pradesh

pincode :

533228

Bank Account :

32076025883

Nominee Name :

Sethamahalaxmi

Nominee Surname :

Vasamsetti

Nominee Relation :

Mother

Nominee Mobile Number :

7013992888

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-2026-0051

Rohini kumar

First Name :

Surname :

Vasamsetti

Mobile Number :

7013992888

Address :

Hno:8-360,Satyanandapuram vanapalli kothapet East Godavari,Andhra Pradesh

pincode :

533228

Bank Account :

32076025883

Nominee Name :

Sethamahalaxmi

Nominee Surname :

Vasamsetti

Nominee Relation :

Mother

Nominee Mobile Number :

7013992888

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

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