Insurance Application ID :

RPG-INS-2026-0053

Sivaji

First Name :

Surname :

Anagalla

Mobile Number :

9346540375

Address :

Hno:6-20,Dhanekulavari street Yanamalaludurulakulu Vijayawada Andhra pradesh

pincode :

520007

Bank Account :

33552210032205

Nominee Name :

Bhagya lakshmi

Nominee Surname :

Anagali

Nominee Relation :

Wife

Nominee Mobile Number :

9346540375

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-2026-0053

Sivaji

First Name :

Surname :

Anagalla

Mobile Number :

9346540375

Address :

Hno:6-20,Dhanekulavari street Yanamalaludurulakulu Vijayawada Andhra pradesh

pincode :

520007

Bank Account :

33552210032205

Nominee Name :

Bhagya lakshmi

Nominee Surname :

Anagali

Nominee Relation :

Wife

Nominee Mobile Number :

9346540375

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

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