Insurance Application ID :

RPG-INS-2026-0056

Laya

First Name :

Surname :

Bakarapu

Mobile Number :

7095386997

Address :

Hno:8-2-443 Kattarampur Near Shathavahana Apartments Karimnagar.

pincode :

505001

Bank Account :

72095118097

Nominee Name :

Ramadevi

Nominee Surname :

kota

Nominee Relation :

Mother

Nominee Mobile Number :

9848061785

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)