Insurance Application ID :

RPG-INS-2026-0057

Ramulu

First Name :

Surname :

Gotte

Mobile Number :

7842135565

Address :

Hno:4-48,Kasulaqpalli,Peddapalli,Karimnagar.

pincode :

505187

Bank Account :

044810100153354

Nominee Name :

Narsamma

Nominee Surname :

Gotte

Nominee Relation :

Wife

Nominee Mobile Number :

7207329981

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-2026-0057

Ramulu

First Name :

Surname :

Gotte

Mobile Number :

7842135565

Address :

Hno:4-48,Kasulaqpalli,Peddapalli,Karimnagar.

pincode :

505187

Bank Account :

044810100153354

Nominee Name :

Narsamma

Nominee Surname :

Gotte

Nominee Relation :

Wife

Nominee Mobile Number :

7207329981

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

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