Insurance Application ID :

RPG-INS-2026-0058

Harish

First Name :

Surname :

Ramagiri

Mobile Number :

8790234089

Address :

Hno:3-47 Manakondur,Annaram,Karimnagar.

pincode :

505469

Bank Account :

40083628134

Nominee Name :

Supriya

Nominee Surname :

Ramagiri

Nominee Relation :

Wife

Nominee Mobile Number :

8790454029

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-2026-0058

Harish

First Name :

Surname :

Ramagiri

Mobile Number :

8790234089

Address :

Hno:3-47 Manakondur,Annaram,Karimnagar.

pincode :

505469

Bank Account :

40083628134

Nominee Name :

Supriya

Nominee Surname :

Ramagiri

Nominee Relation :

Wife

Nominee Mobile Number :

8790454029

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

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