Insurance Application ID :

RPG-INS-2026-0059

Prakash

First Name :

Surname :

Gugulavath

Mobile Number :

9346409307

Address :

Hno:2-80/5 Gorrepalle,Mallapur,Karimnagar.

pincode :

505331

Bank Account :

42980587872

Nominee Name :

Rajesh

Nominee Surname :

Gugulavath

Nominee Relation :

Brother

Nominee Mobile Number :

9100711597

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-2026-0059

Prakash

First Name :

Surname :

Gugulavath

Mobile Number :

9346409307

Address :

Hno:2-80/5 Gorrepalle,Mallapur,Karimnagar.

pincode :

505331

Bank Account :

42980587872

Nominee Name :

Rajesh

Nominee Surname :

Gugulavath

Nominee Relation :

Brother

Nominee Mobile Number :

9100711597

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

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