Insurance Application ID :

RPG-INS-2026-0067

Sunitha

First Name :

Surname :

Mekala

Mobile Number :

7013343987

Address :

Hno:6-5-24/1 Kharkhanagadda,Karimangar.

pincode :

505001

Bank Account :

62323136105

Nominee Name :

Sindu

Nominee Surname :

Ragati

Nominee Relation :

Daughter

Nominee Mobile Number :

7995665080

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)