Insurance Application ID :

RPG-INS-2026-0072

Rajaiah

First Name :

Surname :

Astapuram

Mobile Number :

9440842974

Address :

Hno:3-67/1 Rekurthi Karimnagar.

pincode :

505451

Bank Account :

100204001000213

Nominee Name :

Rajeshwari

Nominee Surname :

Astapuram

Nominee Relation :

Wife

Nominee Mobile Number :

9866033878

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-2026-0072

Rajaiah

First Name :

Surname :

Astapuram

Mobile Number :

9440842974

Address :

Hno:3-67/1 Rekurthi Karimnagar.

pincode :

505451

Bank Account :

100204001000213

Nominee Name :

Rajeshwari

Nominee Surname :

Astapuram

Nominee Relation :

Wife

Nominee Mobile Number :

9866033878

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

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