Insurance Application ID :

RPG-INS-2026-0076

Yelender

First Name :

Surname :

Samala

Mobile Number :

8978221520

Address :

Hno:2-16 Kothur Karimangar.

pincode :

505525

Bank Account :

100204001000259

Nominee Name :

Manjula

Nominee Surname :

Samala

Nominee Relation :

wife

Nominee Mobile Number :

8978221520

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-2026-0076

Yelender

First Name :

Surname :

Samala

Mobile Number :

8978221520

Address :

Hno:2-16 Kothur Karimangar.

pincode :

505525

Bank Account :

100204001000259

Nominee Name :

Manjula

Nominee Surname :

Samala

Nominee Relation :

wife

Nominee Mobile Number :

8978221520

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

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