Insurance Application ID :

RPG-INS-2026-0084

Suresh kumar

First Name :

Surname :

Polsani

Mobile Number :

8977303038

Address :

Hno:2-34/2 Lingapur manakondur Karimnagar.

pincode :

505469

Bank Account :

100204001000236

Nominee Name :

Padmaja

Nominee Surname :

Polsani

Nominee Relation :

Wife

Nominee Mobile Number :

9941820719

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-2026-0084

Suresh kumar

First Name :

Surname :

Polsani

Mobile Number :

8977303038

Address :

Hno:2-34/2 Lingapur manakondur Karimnagar.

pincode :

505469

Bank Account :

100204001000236

Nominee Name :

Padmaja

Nominee Surname :

Polsani

Nominee Relation :

Wife

Nominee Mobile Number :

9941820719

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

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