Insurance Application ID :

RPG-INS-2026-0094

Lachaiah

First Name :

Surname :

Palamari

Mobile Number :

9701086332

Address :

Hno:2-51/2,Aithupalle,Pegadapalle,Karimnagar.

pincode :

505531

Bank Account :

62094301473

Nominee Name :

Lavanya

Nominee Surname :

Palamari

Nominee Relation :

Wife

Nominee Mobile Number :

9701086333

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-2026-0094

Lachaiah

First Name :

Surname :

Palamari

Mobile Number :

9701086332

Address :

Hno:2-51/2,Aithupalle,Pegadapalle,Karimnagar.

pincode :

505531

Bank Account :

62094301473

Nominee Name :

Lavanya

Nominee Surname :

Palamari

Nominee Relation :

Wife

Nominee Mobile Number :

9701086333

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

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