Insurance Application ID :

RPG-INS-2026-0097

Rajitha

First Name :

Surname :

Eluka

Mobile Number :

6304344931

Address :

Hno:2-82/53,Thallapalle,Karimnagar.

pincode :

505530

Bank Account :

030610100069073

Nominee Name :

Rishi

Nominee Surname :

Eluka

Nominee Relation :

Son

Nominee Mobile Number :

6304344931

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-2026-0097

Rajitha

First Name :

Surname :

Eluka

Mobile Number :

6304344931

Address :

Hno:2-82/53,Thallapalle,Karimnagar.

pincode :

505530

Bank Account :

030610100069073

Nominee Name :

Rishi

Nominee Surname :

Eluka

Nominee Relation :

Son

Nominee Mobile Number :

6304344931

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

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