Insurance Application ID :

RPG-INS-2026-0116

Swapna

First Name :

Surname :

Sanga

Mobile Number :

8099348727

Address :

Hno:1-2-20,Thurpuwada,mallial,Jagital

pincode :

505452

Bank Account :

105720021004984

Nominee Name :

Gangaram

Nominee Surname :

Sanga

Nominee Relation :

Husband

Nominee Mobile Number :

8099348727

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-2026-0116

Swapna

First Name :

Surname :

Sanga

Mobile Number :

8099348727

Address :

Hno:1-2-20,Thurpuwada,mallial,Jagital

pincode :

505452

Bank Account :

105720021004984

Nominee Name :

Gangaram

Nominee Surname :

Sanga

Nominee Relation :

Husband

Nominee Mobile Number :

8099348727

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

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