Insurance Application ID :

RPG-INS-2026-0119

Venkatesh

First Name :

Surname :

Medida

Mobile Number :

9553322000

Address :

Hno:7-91/4,Ushannapally,Gangaram,Karimnagar.

pincode :

505153

Bank Account :

0333324000000462

Nominee Name :

Sunitha

Nominee Surname :

Medida

Nominee Relation :

Wife

Nominee Mobile Number :

0

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-2026-0119

Venkatesh

First Name :

Surname :

Medida

Mobile Number :

9553322000

Address :

Hno:7-91/4,Ushannapally,Gangaram,Karimnagar.

pincode :

505153

Bank Account :

0333324000000462

Nominee Name :

Sunitha

Nominee Surname :

Medida

Nominee Relation :

Wife

Nominee Mobile Number :

0

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

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