Insurance Application ID :

RPG-INS-2026-0129

Venkatrao

First Name :

Surname :

Patil Kamlakar

Mobile Number :

9030094411

Address :

At Sangvi Umar Post,Tamlur,Tq,Degloor,Sangvi Umar,Po:Tamlur,Nanded,Maharashtra

pincode :

431723

Bank Account :

030610100088704

Nominee Name :

Shila Kamlakar

Nominee Surname :

patil

Nominee Relation :

Wife

Nominee Mobile Number :

9030094411

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-2026-0129

Venkatrao

First Name :

Surname :

Patil Kamlakar

Mobile Number :

9030094411

Address :

At Sangvi Umar Post,Tamlur,Tq,Degloor,Sangvi Umar,Po:Tamlur,Nanded,Maharashtra

pincode :

431723

Bank Account :

030610100088704

Nominee Name :

Shila Kamlakar

Nominee Surname :

patil

Nominee Relation :

Wife

Nominee Mobile Number :

9030094411

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

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