Insurance Application ID :

RPG-INS-2026-0148

Megavath

First Name :

Surname :

Mothilal

Mobile Number :

9652202752

Address :

H No 6-73, Ramdas thanda, Nampally, Peddapur

pincode :

508373

Bank Account :

62260692672

Nominee Name :

Srinu

Nominee Surname :

Megavath

Nominee Relation :

Brother

Nominee Mobile Number :

9908290705

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-2026-0148

Megavath

First Name :

Surname :

Mothilal

Mobile Number :

9652202752

Address :

H No 6-73, Ramdas thanda, Nampally, Peddapur

pincode :

508373

Bank Account :

62260692672

Nominee Name :

Srinu

Nominee Surname :

Megavath

Nominee Relation :

Brother

Nominee Mobile Number :

9908290705

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

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