Insurance Application ID :

RPG-INS-2026-0154

Rajesham

First Name :

Surname :

Kodimala

Mobile Number :

9705314907

Address :

Hno:26-81 Sundharahiah Colony CCC Narspur Mancherial.

pincode :

504302

Bank Account :

50100749960648

Nominee Name :

Lavanya

Nominee Surname :

Kodimyli

Nominee Relation :

Wife

Nominee Mobile Number :

9705314907

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-2026-0154

Rajesham

First Name :

Surname :

Kodimala

Mobile Number :

9705314907

Address :

Hno:26-81 Sundharahiah Colony CCC Narspur Mancherial.

pincode :

504302

Bank Account :

50100749960648

Nominee Name :

Lavanya

Nominee Surname :

Kodimyli

Nominee Relation :

Wife

Nominee Mobile Number :

9705314907

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

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