Insurance Application ID :

RPG-INS-2026-0158

Rajitha

First Name :

Surname :

Takur

Mobile Number :

8500366167

Address :

Hno:9-7/A Shivaji Vigraham Julapalle, peddapalli.

pincode :

505525

Bank Account :

6686085662

Nominee Name :

Sangaram Singh

Nominee Surname :

Takur

Nominee Relation :

Husband

Nominee Mobile Number :

8341616167

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-2026-0158

Rajitha

First Name :

Surname :

Takur

Mobile Number :

8500366167

Address :

Hno:9-7/A Shivaji Vigraham Julapalle, peddapalli.

pincode :

505525

Bank Account :

6686085662

Nominee Name :

Sangaram Singh

Nominee Surname :

Takur

Nominee Relation :

Husband

Nominee Mobile Number :

8341616167

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

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