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    Subscriber Registration Form-APy

    Uploaded by

    Rajesh Punia
    Atal Pension Yogna Form

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Subscriber Registration Form-APy

    Uploaded by

    Rajesh Punia
    82 views1 page
    Atal Pension Yogna Form

    Original Title

    Subscriber Registration Form-APy[1]

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

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    Atal Pension Yogna Form

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    82 views1 page

    Subscriber Registration Form-APy

    Uploaded by

    Rajesh Punia
    Atal Pension Yogna Form

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    ATAL PENSION YOJANA (APY) -SUBSCRIBER REGISTRATION FORM

    (Administered by Pension Fund Regulatory and Development Authority)


    To,
    The Branch Manager, _______________________________________________________ Bank_______________________________ Branch
    Dear Sir/Madam,
    I hereby request that an APY account be opened in my name under National Pension System (NPS) as per the particulars given below:

    * Indicates mandatory fields. Please fill the form in English and BLOCK letters
    1. BANK DETAILS:
    Bank A/c Number*
    Bank Name*

    Bank Branch*

    2. PERSONAL DETAILS:

    Name of Applicant

    Shri

    Smt.

    Kumari

    Full Name
    d

    Date of Birth*

    m m

    Age

    Mobile No

    Email ID

    Aadhaar

    Married

    Yes

    If married , spouse name is mandatory

    No

    Name of Spouse

    Aadhaar

    Nominees Name*

    Aadhaar

    Nominees relationship with the subscriber


    Additional Details in case nominee is a Minor
    Date of Birth*

    m m

    Guardians Name*
    Whether beneficiary of other statutory social security schemes

    Yes

    No

    Whether Income Tax Payer

    Yes

    No

    3. PENSION DETAILS
    Pension Amount (Please tick()) *

    1000

    2000

    3000

    4000

    5000

    I hereby authorize the bank to debit my above mentioned bank account till the age of 60 for making
    payment under APY as applicable based on my age and the Pension Amount selected by me. If
    the transaction is delayed or not effected at all for insufficient balance, I would not hold the bank
    responsible. I also undertake to deposit the additional amount together with penalty thereon.

    Contribution Amount (Monthly )


    (in Rs.)
    (To be filled by the Bank)
    Declaration & Authorization by all subscribers

    I meet the prescribed eligibility criteria for assistance under APY and I have read and understood the terms and conditions of the Scheme. I hereby agree to the same and
    declare that the information furnished by me is true and correct, to the best of my knowledge and belief. I undertake to immediately inform the bank of any change in the above
    information furnished by me. Further, I do not hold any pre-existing account under NPS. I understand that I shall be fully liable for submission of any false or incorrect information
    or documents. I have read/been explained and have understood the APY guidelines. I further agree to be bound by the terms and conditions of provision of services under the
    scheme as approved by PFRDA/Govt. of India.

    Date

    m m

    Place

    Signature/Thumb Impression* of Subscriber


    (* LTI in case of male and RTI in case of female)

    ACKNOWLEDGEMENT - SUBSCRIBER REGISTRATION FOR ATAL PENSION YOJANA (APY)


    (To be filled by the Bank)
    Name of the Subscriber:
    PRAN Number
    Guaranteed Pension Amount

    Periodicity of Contribution

    Monthly

    Monthly Contribution Amount under APY


    (in Rs.)
    Name of the Bank:
    Bank Branch:
    Receiving Officers Name:
    Date of Receipt of Application:

    Stamp and Signature of the Bank

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