t.

rqf{q {eTT +qr qPrrt F-{iTfi

Principal Conroller of Defence Accounts
{'. roz, dq< 3ru-c +s, qrc +€, itr-{r - s6o 007
No.107, Lower Agram Road, Agram Post, Bangalore-S5o 007
No: ANPAY/llGen Corr Datedi 22lul2ol9

To

The Officer-ln-Charge,
EDP Section,
LOCAL.

SUB: Uoloadinq of forms and apolications to PCDA Banealore website-regardine

*i ***** * ** **
'1. 'l '|.{.

It is requested to upload the following forms, applications and formats related to AN

PAY I section to the website of PCDA Bangalore for the easy access to the officers and staff
of the main office and all sub offices:

1.) CEA form, certificate from school and self declaration form

2.) GPF Final Withdrawal and Ty Advance Form alongwith contingent bill and five year
statement

3.) GPF final settlement forms along\ /ith checklist of documents to be submitted

4.) CGEIS application format

5.) HRA certificate

5.) Various forms related to NPS

Encl: As above

q"

\*
SAO (ANPAY)

Gen Corr cmail: [email protected] Page 1

frt/Phone: o8o-297 Lo47 4/5 fr-fr/Fax: o8o-297 ro]3.z/ 3

 troRM-2
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' Od(}ovt totcoldd. .t/e l{o.:
 Authority vide Government of lndia

Ministry of Personnel, P.G. and pensions Department of personnel & Training New Delhi

Order No. N..A-27OtZlO2l2O17-Estt.(At) t6 August, 2017.

(This order shall be effective from tst J uly,20.t7l

CERTIF ICATE FROM E HEAD OF I STITUTION/S cHoot

(FOR REIMBURSEMENT OF CEA)

Ref.No

D ate:-

It is certified that master/Kumari having, Admission No

.... D.O.B ............... .. Son/Dauther of Mr/Mrs

was studying in class 5ec

........,..... Roll No during the previous academic year from

to School/institution, namely

........... vide affiliation Regd. No./Code

..,.. and Pattern,..... Curriculum

PIace:-

Date:-

Signature of Principal

(Affix School Stamp)

 SELF DECLARATION

I
do hereby certify that my Son / Daughter namely
Studied in Class _ Sec Roll No. during
Previous Academic Year in

School.

In the event of any change in the particulars given above which affect my eligibility for
children Education Allowance. I undertake to intimate the same promptly and refund
excess payment, if any made to me,

Signature of Govt Servant

Name:

Desgn:
Acc. No.

Place:

Date:
 APPLICATION FOR FINAL WITHDRAWAL FROM G.P.FTJND
l. Name of the subscriber

2, (r) Account No.

(b) GPF Account NO.

3. Designation
4. Basic Pay

5. (a) Date of birth

(b) Date of appointment
( c) Date of Superannuation

6. Balance of Credit of the Subscriber on

The date of application
Details
Balance as per GPF A./c for the year
ADD: Contribution during the period
Subscription @ Rs. From to

Subscription @ Rs. From to

Subscription@Rs. From to

Subscription@Rs. From to

Total
LESS: Withdrawals for financing Insurance policy
Or other purpose durng the period

NETBALANCE :

7. Amount of final withdrawal required (Contingent Bill

To be attached)

8. (a) Purpse for which the final withdrawal is required

(b) Date fired for the function (wherever necessary)
(c ) Certificate of dependency to be separately
Attached (wherever necessarY)
(d) Rule under which request is covered
9. Whether any withdrawal was taken for same purpose
Earlier, if so, indicate the amount & yerr
10. Name of the Accounts Officer maintaining the Provident
Fund Accounts

Date : Signature

Scanned by CamScanner
 l. Nrreofthcsuhcriber

2. Grrdc & A/c No.

3 Pey(BuicPay)

a. Dac of Apoimt I Srrymanraitn

5. nalrace t crcdit of th crbscrib€r oo &a of applicaim rs bolorf,

i. Cbsigg brbocc as pc CC09 tuthc par

ii. (a) &rbscri*ftE@Rs.

Frm to

(b) Subaoiption @Rr.

Frsm to

ifi. (a)nefirnd @Rs.

From to

(b)&tud@ns.
Fum b
(c)nctund@Rs.

From to

iY: WitHrtx'd efng thc paiod

v. Nctbeluoedcrdlit

6. Amorm of,rdrram(s) trteo & belanBe '

Ot*uulingaso dat€
7. Anhmtofdvrmcrequirod
& (r) prpo* fwrtiah utnarcois 4{uirEd
(b) nrloo uadcr $hich 6c rcquost iE covu€d.

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 (ci Ifdvuce ii urgh for bor* buildiry cc..
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n"me ofttc mciety tb bcatioa on aod nGanrrE@€trls €tc.,
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clc., tb bcOim dimcnrioo 6s., ruay bc gitpo'
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t. Namc oftf,o sm\da{fuer
It. ctas & Irsianion t coUrgeficrc snqits
[t. Wtetlxr e day rtdrr\ todlor.
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iftaing frmily aemberq
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reqnfood.

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of uod incrllmr i! vtth tb ffiotiddcd dva&o ir
propomd obc npoiL I!- in*dlmr
10. ftll partiarlar dthc poodiry cirsrmeus oftb nlbsttcr
ju@iog thc ryplicdiotr forthc rdvame.

I csti&fu prtiorhru givcn rbowrrcoonoc md corylcteothebccof rytnoc,bdgc

d bdiGf, ud ilry odirry hu ba oomlcd by no.
S&im: nmgUore

Edt SIG.IAN.IRB OF TIIE ATI.IOTNT

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 rN Lrzu oF rAFA- 115 (s^,tALL)
Voucher ltr; -

CONfIN6€NT BII.T
Amount of ollotmeht Rs

Anount expended ond for which bills hore been submitted for poy[r€r I

Bohnce of slbtnent excluding the dnount of this bill Rs

Expenditure on occount of by
during-
Authority: dated

(i) ilonihtyoccount in which hst chorge on this occount wos prelureA

SlNo Dote Detoils of Experdifure NO Rate Per Amount

RS PS Rs Ps
I

Total NIL
Deduct advance received

Net omount due (in words Rupecs

o) Certified ihot ihe obove charges hove been necessorily incurred ih the anierert of lhe stote ond thqt the rqtes
clvrEed ore lhe lowest obtainable drd thot oll receipts for sums of Rs25 ond under e(cept ds regqrds pqyne-nt
r6de in the l,l.E.S to cortroctors on f\running occounts have been so defocd, or mltihted ihot they co.not be
used ogdin ond thof I hore personolly che*ed, tlrp- progressive totol in the bill with rhdr ih the contirgert
regista'ed ord fo.rnd it lo altee.
b) Certified thdt the telegrom $ros sent on Stote Service ond thct cash poyment sros umrroidoble.
c) Certified that pqyment of subsistence dllosronce was in the inlerest of service ond thdt the rejecied re.ruats for
whorr the ollowonce hos been chined were rejected either nedicolly or by enrolling officers.

Mter - "Under Rs......... should be written ocross the bill in red ink in o proninent ploce neor lo ond obove the toiolqnount of
the bill. The onount should be the next Multiple of lF@ rpep exceeding the omount of the bill.

Statioi: Bor€olor. Receiwd Paytncnf

Countersigned
Dote:
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 APPLICATION TOR FINAL WITHDRAWAL FROM G.P.FUND
1. Name of the subscriber

2, (a) Account No.

(b) GPF Account NO.

3. Designation
4. Basic Pay

5. (a) Date of birth

(b) Date of appointmcnt
( c) Date ofSuperannuation

6. Balance of Credit of the Subscribcr on

The date of application
Details
Balsnce as per GPF A/c for the year
ADD: Contribution during the period
Subscription @ Rs. From to

Subscription @ Rs. From to

Subscription@Rs. From to

Subscription@Rs. From to

Total
LESS: Withdrewals for linancing Insurance policy
0r other purpose durng the period
NETBALANCE :

7. Amount of linal withdrawel required (Contingent Bill

To be attached)

required
8. (a) Purpse for which the final withdrawal is :
necessary)
(b) Date fixed for the function (wherever :
(c ) Certilicate ofdependercy to bc separately
Attaehed (wherever necossary)
(d) Rule underwhieh rcquest is covered :
9. Whethor any withdrawal wrs taken for same purpose
year
Earlier, if so, indicate the amount & i
10. Name of the Accounts Officer maintaining the Provident
Fund Aecounts .

Date: Signature

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 IN LIEU OF IAFA- 115 (SIIALL)
Voucher l.lo: -

CONTINGENT BILL
,Ah^'mi.f
^ll6+n, nt Rc

Anount expended and for which bills hor,e been submilted for pcyment__=-_Rs_
gohnce of ollormeni excluding the omounl of this bill Rs

Expenditurc, on occourt of by
duritg-
Authority: doted

(i) llonfhty occount in uhich hst chorge on this occount ms pref rd

SlNo Dote Dctoils of Expcnditure NO Rate Per Amount

RS PS Rs Ps
1

Total NIL
Deduct odwnce recciwd

l.Lt arnowrt due (in wolds Rupecs

o) Certified thct the obove chorges hove been necessorily incr.nred in the interest of the State dnd thdt the rctes
ctwged u'e the lorest obtoiBblc ond thot oll rcceipts for sums of Rs25 ord under ?-xcept 05 regsris poyment
mode in the fl.E-S fo conlroclors oh f\running occounts hove been so ddaced or mutihted thdt they connof be
used og6in ond thot f hove personolly cheeked fhe progressive totol in the bill with that ih the contingen+
registered ond found it to dgree.
b) C€rtifie! th6t thg fglegrom sirds sent on Stote Service ond thot cosh poynent uos umvoidoble.
c) Certified that paymenl of subsislence olhwdnce wos in the interest of se.vice ond thot ihe rejecled recruiis for
whom the ollorvance has b"2n chirEd wers rejected either nedicolly or by enrolling officers.

Mte: -'Under Rs......... should be written o.ross the bill in red ink in o prominenl phce neor to ond obow the totolonounl of
the bill. The onou|lt should be the next itulliple of tlp tq@ exceeding the onrount of ihe bill.

Station : Bdngolor.€ Received Poyrrnt

Countersigned
Date:
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 y> D€

' I! reefi-aLjsir-Bt
izsloth,l. 6o4' qf bolonsz'r
bcd
for flnol PoYn'i*'it'o#?r to
Eot?omt?
Fonn.sf oPFllcotion
h th? Eemrol Prceldr'nr Fwra '

to
rha X.6.D.A. fufJDs)
D.A.D. Wittg,
IAffit/T CANTT.

3lF.

.}o
tlove bc:.rr pcrmcncntly tronrferrcd
,nonlhs / hive becn dischcaed/ di$itsdl
finolf from 6o"i sertricel hove resignEd 5et.vic6-
huve rcsiqned
-
and ny resignqlion
6ovt. to toka uP sPPoirtmenl with
'm' ' forenunlafteYnon f Jolned sarri lca
har been occepted rit'n effecr frot
- on
wit{'t foranoan/oftarnoon

?, ,.My Providcnl fr,rrd otsount ne' i"

'
3, i dalroio racclv. pqimcfit ihtsugh liry otffce -
----------=
(Inpnession in the
oorticulcs t rtv Dersomlnarks oi idontificqtion; left h;d
thmb and fingers
of liferate subscriberx) in
ta.e:oi llllteFote subscribers did sPpcirfleh sig'mturc in the cdse
'
duplicata dulY atte3lzd bY 6 9oz* tlrd offlcEn
of iha govcr^nrtet* amtnclased'
PTRT-I
inol f6
tetlr€mentl

dnding io the credit in mY EFF

4. I rcgue't th{t thc olount sf
nccount !s liiE;ed in llie occolnts ttoicrlant issued lo mt for lhe ycc"-'-------- (anclosed) /
os oppgorirg in rny tedger ociount belng molnlained
by you (*nclored)/ os oppearing in.rny ledger

ociounl beirg rnoiatcind 4 : - -: : . . rnoy pleose be orrorged to

b€Daidfore€firstirlJtgtlmanioffinolP{yrncn,through,thchcadcfi,lre..officc.

5. Tht under mej"tioncd itfe insroncc policilc ucr^e beiii fincnrced hy rne frorl rsy provlCelrt

fund occounl.
Pbllcv hE. Nir E ot rHE comPAr.rY SUII A5ST,,RED

-4.

a
6. Altcr paync,ri 9f th., firsl 'instollmrn t ol 6?F bolcrrc lll aupply fo" the poymanl of
rT

3,$s€{lEnt inttqllm(r*d in Pqrt'I of the fort immedictcly on retirzmcnt'

PART . II
request that the eniira bolonie ot my credi+
with
For thc finol poyrrcm of P.f baloncz, I
intetest dua mder lhc rulcs rnoy.paid to me.

OR

I reguesr thct lhc cntire anourt.at my crodit l'rith intcragt. duc rfider tha rulec may bc

pord io nelirdsferred ___. _

- Signature I
'
Itiane 'l

. Addrass i

(TOR UsE !V HEADS OT 9FETE)

Forworded to the CDA . fon ncaessry acllonl io

corfinuation of endor.scmenl nc. dqled *

2, Hel Shc hqs finolty retired/*lli proeeed o lervs pr€paistory to ieflremenf for
--=
nonths hes beell disdrorged/ disrrise:d, he hos been perrronently/ transfered lo.-__.-=-
under' 6ovt, to toke up eppoiniment with
onC hic^l Er resigndtion hag been nccepted !9ith effect
a--- rr
ortnoor,/of iarnmn. He Joined servica with

on--_-*--..-,_-- -:__F,orcn66n/df?eF oon

3. The lait fi.u;d dedr.stior *a: nrode fro6 hls/}er poy in thts officr pcy bill no.
. oored-fon Rs. - oniy dishrs€,rraht cobh vu:chen
of . The anraunt of dcduction bcing _
ono racovef), on ac.ount of rcfr-urd bf adva,rce is

Certified rhd helshc sas neither .*rctiorcd ony tcmporor.l dvat*e or ory Fincl
xithdr.onqi fr.orrr hig/hen proviciart
furds acc6ut dur.ing lhe lZ month imnadiataly proceeriing the
'dota
of his/hcr guitting scr.rica rnrdcr
Go*. /?r*edirg ,hp
leove
Prcp6olory r.liftficnt or thcrcofter.
! ?\f

vrithdmulol sanctionEd to
Certified thqt tlre following ''cmpomry/final
occouni during the 12 months
hirn/her ond dmun from his/hcr provident fund
, proceeding on leaYe
irnmediately prcccding tlrE dote of

pr€porotoly tc refirement or thereofter'

Dotc Vouo her Nc.

A of odvoncc/withdr-.r"rol

St6tion:
Do",e ' SI6NATURE Of THE HEAD OF THE OFFICE

{FOR UsE Bv HEAD oF oFFTCE'!

qctron'
to iire iiOe (Funds) through CDA for necessary
Forwqrcie€i

, The pruvident fund account ilo

verified from thc stctement furnished
to him/lrer from

of
tokcn the following advqnces in resPect
Certified thst he/she hqd
to
instalments--is yet to be rteco'verEd and crcdited
"uh gronted to him/her org olso
occcuni' The Cetails o f th+ finsl wi*drovrals
the fund
indi,:ded belo!',,i
Finol withdmwols
TemDoi'on- odv'once
I
2
t
-l
 3, Certified thot the following amountj rlrerc withdmwn fron hisher
or:;lwr. .
lo flmnce ltfe tnsurcrce
Poltry,

1.

e.
)
4.

Helshe is due to rctire from servioe on---_

FORM - B

(Intimoting the discontinuation of I

subscription 6win9 to resigndfion/ratirenrent I
from servlce)

illonth in which discontiruied

Norne of the subscriber
Rork

-bept"zCffice DEFENCE AcCOUNTS DEPART'AENT

$r, '*
o/o Tt{E CDA.

A6RA,Ti POST,

BANgALORE - 560 OO7.

6PF A/c No.

Couse of discontinuqtton

SR.ACCOUNTS oFEicER (AN/PAy)

 From the ind ivid ua I No of Co pies
1lndividual's application 2

2 Fina I withdrawal a p plicatio n 2

3 Contingent bill 2

4 Five years Withdrawal statem ent 2

5 Form-GPF-10 (AB) 2

6 CCO-9 in original and l Xerox copy

7 Copy of First Page of Passbook
or 2

Cancelled Cheque
8 Specimen signatu re (Attested ) 2

9 Copy of ldentity Card 2

l0lPart-ll order notifying retirement 2

.,tom:

To

The P.C.D.A.
AN/PAY/I Section,
BANGALORE: 560 007.

Sub: APPLICATION FOR PAYMEM OF ACCUMUI,ATION UNDER

CENTRAL GOVERNMENT EMPI'YEES GROUP INSURANCE
scHEME, 1990.

Sir,

I have been a member of the Central Govemment Employees Group Insurance

Scheme, 1980, since Of/Of/1990. I have retiled from service on 'I
ceaseto be in employrneot with the Central Govemment w'e'f 'I was

holding the post of .-..-.-.... ....""""'before retirement /ceesation of

to me
eEployment with t]le Central GovernEent. I request that the amount due
may be paid to
under t]..e Central Govemment Eaployce's Group Insurance Scheme/
me. S.B. Account No.: ..'.'...... ..... Bank""-"""""'
Branch: ..IFSC Code:

Thanking You

Yours faitifullY,

Place

Date
 HRA CERTIFICATE
ANNEXURE-II
Un substitutio' of the certificates prescrib€d in Annexure-Il-A and II-a of the Mirisrry of Finance,
o.M.No.F.2 (37)-€. [(B)/b a, alated 2z-77-6sl

Certificate to be furnished by all Central Government Servants

(1) I certify that I (have applied for the Government accommodation in accordance
with the prescribed procedure but) have not been provided with Government
accommodationr/ (have refused the allotment of Government accommodation)
during the period in respect of which the allowance is claimed.

(2) I certify that I am residing in a house hired/owned by me/my wife/ husband/

son/ daughter / f ather / mother/ a Hindu family in whicrr l am a-coparcener.

(3) I certify that I am lncurrln sonlc ex enditure on rent

Contributing towards rent.
Or
I certify that the rent value of the house owned by me/owned by a Hindu
undivided family in which I am a coparcener and in which I am iesiding is
ascertainable in the manner specified in para. 7 of o.M. No. F. 2(32) - E.n
@)164,
dt.27 -71,-65 - I certify that I am paying/ contributing towards house
or property tax.

(4) I certify that I am not sharing accommodation allotted to my parent(child) by the

State/Central Government, an autonomous public ,.i". tukir-rg or semi-
Government organisation such as municipality, port trust, etc., allotted rent- free to
another Government servant.

(5) I certify that my husband/ wife/ children/ parents who is/are sharing
accommodation with me allotted to another employee of the central/ state
covernment/ autonomous public undertakings or semi'-Government organization
like municipality, port trust, etc., is f are not in receipt of house rent -a owance
from the Central/ state Government/autonomo* prtli. undertakings or semi-
government organizations like municipality, port trust, etc.

(6) I also certify that mv wife/ husband have not been allotted accommodation at the
same station by the Central/ state Government/ autonomous public under
takings
or semi-Covernment organizations such as municipality, port tiust, etc_

Present Residential / Rental Address

Signature:
Name:
Designation:
A/C No:
Dated :
Present Office :
 CSRT'
NATTONAL PENSTON SYSTEM (NPS) - SUBSCRTBER REGISTRATTON FORM
Central Recordkeeping Agency (CRA) - NSDL e-Govemance lnfrastructure Limited

t-l
PleaBe selec-t yorfi category
I Please tlck(,1 I
To.
Central Govt,
All Citl2en Model fl
State Govt,
CorpaEte Sec{qr n NPS Lite (GOS) t._l
3.5 cm r 2.5 Em sire /
National Pension SFlem Trust-
D€r Si.Aiadam,
rn NPS account b€ @ened in my name ss per the paniculars given beloyr
I h€rehy requesl that

'indicatEs mandato.y fleld* Please fll the fGtm in English ahd BLOCK Hters wih bhd( ink pen. (Rda ss6rd ad.din6 at imtldjes pa6e)
KYC Number, Retirement Arlviser Code and Spouse Name lields are nd applic.bl€ fo. Covcmm€nt & NPS Lite Su&crib€.s
KYC Number {if applicable) Gereretsd rrorn Cenlral l(vc Regisry
Retirement Adviser Code ([ applicable)

l. PERSOIIAL OErAlLSi (P{€a6B !'l€.ld Sr. No.l .(1h6 lrEtudtons)

Name ofApdicant in tu Shn if smt- [ Kumari I
First Name'
Middle Name
Last Name
SubscribGr's Maiden Nane (if any)
Fathe/s Namet
Err.. Sr. No. 1 olrdudo.E)
Mother's Name'
E&&tao.,oftsnlldois)
Faha/s hame will b€ p,imed orl PRAN card. ln ces€, mdle.'s name to be plilrhd instesd d hther's name I Ple6€ fck (r') I []
Date of Birth, I I (Date of Binh should be supponed by relcvant doo.rrnentary pmoo

City ol Birtr-
C@ntry of Birth'
Gchdef {Pleesetick (r')l Mab I Fomale n otners f] Nationality' ln-lndian L
Maritat Status. Manied [--] unmanied f_l Ohers n
Spouse Name'
(Rder S.. No. 1 oI ittudion6)
Residential Status' lndian

2, PROOF OF IDENTITY (Polf (Arv one ol t1e dmtntenlE need to b€ p.ovided aloog ait! $e idenfiicati<n numb€r)
Passport Passport E)Qiry Date
Voter,D Card PAN Card
Driving License Driving License Expiry Date
NREGA JOB Cad
Ohe.s Name of the lD Fl6ase €ler S. No 2 ol lho insvd clions

ulD (Aacihaao
T
I Lhdercland that tlrc

amendnenls made undar Pravsnlbn of Money'Lauhdenng (Maintanancn ol Rercr.ds) Sacond Anen dm6nt Rt//es, 2017 Aadhaar and PAN are mandaw under
do nol \aw Aadhaat and / ot PAN st pteseni Pta.sP suta that thhse deta s an pmvded h:n ex monrhs of srhission of lhis Subs..ibel Rsg/srrat on Fonn.

3. PROOF OF AITORESS (PoA)' CorrBslondsnce Addrtsa PeFranent Addrcas

Passpon rDflrnq uc€rEriJlD (,Aadb )Noler lD cadAREGA Job Passpon,ruitinq ticerlsa'UlD (Aadbarwoler l0 cardNREGA Job
I Pl6as€ tick (r' ), as applicabl€ I
Cad/Rat on Card/Otlsls
cardRalon cardlolh€ls
*Nol mde lhan 3 mondrs oU. Regisie@d l-ease/Sde agEernonl ot esidence
RegisleEd Lerse/Sale ageemenl ot readence
Eeas. rete. sr No 2 or d'e insrrudrons
Eill #-atesl Ga{El€dicityfid€rhonellandli€l Bll

4.1 CORRESPOTIDENCE AOORESS DEIAILS'

Address Type" Residential/Business Residential Business Registered Offce Unspecified

FlauRoom/Door/Block no. Landmark

PremisesiBuildingMllage
Road/Streeulan e
Area/Locality/faluk
City/fown/District PIN Code

State/U.T.

42 PERIANENT AIDRESS DETATLS' f] ri"* (4 in the box h cas€ the add€ss is same as above.

Address Type' ResidehtialiBusiness Residential Business Regislered off ce unspecifled

Flat/Room/Door/Block no. Landmark

Premises/BuildingMllage
Road/StreeuLan e

Area/Locality/faluk
City/fown/District PIN Code

Stateru.T.
1of 5
 CONTACT DEIAILS
Tel. {Off) (with STD code) Tel. (Res): {with STD code) +
lrobile (Desirable) + (Mobile Number is requiGd for communacation and to gel SMS alerts)

Email lD

6. OTHER DETAILS ( Please refer to sr no- 3 of the ihsrudiohs )

t Occupaton Deta s' I please !ck(7) l
Privale Sector i I Public Seclor Govemment Sector .-,
Professional I-':
Self Employed Homemaker I student llOthers (Please Specify)
> Income Range (perannutn) lJptol lac llacto5hc -5 lac to 10 10 lac to 25 lac
25 tac and above lac
> Educational Oualifications Below
-
HSC SSC SSC. Masters Professronals ( cA, CS, CMA elc.)
Graduate
> PleEse Tick lfApplicable Politically exposed person Related to Pditically exposed (Please refer instruciion no.3) Person
7. SUBACR|BER BaI{X DEIAILS ( Pl66s6 I!,6r lo sr no.,l offtc lnstudior6 )
(lf Subsc.iber mentions any of the bank d6tail6, allthe bank details willbe mandatory except MICR Code.)
Acrount Type lplease tick(/] I Savings A,/c Cunenl Nc tl
Benk A/c Number
-
Bank Name
Branai Name
Branch Address PIN Code

Bank MICR Code IFS Code

E. SUBSCRIBERS I{O$XATION OEfA[Sr (Hease rsfor ts 3. No . 5 of fiG irEtudlons]

Name of the Nominee (You can no.y nets up to a maximum of 3 nominees and if you dBshs so pl€ase lill in Annexure lll (Additonal NominaUon Fom) providod separatsly)

First Name Middle Nam€ Last Name

Relalionshrp with the Nominee Date of Birth (ln case of Minor)

Nominee's Guardian Details (in case of a minor)
First Name Middle Namo Lasl Name

9. NPS OPnON DEIAILS (Pleese lick (r') as apdicablc)

I would lik. to sub€cribo tor Tier ll Ac6ount .lso YES - i{O il f Y.., CG.sr submit dltaib in Ann.rure l.

POP-SP6 renddng serv Es unddNPS .nd Annsxle 510 is availade on cRAwebsrlel

lwould llke my PRAI{ to b€ prirted ln Hlndl YES .'NO lfYEs, Please suhmh details on Annexure ll

10. PENSION FUND (PB SELECnON Al{D II{VESTIIENT OPTION* { Ple6e re{er to s' no.6 of the in3audiom )
(0 PENSION FU D SELECTION [ie. l) r Please read below cohdltions before optlhg for the cholce of Pensloh Funds:
i. Gov€lrimcnt Sector: For Govemment Subscribe.s, the loltowing PFs act as defaul! PFs as perth€ guidelines istued by lhe Gcvemmenr
{a) LIC Psnsion Fund Lamited (b) SBI Pension Funds A/1. Limited
(c) UTI R€tirement Solutions Lld.
2. i{i Citizcn odet: SuuscribeG under All Citi2en model have the optioi to choose the availeue PFs 6s per their choice in the table bdow
3. Coipot-rt. ilodEl: Subscribers shallhsve lhe option lo choose lhe avaibble PFs as per the belor/ tsbl€ ih cohsullaron with lheir respecl v. Em
4. pG LiEi NpS Uie is a group chdc,e model ',rfi6r3 subs€nbsr has a d)oice of PF and inveslrnsnt oplion as availabla wilh Aggregalor.
l,lame of the Pension Fund ofthe Pension Funds
Llc PEnsion Fund Limitcd Avallable lo
I sBl Pan€iofl Fun& Private Uhn€d 1

Sectot
lJIl Rstm,.llent Solutions Limilad
lClCl Prudential Pension Funds ldanEgement Company Limited AvailableloAll Corporar€
Kotak Mahindra Pension Fund Limited Cltlzeh Mod€l' uodel'
pital Pension Fund Limited ll
on ManagemaBt company Limit€d
Birla Sunlife Pensaon Managemenl Limiled
' seleclion of Pensio. Fund is mandalory boit! in Active and Aulo choics'.
(iD rNvEsTrrE {T oPnoN
(Pleise'l'lck (r') in the box given below showing your investment optio.r).
Actrve Choice
j Aulochoce ' -
-
1 . ln cas6 you s€l6ct Aclive Choic€ nI up 6o.lioi (ili) below and if you selsct Auto Ch.ice fill up s€djon (iv) b€low'
2. In.€6e iou do not lndic€le any invesineflt option. votr funds wiil b. invested in Auto Choic. (LC 50). -
i. l. *"" i* r'*. "pt"d ror Auio ch.rce and ii up;ection (iii) beld rEiating io Asset Alloca0;, the Asset Allocation instruclions will be isnored and investmenl will
bs rmdo ss p€r tuto Choice (LC 50).
(iii) AssET ALLOCATIoN (to be filled up only in case you have selected lh€'Active Choice' investment option)

E; sPs.,!%
E Ic
100%)
G

100%)
t{ote: 1. The totEl alloralion across E, C , G and A ass€t classes must be equal!o 100%- ln
case, rhs allo€ation is Ieft Hank and/or does ,rol equal 1 00%, lhe apPlicalion shall be r4ecled.
2. Assel class E-Equily and rclated insltumenbi asset dass C_Co.pomte debt and elated
instruments: Assel dass G-Goverment Bohds and related instruments; Asset class
I I I
ve lnveslrnenl Funds including ihstruments like CMBS. MBS, REITS. AIF!.lhvils :!".;

(iv) Auto Cholce Option (to be filled up only in case you have selected the 'Auto Choice' lnveslment optlon). ln case, you do not lndlcate .
choice of Lc, your funds will be invested as per Lc 50.
LiIe Cyde (Lc)Funds Please Tick {"') Only One
Note: 1 . LC 7$ lt is rhe Ufe cycle tund where the CBp to Equity inveslments is 75% of the lol,l asset
LC 75
2. LC 5& lt js lh€ Life cycl6 tund t^tsre the Cap lo Equily invsstm8nts is 50% of lhe lolalass6l
LC 50 3. LC 2S lt is lne Lile cycle tund where the cap lo Equity inveslments is 25610 of the tolal asset
LC 25
11. DECLARAnON BY SUBSCRIBER* ( Ple€se reter lo sr no. 7 oflhe inst^rctions )

D.d.r.6on & Authdi2ation by all EubEcrib€rs

lhave read and undeElood lhe tems and condi$ons of tle NationalPension SFlem and hereby agree lo lhe $me along wilh lhe PFRDAACI, regulations harfed theret]nder
and dedar€ thst the irfo.mslion and do.lments tumished by me 6rE lrue and cdr€ct, to the best ot my knouredge ar1d beliet I undertake lo iifonn imhedaately th€ C€ntral
Reco.d Keeping Agency^atnal Pensisr SFiern Trust, ot any change in the above infomaliofl tumished by lh€. I do not hdd any pre-e*sting account under NPS. I
uhdersiand that I shall b€ tufly liable for submiision of any false o. inco.recl infornaton or do(llments.
I turlher 6gree Io be bound by the terms and condilions of provisioo o[ s6rvic6 by CR^ from lime to lime and eny amondment lhe{eof as approved by PFRDA, whether
completo or parlial without any nar dedaElion b€ang fumish8d by ms. I shell b€ bound by the tenrrs End conditions lor th€ usage of l+lN (to acress CRA websile and visw
delails) & TPIN.

Declaratlon underth€ Prcventlon of iloney LeuhderingAct, 2002

I h€reby doclarc that the contritulion paid by me/on my behalf has b€sn deriv€d from legally dodared and assessed sources of income. I understand that NPS Trusl has
the righl lo peruse my linancjalprofile or share the informalion, riith othergovemmenl aulhorilies. I further agree that NPS Trusl has lhe nght to close my PRAN in case lam
folnd violating the provisions ofanylaw reiating to pr€v€nlion ofmon6y laundaring.

Date

Place

Signaturelhumb lrnpresslon'ot Subscriber in black ihk

('LTl in c6se of male and RTI in ease offemales)
'l2. DECIARAnON ON FATCA* (Foreigo Acrou.t Tar Cornpliancc Act) CO PLIANCE iPlease r€ler ro Sr no. E ot the insuucriohs):

Section l*

US Person' Yes i - ruo Il

Section ll*
For the purposes oftaxataon, I am a resident in the following countries and my Tax ldentification Number (TlNyfunctional equivalent ifi each country is set
oul below or I have indicated that a T|N/tunctional equivalent is unavailable (ktndly fill details of all countries oftax residence if more than one):

Particulars Country (l) Country (2) Count y (3)

Counlry/counties of tax resideficy

Address Line I

Address in the jurisdiclion for Tax City/TownMllaqe

Residence
Staie

ZIPlPost Code

Tax ldentilication Number (TIN)lFunctional equivalent Number

TIN/ Functional equivalent Number lssuing Country

Validily of documenlary evidence provided (Wherever applic€ble)

'l certify that:

a) lt shall be my responsibility to educate mysell and to comply al all limes with all relevanl laws relating to repoding under seclion 2858A of lhe Act read
with the Rules 1l4F lo 1'14H of the lncome tax Rules. 1962 thoreunder and the informatioh provided in the Fom is in accodance with the aforesaid
rules,
b) the infonnation provided by me in the Form, its supponing Annerures as well as in the doclmentary evidence are, to the best of my know{edge and
beliet, true, correct and complete and that lhave not withhdd any material information that may affe6{ the assessmenvcategorization ofthe account as
a Reportable account or otherwise.
c) I permivauthorise the NPS Trust to collect, store, communicale and process infomation relating to the Account and all transactons therein, by the NPS
Trust and any otNPS intefinediades whe.ever situated including sharing,lrahsfer 3nd disdosure betwcen lfreri and to the authorltles in and/or outside
lndia of any clhfdential inlormatioh for compliance with ahy law or regulation whether domestic or foreign.
d) I undertake the responsibility io declare and disclose w;thin 30 days from the date of change, any changes that may take place in the in[orralion
provided in the Form, its supporting Annexures as well as in the documentary evidence paovided by me or it any certifcation becomes incorect and to
provide fresh self-certification along with documentary evidence,
e) I also agree that in case of my failure to disclose any material fact known to me, now or in future, the NPS Trust may report 1o any regulalor and/or any
aulhority designated by the Govemment of lndia (GOl)/RBI/IRDtuPFRDA for the purpose or take any olher action as may be deemed appropriate by
the NPS Trust if the deficiency is not .emedied by me within tho stipulatod poriod.
0 I hereby accept and acknowledge that the NPS Trust shall have the right and authority to carry out investigatlons from the information available in public
domain fcr confirming the informaticn provided by me to the NPS Trust
g) I also agree to fumish such information and/or documents as the NPS Trust may require from time [o time on account of any d]ange in law either in
lndia or abroad rn the subiect matler herein.
h) I shall indemnily NPS Trust lor ahy loss that may arise to the NPS Trust on accouht of providing inconect or incomdete information.

Date

Place
SignaturelThumb lmpression' of Subscriber in black ink
('LTI in case of male and RTI in case offemales)

Name of subscriber

3of5
 CSR]
13, DECLARATION BY EMPLOYER

Appllc.ble to Goyomrn6nt Subscrlbers only

(Subscribers Employment Oetalls to be filled and attested by the Deptt. (All Oetails are ilandatory)

Date of Joining I I Date of Retirement I

Emdoye€ CodeilD (lf applicable) Employee Code/lD and PPAN are optonal. ll you intend
PPAN (lf applicable) lo provide, mentjon any one.

Group ol Employee (T'ick as applicable) Group A I

GroupB Groupc GroupD -'
- -
Offce
Oepartment
Ministry
DDO Registration Number
Of O/PAO/CODO/DTA/PiAO Registration Number
Basic Pay
Pay Scale

It is certified lhat the details provid€d in this

subsciber registration form by employed with us, including
the address and employment details provided above are as perthe service record ofthe employee maintained by us. Also, it is further certified that
he,lshe has read enlries/enties have boen read over to him/her by us and got confirmed by him/he..

Signalurc of the Authorised perEon Rubb€r Slamp oi the DDO Signalure of the Aulhorised percon Rubber Stamp ol the DTO/PAO/CDDO/
(ln the box DTtuPrAO (ln the box above)

I Dssignalion of th€ Authorissd P€rson Designation of the Authorised Persoh

] Name of the DDo Name of D-IO/PAO/CDDO/DTtuPIAO

l
]
Deptt/Minisrry Dat6 I I

I4. DECLARATION BY EMPLOYER/ CORPORATE

Applicable to Corporate Sub8cribers only
(Subscri6ers Employment Details to be filled and attested by Corporate (All Details are Mandatory))

Date of Joining Date of Retlrement

Employee CodellD

Corporate Regd. Number (CHO No.)Allottod by CRA

CBO No. allotted by CRA

Certified that the details provided in this subscriber reglst ation form by employed wilh us, including the
employment details provided above are as per the seNice record of the employee maintained by us. Also, it is further certifled that he / she has read the
entries / entries have been read over to him / her by us and got confrmed by him / he.

Dale t I Place

ShneUrre ol lh6 Autf'dis€d *oon 1,-rr" bo,

"*""1 I

Designatjon of the Authorised Person Rubber Siamp ofthe Corporate (lh the box above)

15. DECLARATION BY THE AGGREGATOR

Af'plicable to NPS Lite Sub6c.ibe6

Authorisation by Aggrcgator'3 offic. (NL -AO)
Certmed that the subscriber is registered wilh the aggregator and he/she has opted to join NPS. I hereby dedare that the subscriber is eligible to join NPS
and the above dedaration has been signed nhumb impressed before me by ..............-............... ....................after (s)he has read the entries/ entries have
been read over to hor/him by me.
I

I
Sisnature ol the Auhonsed peiEon (ln the box above) Rubber Siamp of the Aggregator (ln the box above)

Nahe of the Aggregalor

NpS Lite Account Otrce (NL'AO) Regis!'alion Number NPS Ute - Collection Cenlre (NL- CC) Regisualion Number

Membership No. allotted by Aggregator (ifany)

Place Date

4of5
16. TO AE FILLED BY POPSP

Receapt No. (17 digits) POP-SP Registration Number

Oocument ac.epted for date of Birth Proof:

copy of PAN card submitted YEs f.:-l No Lr t(YC Compliance YES L i NO i- .1

Oocuments Received: (O.iginals V6rfied) Self Certified (Attested) True Copies

:
ldehtity Verificatjon Done

Erisling Bank Custom.r:

which matcir the requirements for opening NPS account have been fully complied with. We turther confirm that the S. B. a/c of Sh/Smt/Kum
...is not a 'Basic Savings Bank Deposit Account'

Adhaar Based l(YC Certificatoi

l^re he.eby certify thatAadhaar Number -.............................of Sh/SmUKum.........-... .....has been checked and the name
and address mentioned on the original Aadhaar card are hatching with that mentioned on NPS application fonn.

Designation

POP^sP Seal Signalure of AutfErned Signalory Dale

lfo be fllled by CRA - Facllltatlon CentrE (CRA-FC)!

CRA-FC Re$$tration Nrl{nber

Recaived ai

Acknoxledgerner( itumb€r (by CRAFC)

PRAN Allotad

ACKNOWLEDGEMENT
Name of the Subsctiber:

Contribution Amount Remitted: a

Date of Receipt ofApplication and Cont.ibution Amount:

Stamp and Srgnature of lhe Employe./PoP:

of5
 INSTRUCNONS FOR FILLING THE SUBSCRIBER REGISTRATION FORM
General Guidelines

a blank box afrer €adr word.

h case, you menlion the KYC number submission of pmof ftr the sem€ is necess€ry

leit blank or the application lorm is p.inled back to back

The suhscribsr should not sign a.ross th€ photogrdph. The photograph should not b€ stapled or clipp€d to the lorra. lf lhere is any mark on the photograph sudt that it hinders
the dear visibility of the face of the subscribet lhe applicatiorl shall not be acccpled.
(e) Cofies of all the documents submitled by the apdicant should be selr-atlested and accompanied by o.rginals for verifcaton by the nodal offce.
(f) Name 3nd Address of the applicanl menlioned on the fdm, should match with the doclmentary prEol 6ubmrlted.
(s) Ths 6obsdibeis thumb's impression 6hould be verifed by lhe designated officer oI PoP-SP / Nodal oflice.
s. ll€m Dctalls lnsr'uclions
iio '$I
i. This Folm is applicable to Re.ident lhdians and the.e is a separale Forn for Non Residenl lndians.
PersonatDelaits ii. Curr€ntiy, Foreign Nalionals / Oth€r Country lndividuals (OCl)and Persons of lndian Origin (PlO)ars not allowed to op€n PRAN.
iii. The applicant shall mentjon fahels neme and molher's name a6d shallselectthe opton to be pdnted o't PRAN Card.
Spouse Name l{mamed. spouse name is mandatory
I -- ., i. Falhels hame rs mardatory
ii. lf fsther's nams has more lian 30 digits, you may lill Annexur€ ll fo. the sams.
Mother's Name
i, Mobels name rs mandatory
ii. lf Mothe/s nsme has more ihan 30 digits, you may fillArnexure llfo.the same.
Date ot Birth Please ensure thai the date of birth matches as indicated in the document provided an lhe support.
S.ilo on.)
Proof ol ld.ntig (Copy of any S.No Proof oI Addr€ss (Copy of any on.)
I Passport issu€d by Govsmment of lndia. 1
Passport issued by Govommenl of lndia
Z Ralion card wlm pholograph. 2
Ralio.! c€ro !ti$ pholograph ano .esdenlial address
3 Bank Pass book or cenifcate withPholograph. 3
Bank Pass boo* or codjfcate wilh photograph and rcsidential

Certificate ol lhe POP bahk for an existjng Bank customer certifcste of the POP bank lor an exisling Bank cuslomer.
5 Voters ldentity card wilh pholograph and residantial address. 5 Voters ldenlity card with pholograph and .esidefltial address
5 \hlid Dnying lic€nse with phologr.ph 5 valid Odving license'a/tth photograph and residenlial address
7 C€rtifcate of idenlity with photograph signed by a Msmb€r of 7 Let!6r from any recogDized public aut'1o.ity at trhe bval of
Parliament or Member of Legislative Assembly Gazetted offcer like Distrcl lragistrate, Divisional commissioner.
BDO, Tchsildar, MandalRevenue Ofli6e( Judicial Magistrate etc.
I PAN Card i6su€d by lncomo tax depanrnent a certificate of addross with pholograph Eignsd by a Member of
Parliamenl or Member of Legislalve Assembly
lde,llily,
Correspondence & s Aadhar Card / l€tter issued by Unique ldenlrfcation Authority I Aadhar Card / leue. issued by Unique ldenlification Authority of
oflndia lndia clsarly Ehowing lhe address
details 10 Job oards issued by NREGA duly signed by an officer of the 10 Job c6rd6 issued by NREGA duly signed by an oflicer of the
State Govemment State Govemment
2 2,3 &4 11 ldentity card issu6d by C€nlral/Stale govemmenl snd its 1'l The id€ntity card/document wilh addrass, issuad by any of
Departments, statuaryl Regulatory Autho.ites, Public Sedor ihe following: Centraystate Govemment and its Depanments,
Undertakinss, Sdleduled @nnrcrcial BBoks, Public Fiia'rciai SktuaryRegulato.y Auurorines. Public Secior U,derlakinss,
lhstit tions, Colleges affiliated to universities and Professi@al Scheduled Commercial B3nks. Public Financial lnstitutions for
Bodies suci as lCAl, ICwAl, lcsl, Bar Cooncilelc.
12 Photo. ldentily Csrd issued by Oefeflce, Paramilitary and 12 Latest ElecLcrt/waler bill in tlte mme of the Subscriber /
Claimsni and showing lhe address (less than 3 monlhs old)
13 Ex-SeNic€ Man Card issued by Ministry ol Oefeoce to lheir 13 Latesl Telephone bill in lhe n3me of the Subscdbe. / Claimant
and showing the addro6s (l€ss than 3 monlhs old)
11 Late6t Property/hous€ Tav receipi (hot more than one year old)
15 fxisl'ng valid registored l6ase agre€ment ol lhs hou$ on slamp
Dape, ( rn case ol rented,lessed accommodauon)
Nolel
(i) t'e pr6pectve customer h same ts that declared by hidher in ihe accsrnt
tf the addrEss on the document subrnitt€d for idenlity p.oof by
openinq form, the dooJmenl may be accEpld as a valid proof of boltr identity and address.
{ii I tl the aadras.s indicated on ths d;*m€nt sut||nittgd for ident ty proof differs from lhs c.rnont address msntionBd in lhe €ccount op€ning
''form,aseparatep/oofofaddressshouldbeoblained.Alltutureaommunicationswillbesenttocorespondenceaddress.lfcorespondenc€
& Permanent address are dfierent, lhei p.oof for bolh have to be subdnilted-
{iii) Th€ KyC documents may be submitted viithin a p€riod of 30 days after
gensmlron of PRAN. (Only for Govemment SubscrlbeG)
irotntc"ly erposeA personsi(PEPs) are indrvidusls f,,tro are or have been enlrusted with Fo.ninenl public tunctions in a foreign country for
Politicaliy Exposed .iampdr'*ts state or of the s;vemment, s€nd politiciahs senio. ldemmsnt, judicjal or military officials. senic erecrnivas of state-
"r important poliljcel pany officjals.
orvngd corporations,
For Tier l, ba* delails are optronal. ln case, subscribet provides b3nk details, it shodd be supported by cancelled cheque.
F;r activaton of 'Tier ll, ban(details are mandaiory. Plesse attach a Cancelted cheque (co.taining Subscriber Name, Bank Account Number
Subscriber's Bank and tFS Code! or Bank Cerrficate containinq Nami, Eank Account Numberand IFS code, for dircct dedit or eleclroflic t'ansler. ln case fihe
47 Debils
dloouo iE nol prgpnnlsd wirh name, addi[cira y, a copy ofth€ bank passbook or bank c€nilicale mntaining Name, Bank Account Numlrer
and IFS code should b€ submitled.
ln cas6 of more thsn one nominse, p€rcontag€ shsr€ value lo. all lhe nomine€3 must b€ int€g6r. D€cimals/F.sclional valuas shall not be
Subscriber's acc€pted in the nomination(s). Sum ;f p€rc€n-tags 6hare adoss all ths nomin€€s must be equal to 1 00. lf sum of p€rc€ntag€ is not equal to
58 Nom;nation Details 100, entire nomination will be rejecled.
Eo, more oeLarls o,'lnveslrnmr Opuon. you may visil CRAwebsile.
6 10 Sedion and Subscnbers from Govemmert sedor ar, clrenUy nol allowed lo exe.ose the investmenl optron. As menlioned, your conltibution will b€
lnlL.stlnent Option invested by defas[ PFs as per the guiddines issued by the Got€mment
SiEnaiure / Thumb impression should ohv be wlhrn nre box provrded rn the form. Thumb ilnpression, il ssed, shdrld be attestedty lhe
DedaEtioh by
7 ',l1
Subscriber
O*rgnareo omcer ot iOe/POP-SP/Noo al 6fice w h rhe offici;l s€al and siamp. Lelr T humb lmprcssron in case ol males and Rrght Tlumb
lmDresson in case ol females.
Clariric€ton / Guidelines on flling details if applicahl residence lortax purposes in iunsdidion(s) outside lndia
. Jurisdicrim{s) orTax Resid€n-cs: Sinc€ US bxs6 tE globalincom€ of its cilizen.6v6ryLJs lilizsn ofwlBtever naljonality, is also a lesident
tor tar purpose in llSA
. Tax ide;fficarion Number anN): TIN need not be reported rl I has nol been rs.sued by tr€ iudsdiclion. However, if lhe S3id iunsdiclion has
issued a high iht€grity nu;ber with an equival€nr level of denuficaloh (a "Functlonal equivalenl'), the same may be repo&d. Examples
812 subscriber on FATCA of that typ€"of nu;b; for individuel indua6, a sooal s€cuity/insurance number, citizsrrporsonsl id€nlifrc€tion/servi.r€s cod€/number and
resid€nt r€gistratioo number)
.lfapplicam-residencefortaxpurpGeinjudsdiction(s)witinlndia,PemanenlA..oontNumber(PAN)tobeprovidedasTaxldenlrfcat'on
Number aflN )
, tn case ippti;a is dedariflg Us person statrs as No'hlt hiJher CoJntry of Birsl is US, dodment evidenong Relinquishment of
Citizenshib shdrld be provid6? or reasons for not having relinquish ent certmcat€ is lo b€ ptovided
G€n.ral lnformatlon for Subscrlbc6
a) The Subscrib€r can oblan lhe status of his/her applicalion from CRA and lh€ir designet€d nodal offioer.
b; Subs;;be6 are adv,sed ro retsrn the sctnoryH6;rnent slip signed/ stamped by the dEignsted noosl officer where they submit the appli€arion
c) Fn more information / clanncatio.s, conlact CRA:

1st Floor, ]'lmes Towsr, Kamala M lls Compound, sen€pati Bapat Marg,
Lower Paral (W, Mumbn - 400013
 Forn-ISS-l
N.tioltrl P.osior SysteE 0iPS)
S brcribcr Shuairg

{Ple$c lick the resp€ctive blek which is applicnblc to you)

,L Gcrcr.l Intom!.ioD:

I Ni\ME '

II) Peruns!Renrdnn. Accounr

II IT
III) Dn tl!! PR^N $Bi.dd (r.fd Iutlr<rle b I)
,) sdrd: . c.nrd c,6v.rnnEnt I saa c-*** AllCiliH.fln'. fuOsi E
b) Dm / cBo / PoPSP R.3. No:
'
cl DDo/CgO/ ft)P-SP N.ft: '

l\1 rt.g.r Pn^N $tu.i.dutr {rd.r lEirucn{n trL 1l)

.) S.dDr' Centzl Cov@nEr'r tr All Citiz.ns ofl.dr (UOs) ! "*r."*.. I

b)Dm/ CBO / POP-SP R.!No: '
c) DDO / CBO / POP-SP Nm.: .

AdditiDhd InformrtioD for iubscrlbrrs .o AI Citizens of India - lios

!'- Strhkrtbd Sci€e Prrtir..r.
rl PFM Ndr r alo6.6cri.J ord.r)
r Ilce till dnl, on.

I DSE rxt(U{Gt Ptuion trnd Mrusd Pnrd. Lihicd 5 Ll( P.Blot lnhd Untr.d
: HOFC PrEion \ranaenrnt Cotrarnt Limit d
I ICICI Prclon fud Mrug.&rt Coqry Litritrd
6 R.ll.n.. C.pILl P.nr,otr fu.l UnnI.d
7 SBI P.dlon fudi rtr.tr LiDikd
E
I Knlrk Mrtlbdrr PrBior Fud Lirittd E 3 trt R.tl..Drt snhdDlr Lldi.d
H
(Scl6td or PFM is Fri2r6ry holh ir Acriv. ud Auio Chon!. ln .B F{ do rc. indic.ra . .hoi* orPFM, y,u .lplidior lim
ita! 6c @ily &jeEd).

b) h,esftnr thnon (rete' nriruur.nno. Vl& Ml)

n tr (!tr dc{ils dn Aub ctoicc, plGc Ei6 b thc ofs Do.ber)

l. h ,ou do dor irdiqr ry iNd(fur oprio, you tu!& *iU bc irvBnd i! A!!o Choicc
tur
2. In yo{ h.v. opred for Alb Cnoic.. DO NOT fill up s4tion (V,c) b.low El4ing 1o Asr Alleatio. In
ce .a y@ do, rh. A$cr AUodlion in6rretioN sill b. ignor.d md
nrrtsrdr *ill b. trEtL d p.r Auto Ch{iE.

!rA;sel\ll,p!.irablcrn,tu,:lieduo.nlv,d.:selouhr\.{..reatl,e \dn.(lhoi.€ r!.nnrft.otpnr

c G

NdE: The dtpnon .doJs ll (r dd G d*I chsks mr cqul I 00'?6. ln c&, dr! .l1Mtiotr b l.t bLrl &d/or dod tut qud I [xr'i, lne applierion s[r[ be rcj.ctd by dr. Pof

vl. KYC .t l.lb ( amllobl! rtj if rd{.rlt r i. rlifdrs rrm Gordt5l S..ror)
.) KYc druldt e.Dl.d rbr i{tati,} o@t
b) KYC dodGnt &!@Gd fo, addEs p@f
c)Docurcltacrcpbd lirr Drrcof biit p@t

C. Aaldltioo3l informrtion for rabr.rlb.rr .[iffrg to Ccnrd Gov€r-nrBdra or Strtc Gov.rnm.ir (to b. find ]y tr.g.r DDO)
tPtr.s. rcfcr to irxtructioi No- VIII & m
lll Sube.rib.B Eoplow$r D.tdlsro br rill.d ud rnlrr.d b! DDo {rll t}rtrils rre MrDd.(ory)
T-r-T-r-TT-t IIIITIII
D D MMY Y Y Y D D MMY Y Y Y
c) Croup ol Ut 6rt9loy.. aI E c[ o[
 IIIIITITITIIIIIIIII - IIIT
IITII II IITIII II
IIT IIIIII -IIII'
T-rr-r-rT-r-T-
-r- I IIII'IIIIIIIITIIII
cd ln{ 6. ,.60\ < .ldl&tid h{ b.a signEd / l[mb i4E*d bttft ft by
h. / ilD [s r.dd the enbi$ / Erri.s hav. b€cn Ed oler to tim / lls by m€ dd sd oantud by him / ts. A]so .sdn.d i[t rh. .bt of bi.dr ed cmployMl
s is 6 pd cmproy.. rbordr auil.blc *iln 0. Dcprirndr.

ln!tue or'dc rru 'discd PGM.

ul tle Pe6o" Rtrbb.r Strn', olthe DDo

^!(totu.d

N@ ofthe DDO_
D.!a r!/Mhiity_

VIll.SuL!.rib.r'sBrokDrhil!'(Ttrsub.cnb.st.llpro dr r.rnrdled.h€que.rh. dtlrils or *hi.lr shoulil urch th. b{nl d€oik providcd)

II rI II
IIIII rI
-IIIIIIIIE IIIII II
ffi IITI
+FFFFFFF+tr
IIITIIT
r) las ..d. 0la.r?r.r lpplt.ru.) III
D. Addldord lnformadoD for rut'$rlberr shtfdnS to Corpont Sector (to be aerlfied by rhe Corporate offlc€ of1ne 3rhi.rtbcr corcencd)

t\. S.bs.rIb.rr Enprnymn PA { ttdrrk

'nd

D D MMY
IIIITI Y Y Y DDMMYl'YY
II II
IIIIIIIIIITII
IIII II III
Cmified rh.! ine ato!. d..laari@ hd b.6 slgn.d b.f6r. me by
.i6 h. i $r has rcrd lbc €rE cs i oE''6 havr b.a Bdd over ro him / nd by dr sd so( uridd b, Lid / h{. Al& c€ni6€d tur dr. &tc ol b! dd qrrloruet &6i[ Ns
F. .s+loyE !!wdr !yrl,!L *ilh llt CoO@r.

Sigut!rc .l'ttc -Aulnriscd P*on

ol ue Aurno.i*d nersn Robbr Sl,q! oft[. coqwaE

Rlbb.r SbDp Dt tnc ColloBk

X. slbsnb.r! B.n[ D.ailr (Thc $b:..ih. rhrll pr.lidc r ..n.elled (n.quq rt! det il, or whi.h 3hold Et h rn. b.,l d.Eilr pr.!irl.d)

TIIII TIIIIITIIIIIIII II II
IIIIIIITITIIITTITIT
ltlltttll II rI II
IITIIIIIIII II
IITITIIIIII II
IIIIIIIIITIIITIIII
T-T--r-r II
III II
d las cod. ('v\'t r.v.r rppla.rriel
Xl. Stbkrlb.r S.h.ft Ptfd6.. ( {pDri.ru. onl} if lh. l,g.( CorponE ftr. qiy.n ttE oplin ol s.l.ctll' *h.r p..f.r.E t. rh. rlsi.t d ..ploy.6)

d-Euliaasia-dd44ild-adc!)
I OSP Bl.ctRcl Fdim F..tl Mu.rh Prir.t. Li'ir.d 5 LIC P.di@ fNd Uni{Gd
2 Ht fC Pdbtr nhn.s.Er Corp.ny LtiJLd 6 R.lirE. C.pibl P.Bld rud Lldl.d
3 lclcl PccioD r@d Mi..rr@nt Co!+uy l,ilited 7 SDI P.dor lrEdi Pnv.r. LiDlrtd
t Kotrt Mtf,irdr, P6ld Frrd lldr.'l E I UTI R.rl.cDnr S.ludd Llrdt.d E
hrInlr\hE.rOmionr,ur'u.In turLnrno.\4&\'lll

E (Fa ddils o! -Aub Choic.. plc$c r.Ii, b tL. Odia DuMo

L ln x. you do nor indielc oy i,v6r6r option, ,Dur tun.ls sll be inrskd in Auro Choie

i!v6l,q *iU h.da. rErAdo Cf,oie-

cl Assci Allmlion iabl.llc be 1ill.d b nlv i. (4. \ou hav. tlccEd tn. Acrivc choift arv.sInEnt..rio. !

ill@rJon u6i t, C dd C a€ clas oEd equ, I 0C4 lo Ia, rlr. .llEarid ir hn blaol andlot ils tor .qel I OC/q rn€ snpliclrion rh.n b€ Ejecd b] lh. ]OP

l-IL XY(: d.tdk (AptJa.rble olly lf bs.rlhlr t! Ihlldng r'ion' Srs& / (:.ncil C{v€rnnkr Se.tor)
a) idorili p@f
KYC do.u@r ...crtcd for
b)KYC delE &..dsl
fd rddE$ 0rml
c)Docuhot:ccepkd forD.leoab'nh prmt

Declerrtion (Appllca ao subscriber lcroi. dl iedoB):

t.arc. b b. beDd by d'. t.m $d (oadnioff for rh. krd 5.d (ir $ticL B) PP-{N vi! bdog ,hd D.ersi.s of di. IIErfu stiniq r.q6r) 6d udI&nn rh.r
CRA @r. a @Fortrl olq liFtDA, dod y orfi. sfli@s @npl.try a pdtiarry sithout a.y no DElaration / Urdehng b<ing signd. lunner I zgrE ro Fy rll fi.
Ndsry .h{96, a .pplicable, ol d. k ed *L1or.

Sigrlu\*/Lci Tnumb iBlrcssnr ol Subscrib.a

For Onici. u! only (To bc lilLd !, l,y lh. oliicq ac(.ptina t[e 1'or )

r'ao,m! -SP Res6t r,oi Nufrbd

D.E: _ iih. shp

R.cripr Nmb.. L$.J b, !r. Eccivins ot[& looly lb. POP-SP) ITIIIIIIIIIIIIITIIII
LrLttxxY)ci()L\-1-la1)Ll(LxxicraL\x
Itr5E{cdoE lor 6ling th. tonn
l. D.t li ofthe DDo / P0P-SD with whi.I tb. PIAN is @endy Esodr!.d.
ll. D.t il5 of rh€ DDo / PoP-sP wth Etlid rle PRAN witl be asocirred.
lll, Pl..* qlot tte cor..t PttAN dd aua.h a opy ofrhe PX,N C{d
w. Itis fom i6 to b. 6.d !y dr. sb6sib.r ohly
V. Se(tor lor 'Ex*tina PRAN adiatiDn dd Targ€t PR-{N sso.i.b6n' 6n b. th. qD. d{y if. suhsdiber i. $iftin8 from on St t Goremehtrt to od.rSt t
Vl. l.tiv. cboic. - Utd.r A.tjt. choice, subsoib€ri lEve o option ro dl@. a 6rd mag.r .nd prdid. tI. r.tio in whicb his / h.r tund5 e to be i.vdt d :mong Get
a, PfM sel€tion is mud.rorr. The fo@ slbll b. .ejccted ifa PIM is not optcd tor
h All@rj M under Eq!'ry {E) Brnor dcerd s0%
a A subrib€r optinA for .div€ doi.e my 3el..t th€ av,il,bL set cl36 f'd, 'c', & -C-). How4€r. tle suD of Fe..€nta8e allo€don adB all the selert.J ss.t
da6 mEt .qD, 100. IlUr. sm of p.r..ntage allo@tioE is not e{!rl to 100%, or the aet aloetion tablc * len bbrk tle applic.tion shzl] b. reiert d.
Vll. Auto doie - Und.r Alto choic inv6tBent pill b€ made in a lif.cycl. tund in lhe sch.h.s of PFM dos.tr by SubsqilEr.
A subsdibd optine fo. Alto Choie nust .lso s.l.ct a PFIr,l- Th. applietio. sh,ll b. ..j.ct.d il th. subsGibcr do.s nor irdj@t. his^.r.hoie of PFM.
ln c.s. b.th,nverthetrt option andthe.s3.t2llocatior table aF l.ft bl.nh$r sbscnb.,'s tundr will b. i.v6t€d es per Auto Chor..
For h... details on invament opltroDs and asset dasser pl. . .ol'.r to 0p offer D6.un.nt.

Vlll, EBplo)Beht detalls .E to be epErred ln CRI ststem by dr€ t rlet PAO/DTo dog wlth orhd det ils, iftnr subssiba i! shilrii.t ,rom UOS ro C.nrEl / Sr.re

t)( PAo/DTo have td modily th. enploymdr d.tails olt[€ s!!6dib.r.fr.. u'. shifiinA of the PR N. i. s€ otsubsibn shiftin8 froo C.nEal Gs.mo.ntro State
Covernm.nt or vic. veBr o' 3oN t*o St*e 6oremnmtr i.. bo$ existing ed n€w PtutB .ssociation . cov.rn.rent Sectors
Msr.rirc Ii* oI d!.u,MB .ca@bl€ e prmf oa id.ntity ed ad{,fts
ftMf.lldrnLr! 1( i)N olat oB.l Itool ol Addr.ss la'sv ol anvonel
Schml l.ca!i.! C.r!,iutc
iil iir
D.F.. ol R.oFiz.n anu*iion, l.sltul,on D.Doril.ry aso! Satut^
D.Dosnon Accdnr Sk!.m.n!
Brnl Accoet SbI.rErr , Prssbook
FrIc,--ri-r--il 1
vl Buk 1.(unr \rarcbcnr r Pxsh.rt

viil

PnDcry- Td Arsrnrnr Ordn Prornv Ta\ .sdM( Orda l ) It&fof [email protected] in s'. No rrovr(^)
II rld ^ddrB
mt b( ff. rt{ sn mlh6 old on th. dak
rl)

ccrrilistc ofai r6s si$cd by ! Mc bsof 2, Yd d quid to kins digin l dl,lild5t! &
Parlia@ or Membd ofl.gislilia. A$ehb], oi two *lfi@&d nhobolid (o?isin.r. will h.
CcdtiqE ofid.nlny 6igftd hy ! MedEr ur
PulieE.l or Mmber o, t2eiil.tiv. -dr*mhl, Mbici/.I Coutrcilor or a G&trd Ottrcq.
coutll vs'lic&M,
or Municipsl Cs(illm - J Cdcd Ofiicd. sltcr
 Annexurc 52 Pase I
Request For Change/Correction in Subscriber Master details And/Or Reissue of I-Pin/T-Pin/PRAN Card
(To avoid mistakc(s), plcase read th€ accompanyins ins&ucrioN .arctully bclbre 6llirg up l}Ic tbrm)

For DIrO Ure: For PAO us€:

Datc ofReccipt: Date ol Receip! PAO Stnmp:

Enleied By I Date:

Sitnature ,rnd Stamp ofDDo V€rified By: Dilt€:

Acknowledgcm€nt No.
(To b€ fillcd by PAO as g€nerated by NPSCAN s)Erem)
IIIIIII
I hcreby re4u€st for lhe follo\.ing dctails for the clang€. (PlBle dck )

I
A) Chrngca.rr Correction in Personrl detdls C) R€isruc of T Pin or I PIN

B) Ch.tges or correcdoni ln Nomlnsdo! Dea.lls D) Rcl$.Ee of PRAN C.rd

Pemanert Rltir€m.nt Accounr Nmbcr *:

I hcrcby submit &e lollowing dctails ot chargc. (Pl€..c dck the bor on |.ft mirgin of rppropriite mu, rvherc chrryf/.orr€ction is r€quir.d atrd provid.
tht d€taik in tne srrtcsiEndirg rowr.)

Secdon A - Change ln Personal Details ( ' Indicrtes Mandato.y Field)

tr 1. F.llIl Narrte {Full expanded nam€ : iniLiils are not

Pleasc trck ai applicable, 5hn s-, f r'.-i fl
FirstNamB *

Middle Narle
M--I-II .I
l-a$ Name
IIIIIIIII-IIIIIIIIIIIIIII
+
II
IIIIIIIIIIIIIIIIIII
tr 2, PAN\. lt
tr 3. !'alher's Full Narne:

IIIIIIIIIIIIIIIIIIIIIIIIIIIIII
Midrtle Name

kst *
IIIIIIIITIIIIIIIIII
Name
IIIIII-IIII-- I'
Would you liki to hevc r reprltrt of lhc card otr eccoutrt of rhrtrges ln potnt I or 3 (Pleese drk)
"*n No u
tr FIln(Init N
I

Name ofPremiscEuildin l1
IIIIIIIIIIIIIIIIIII
ttltlitilii
Districul'
III IIIIIIIIIIIIIIIII II
rIII
__l i Uniofl Tcri
SEra
II IIIIIIIIIIIIIIII
IIIIITII
Pin Codc r II
tr 5. Perftaneflt Addr€ss:
l:laL(l,it N
If same as above, Please Tick

IIII IIIIIIIIIIIIIIIIIIIII
Nare ol Premisc/Bdldin
fITTITfT l mlrf Tr
IIIIIITIIIIIIIIIIIIIIIIIIIIIII
IIII II III IIIII II
 Slrtc / Union Tcri

C
III llt IIII III
Pin Code . T-T--f-T--f-r-
(STD eode)
III-' T--r-T-
7. Mobile No. III
tr 8- titnailtD
tttllltttlltl
T---r--T-T--T-r-rT-=l
tr 9. SubscribErs Bank Details
Rank A/c Number *
Savinss A/c
tr Cur€nt A/c n
BmkName r
f-T_-f-T_-r_l ll
*
mfrt'
Bant Bnnch
---T-t--r-r-r-f-T--f-l
Bank Addrcss

rT_l
Pin Code ' t--T- II
Bank MICR Codc r-T--f-T_-f-T_-r-T_-r (wterever appljcable)

l0 Vaiue Addcd Service i) SMS Alert Yes tr No tr

ii) Email Alen: Yes
tr No
tr
Scction B - Subscriber's Nomination Details ('Indicates Mindatory Field Iornomine€)

1.Narn. oithc n"onrh.c':

lstNomin€€ znd Nomincr lrdNominee
Finit Nane * Firsl Name * Firsl Name *
IIII
tltttttttll
tttlttttttttttt
ltttttttttttttt tttttltttttltl
Middlc Name Middlc Name Middlc \ame

tttttIIII tttttltttttttl
ttlttllltttttll
l t l t t t t l t t Ll I
TITITI]I]I]II t

IIIIIIITIIII IITIIIIIIIITITI
IIIIIIIIIIIIII IIIIIIIIIIITIII
2. Datc ol Bini
lsl Nomine€ IIIIITI 2nd Nominee IIIIITI 3rd Nonrin60 IIIIIITII
i. Rclationshi
2nd Nominec 3rd Nominec
IIIIIIIIIIIIIIII TIIIIIIIIIII IIIIIIIIIIIIIIII
IIIIIIIIIIIIIIII IIIIIITIIIII TIIIIIIIIIITITII
,1

lsiNominee
Share '
ag 2nd Nominee rr v, 3rdNominee I ITZ
5. Nomin€e's Guardian Detaik (in case ofminor)+
I st Nominee's C,uardiatr Delails 2nd Nominee's Guardian Deraili 3rd Norrunee's Guardian Ddails

ffiIIIIIIIIIIITII
First Name + Firsl Namc '

TTTT] TITIITIIIII
Middlc Nrme Middlc Name Middlc Name
fT fT rT frfII
IIIIIIIIIIIIII IITITIIIIIIIIII
IIIITIIIIIIIII IIIIIIIIIIIIII IIIIIIIIIIIIIII
lrst *

+
Name

tltttt tttt
ttt tttttt
tttlttttttttttt ltlttttl tttl
TTf F.t
 Annexure S2 Page.1

Conditions
1!l Nominee

IIITIIIIIITIIII
Section C -Rcquest for Reisrue of I-PIN/T-PIN
I T Im |ll I I
3rd Nomirec

ll Il||l TIII
I hErEby, rcquqtt you to rcissuc thr lirllowing

T-PIN I-PIN

Sectton D -Requert for Reissue of PRAN c.rd.

I horoby roquest for reissue of PRAN card on account of

Loss oI PRAN card Damagc to old card

I , the applicant, do
hereby dcdlar. lhat what is st tcd above is truc ro thc bcst olmy informatioo & bclicf.

Dlrtc
fT-fT-f-r-fr
DD M M Y Y Y Y
Signature/Left Thumb
Impression of Subscriber

INSTRUCTIONS FOR }'ILLINC FORM

l.
this form is to be used for rhe pupos€ of change/corection in subscriber personal details, trominee details, reissue ol l-Pin /]'-Pin
or reissue ofPRAN card.
2. The form is to be submitted ar the Nodal oflice for carrying out the necessaty changes
3. Please tick the box on the left margin of appropriat aoq, whcre changdcorrection is iEquired' and provide thc details in the
mrrqspondi[g mw. Please shike off th€ remaining blank rows for which no change is requested
4. Form Io be filled legibly in BLOCK LETTERS afld in BLACK INK oDly.
5- Detsils Mrrked with (*) .re th€ mrrd.tory fields.
6- Mentlor 12 digitr PR{N correctly,
7. All Dates Shouldbe in "DDMMYYYY'Format
I 8. Ifpcrmanent address & present address +,119 different all future comrnunicaiions will be sent to presen! address.
9. N_ohlnrtion: Subscriber can nominate maximum three oominees.
Subscriber can not fill the sade norEinee details more ihan once.
Percentage sharg value for all the nominees must be integor. Fraotioral valuc will not be accepted
Sum ofperc€ntage share aoross all tbe nominees must be oqual to 100. If sum ofpercentago is not equal to 100, nomination will be
rejected.
10. Reissue ofT-Pin, l-Pin .nd reissue of PRAN csrd will be ch.rgeable by the CRA.
FOqM:601Pw ll.Uon l Pan bn sytlmlr'|1ti
{unde. flegul.tlons 8 of PfRDA (Exlts & Wthdr.wak) Re8ulations, 20151
P.nhl lMthdr.w.l fonn tor Th. I .count und.r l1P15
lPh.!. fi! .ll !h. d.t ll5lnc Plfat ttTnRs I ln 8t c|( lifl( onlv)

I
I

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 Form 601 - PW
(Undar Regulation 8 of trRDA Exits & Wfthdhwals Regulatons, 2015)
ln3t uctions Paoo

lnstruc{om for fllling up lte fom:

1. Allfields nrarked with'are mandatory. Aff dates shouk be in DDMMYYYY formal.
2. The Subscriber shall submit the application to the respective Nodal Ofttce/PoP/Aggregator for processing of
request.
3. Bsfore submilting the withdrawd !orm, sxbscrib€r should ensure lhal tha bank account details are matched
from th€ bank psssboou bank statement or cheque etc lo ensure thgt the dgteils arE cofiecl. Subsariber
should also auach the bank proof (csncalled cheque/copy of bank passbooklbank csrlifcato) with the Partial
WitMtawal Form submitled.
4. Subscrib€r should speciry the purpose of Partial Wthdrawal aad a proof need to be submitted for the same.
5. SubEcriber should be in the NPS alleast fur I period of 10 years.
A suhctib€r shal be permitted to wilhdraw not excseding 25of ot the contribuuons mad€ by sudr subscriber
to hbihsr individud ponsiqr ac€ount,
6. The Nodal offcer/PoP/Aggregator mu6t verify the dstails of he bank accounl of subscfiber.
7. W drawal amount rccelved afiar the execution of the withdrawBl requ$t can be difisr€nt lrom the
requ66td
amount to the extent of difference in l.lAV of two difierent days.
8. Ths withdrawal amount shall diredly be cr8dited to the bank accounl of lhe subscrib€r as menlion€d in the
vJfidra^.al fom.
9. ln case, th6 subsc.iber already owns either individually or in lhe ioint name a residenthl house or flat, other
Aran ancastral property, no withdrawal und€r PFRDA regulations is permitted.
10. Trealment of spedfic illne6s corers the subscribsr, his legally wedded spouse, drildren, including a legslly
adopted child or dopendent parents sufier from the sp€cifed allness, which shall compriss of hospitalization
and trealrnent-
11. Ihs pemitled withdrawal shall be a{otyEd onty if the eligibility criteria and limit for availing the benefit are
complied with by the subscriber.
12. Frequencl: $e subscriber shall be allorved to withdrary onty a maximum of three times during he entire
tenure of subscription under ths llational Pension System and not less than a period of five years shall hevo
elap6ed ftom the lasl date of eacit of sucrr withdrawal. Five years shouH hgvs elapsed between two
withdrauals shall nol apdy in ca8€ of 'troatment br specirisd illness€a or in case of withdrawal arising out of
cnt trom Nelional Pansion Sy8tsm fue to the desth of the subs€riber.
13. For more delaibd dBcriptbn of Partial Wrthdrawal option under NPS, please refer Regulation 8 of PFROA
(Exts & Wthdrawals) Regulalions, 2015.
14. The Nodal offce/PoP/Aggregator shall capture lhe dgtails of ths Eubscrib€r mentioned on he form
and forward the same to NPS Claims Processing Cell (NPS CPC) at address rn€nlioned b€low:
t{PS Clalm Proc6sing Cell,
Contral Roco/d Ke€ping Agency, NSDL,
1Oh Floor. llm6s Torvsr, lGmala Mills Compornd,
Senapati Bapat Marg, Lor rer Persl West, Mumbai - 4000013

a
 {en ffi frffqTrdt *t PENSION FUND REGULATORY
ft-orfl crk€'{ql AIiID DEVELOPTIIENT AUTHORITY
d-14/o, E{qft Firalci} ra-a, B-14/A, Chhatrapa[ Shivaji Bhawan,
qgo dwrn S:, Outab lnstitutional Area,
o-rarftqr mrq, TS Fdd-110010. Katwaria Sarai, Nsw Delhi-110016.
{{qrs : 01'1-26517501, 26517503, 26133730 Ph : 011-26517501, 265'17503, 26133730
Sry :01'l-26517507 Fax:01'l-26517507
da:urp : m'a,v.pfrda.org.in Website : www.pfrda.org.in

Circular

Cir. No PFRDAIZA 1 I I 40 lExit Date: 10.01.2018

To,

CEO, National Pension System TrustlCentral recordkeeping Agencies/Pensicn

FundsiTrustee BanUGovt. Nodal Offices/Points of Presence / Aggregators

Dear Sir/Madam

SUBJECT: GUIDELINE SONP ROCESS TO BE F LLOWED BY SUBSCRIBERS

AND NO DAL OFFICE/P OP/AGGREGATOR F OR PROCE SSING C F PARTIAL
WITHDRAWAL REQUE$I

Pension Fund Regulatory and Development Authority (Exits and withdrawal under
the National Pension System) (First Amendment ) Regulations 2017 have been
notifiedlpublished on the website (www.egazette.nic.in.) w.e f.10 08.2017 ln light of
lhis , circular dated 21.03.2016 has been modified and norms for partiai withdrawals
have been liberalized .This circular shall be effective from the date of the notification
of first amendment i.e. 10-08-2017,

2. As per Regulation 8 of the PFRDA (Exit and withdrawal from National

Pension system)(first amendment)Regulations 2017, following provisions have been
notified in respect of the partial withdrawals under National Pension system (NPS).-

(1) A partial withdrawal of accumulated pension wealth of the subscriber, not

exceeding twenty-five per cent. of the contributions made by the subscriber
and excluding contributions made by employer, if any, at any time bcfore exit
from National Pension system subject to the terms and conditions, purpose,
frequency and limits specified below:-

(A) Purpose: A subscriber on the date of submission of the withdrawal form,

shall be permitted to withdraw not exceeding twenty-five percent. of the

Y
contributlons made by such subscriber to his individual pension account, for
any of the following purposes only:-

(a) for Higher education of his or her children including a legally

adopted child;

(b) for the marriage of his or her children, including a legally adopted
child;

(c)forthepurchaseorconstructionofaresidentialhouseorflatinhis
or her own name or in a joint name with his or her legally wedded
spouse.lncase,thesubscriberalreadyownseitherindividuallyorin
thejointnamearesidentialhouseorflat,otherthanancestralproperty,
no withdrawal under these regulations shall be permitted;

(d) for treatment of specified illnesses: if the subscriber' his legally

wedded spouse, children, including a legally adopted child or
dependent parents suffer from any specified illness' which shall
comprise of hospitalization and treatment in respect of the following
diseases:
' (i) Cancer;
(ii) Kidney Failure (End Stage Renal Failure):
(lii; erimary Pulmonary Arterial Hypertension;
(iv) MultiPle Sclerosis;
(v) Major Organ TransPlant;
(vi) Coronary Artery BYPass Graft;
(vii) Aorta Graft Surgery'
(viii) Heart Valve Surgery;
(ix) Stroke;
(x) MYocardial lnfarction
(xi) Coma;
(xii) Iotal blindness;
(xiii) ParalYsis;
(xiv) Accident of serious/ life threatening nature
nature as
ixv) any other critical illness of a life threatening
stipulaied in the circulars' guidelines or notifications
issued by the Authority from time to time

(B) Limits: the permitted withdrawal shall be allowed only if the following
with by the
etigiUitity criteria and limit for availing the benefit are complied
subscriber:-
at
(a) the subscriber shall have been in the National Pension System
least for a period of three years from the date of his or
her 'ioining;

not
(b) the subscriber shall be permitted to withdraw accumulations
made by him or her
exceeding twenty-five per cent of the contributions
pension
and standing to his or her credit in his or her individual
account' as on the date oI application for withdrawal;

4t
 (C) Frequency: the subscriber shall be allowed to withdraw only a maximum
of three times during the entire tenure of subscriplion under the National
Pension System. The request for withdrawal shall be submitted by the
subscriber, along with relevant documents to the central recordkeeping
agency or the National Pension System Trust, as may be specified, for
processing of such withdrawal claim through their nodal office. Provided that
where a subscriber is suffering from any illness, specified in sub-clause (d)'
the request for withdrawal may be submifted, through any family member of
such' subscriber.

3.P I Withdrawal process/docu +a.

Operational process/documents to be adhered to / submitted for availing partial

withdrawal would be as per the norms/guidelines prescribed/specified earlier.

Yours sincerely,
.-z-<":
r.oh\\s
(Venkateshwarlu Peri)
Chief General Manager

3/s
1. LIST OF DOCUMENTS FOR NEW SUBSCRIBER REGISTRATION
. COPY OF PAN CARD
. COPY OF ADDAHAR CARD
. CANCELLED CHEQUE/ FIRST PAGE OF BANK PASSBOOK.

2. FOR INTERSECTOR SHIFTING

. COPY OF PAN CARD
. COPY OF ADDAHAR CARD
O CANCELLED CHEQUE/ FIRST PAGE OF BANK PASSBOOK.

3. FOR SUBCRIBER DETAIL5 CHANGE

. PROOF OF DETAILS TO BE CHANGED.

+ Nl Doa,.,a,ld % b, tq dlufri