Fillable Printable National Pension System

National Pension System

CSRF 1

NATIONAL PENSION SYSTEM (NPS)

SUBSCRIBER REGISTRATION FORM

          PleaseSelectyourCategory[Pleasetick(√)]

To, Government Sector Corporate Sector

National Pension System Trust. All Citizen Model NPS Lite/Swavalamban

Dear Sir/Madam,

I hereby request that an NPS account be opened in my name as per the particulars given below:

* indicates mandatory fields. Please fill the form in English and BLOCK letters with black ink pen. (Refer general guidelines at instructions page)

1. PERSONAL DETAILS:

Name of Applicant in full Shri Smt. Kumari

First Name*

Middle Name

Last Name

Date of Birth* d d / m m / y y y y

(Date of Birth should be supported by relevant documentary proof)

Gender [ Please tick (√) ]

Male

Female Others

Father's Name* F i r s t M i d d l e L a s t

(Refer Sr. No. 1 of instructions)

2. IDENTITY DETAILS* (Any one of the documents need to be provided)

PAN Aadhaar Voter ID

Passport

Others Name of the ID I D N u m b e r

Please refer Sr. No. 2 of the instructions.

3. CORRESPONDENCE ADDRESS DETAILS*

Flat/Room/Door/Block no. Landmark

Premises/Building/Village

Road/Street/Lane

Area/Locality/Taluk

City/Town/District PIN Code

State/U.T. C o u n t r y

4. PERMANENT ADDRESS DETAILS Tick (√) in the box in case the address is same as above.

Flat/Room/Door/Block no. Landmark

Premises/Building/Village

Road/Street/Lane

Area/Locality/Taluk

City/Town/District PIN Code

State/U.T. C o u n t r y

Proof of Address (Correspondence/Permanent)

Aadhar card Passport Voter ID card Driving License Ration Card Registered Lease Sale agreement of residence

Latest Gas Bill

Electricity Bill

Telephone[Landline] Bill

Others (please specify)

Not more than 3 months old. Please refer Sr. No. 2 of the instructions

5. CONTACT DETAILS

Landline Phone (with STD Code) Mobile + 9 1

Email ID

Do you want to subscribe to SMS Alerts : Yes No

Mobile number is essential for receiving sms alerts regarding your NPS account

6. OTHER DETAILS ( Please refer to Sr no. 3 of the instructions )

 Occupation Details [ please tick(√) ]

Private Sector Government Sector Public Sector Business Professional Agriculture

Homemaker Student NRI Other (please specify)

 Please Tick If Applicable Politically exposed person Related to Politically exposed Person

 Income Range (per annum) Upto 1 lac

1 lac to 5 lac

5 lac to 10 lac 10 lac to 25 lac 25 lac and above

 Educational Qualifications

Below SSC

SSC HSC Graduate Masters

Professionals ( CA, CS, CMA, etc.)

7. SUBSCRIBER BANK DETAILS ( Please refer to Sr no. 4 of the instructions )

Account Type [ please tick(√) ] Saving A/c Current A/c

Bank A/c Number

Bank Name

Branch Name

Branch Address PIN Code

State/U.T. C o u n t r y

Bank MICR Code IFSC Code

Afx

recent colour

photograph

3.5 cm X 2.5 cm

size

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8. SUBSCRIBERS NOMINATION DETAILS* (Please refer to Sr. No . 5 of the instructions)

Name of the Nominee (You can nominate up to a maximum of 3 nominees and if you desire so please fill in Annexure III (Additional Nomination Form) provided separately)

Nominee Name F i r s t M i d d l e L a s t

Relationship with the Nominee

Date of Birth (In case of Minor) d d / m m / y y y y

Nominee’s Guardian Details (in case of a minor)

Nominee’s Guardian F i r s t M i d d l e L a s t

9. NPS OPTION DETAILS (Please tick (√) as applicable)

I would like to subscribe for Tier II Account also YES NO If yes, please submit details in Annexure I. (Tier II account is not available for NPS Lite/

Swavalamban subscribers).

I would like my PRAN to be printed in Hindi YES NO If Yes, please submit details on Annexure II

10.PENSIONFUND(PF)SELECTIONANDINVESTMENTOPTION*

(i) PENSIONFUNDSELECTION(TierI):ThenamesoftheallPFsarementionedintheinstructionspageandareavailabletotheallsector

subscribers with following conditions:

(i) Government Sector: For Government Subscribers, the following PFs act as default PFs as per the guidelines issued by the Government:

(a) LIC Pension Fund Limited (b) SBI Pension Funds Pvt. Limited (c) UTI Retirement Solutions Ltd.

(ii) NPS Lite/Swavalamban: NPS Lite Swavalamban is a group choice model where subscriber has a choice of PF and investment option as available with Aggregator.

(iii) All Citizen Model: Subscribers under All Citizen model has the option to choose the available PFs as per their choice in the table below.

(iv) Corporate Model: Subscribers shall have the option to choose the available PFs as per the below table in consultation with their respective Employer.

Name of the Pension Fund PleaseTick(√) Availability of the Pension Funds

LIC Pension Fund Limited

Available to

Government

Sector

Available to

NPS Lite/

Swavalamban

Available to All

Citizen Model*

Available to

Corporate

Model*

SBI Pension Funds Private Limited

UTI Retirement Solutions Limited

ICICI Prudential Pension Funds Management Company Limited

Kotak Mahindra Pension Fund Limited

Reliance Capital Pension Fund Limited

HDFC Pension Management Company Limited

* Selection of Pension Fund is mandatory both in Active and Auto Choice. In case, you do not indicate a choice of PF, please note that it is deemed that you have consented

for the default PF specified by PFRDA. Currently, SBI Pension Funds Private Limited is the default PF.

 (ii) INVESTMENTOPTION(AvailableforAllCitizenModelandCorporateModelSubscribers)

( Please Tick (√) in the box given below showing your investment option).

Active Choice Auto Choice

For details on Auto Choice, please refer to the Offer Document. Please note:

1. In case you do not indicate any investment option, your funds will be invested in Auto Choice

2. In case you have opted for Auto Choice, DO NOT fill up section below relating to Asset Allocation. In case you do, the Asset Allocation instructions will be ignored

and investment will be made as per Auto Choice.

(iii)ASSET ALLOCATION (tobelleduponlyincaseyouhaveselectedthe‘ActiveChoice’investmentoption)

Asset Class

(Cannot exceed 50%)

C G Total

Note:- The total allocation across E, C and G asset classes must be equal to

100%. In case, the allocation is left blank and/or does not equal 100%, the

application shall be rejected.

11. DECLARATION BY SUBSCRIBER* ( Please refer to Sr no. 6 of the instructions )

Declaration & Authorization by all subscribers

I have read and understood the terms and conditions of the National Pension System and hereby agree to the same and declare that the information and documents furnished

by me are true and correct, to the best of my knowledge and belief. I undertake to inform immediately the Central Record Keeping Agency/National Pension System Trust,

of any change in the above information furnished by me. 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 further agree to be bound by the terms and conditions of provision of services by CRA, from time to time and any amendment thereof as approved by PFRDA, whether

complete or partial without any new declaration being furnished by me. I shall be bound by the terms and conditions for the usage of I-pin (to access CRA/NPSCAN and view

details) & T-pin on the CRA website.

Additional declaration by Swavalamban subscriber

I have read/explained to me and understood the Swavalamban guidelines and I meet the prescribed eligibility criteria for assistance under the scheme. I also undertake to

adhere to the prescribed contribution limit of minimum Rs. 1000/- and maximum of Rs. 12000/-, failing which the Central Government contribution credited to my account

may be forfeited along with such interest rates as may be prescribed.

Declaration under the Prevention of Money Laundering Act, 2002

I hereby declare that the contribution paid by me/on my behalf has been derived from legally declared and assessed sources of income. I understand that NPS Trust has the

right to peruse my financial profile or share the information, with other government authorities. I further agree that NPS Trust has the right to close my PRAN in case I am

found violating the provisions of any law relating to prevention of money laundering.

Date d d / m m / y y y y

Place :

Signature/Thumb Impression* of Subscriber in black ink

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

ACKNOWLEDGEMENT

Name of the Subscriber:

Contribution Amount Remitted: `

Date of Receipt of Application and Contribution Amount: d d / m m / y y y y

Stamp and Signature of the Employer/PoP/Aggregator:

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12. DECLARATION BY EMPLOYER/POP/AGGREGATOR

Applicable to Government Subscribers only

(SubscribersEmploymentDetailstobefilledandattestedbytheDeptt.(AllDetailsareMandatory)

Date of Joining d d / m m / y y y y Date of Retirement d d / m m / y y y y

Employee Code/ID

Group of Employee (Tick as applicable) Group A

Group B Group C Group D

Office

Department

Ministry

DDO Registration Number

DTO/PAO/CDDO/DTA/PrAO Registration Number Basic Pay

Pay Scale

It is certified that the details provided in this subscriber registration form by ______________________________________________________ employed with us,

including the address and employment details provided above are as per the service record of the employee maintained by us. Also, it is further certified that he/she has

read entries/entries have been read over to him/her by us and got confirmed by him/her.

Signature of the Authorised person

(In the box above)

Rubber Stamp of the DDO

(In the box above)

Signature of the Authorised person

(In the box above)

Rubber Stamp of the DTO/PAO/CDDO/

DTA/PrAO (In the box above)

Designation of the Authorised Person

Name of the DDO

Deptt/Ministry

Designation of the Authorised Person

Name of DTO/PAO/CDDO/DTA/PrAO

Date d d / m m / y y y y

Applicable to Corporate Subscribers only

(Subscribers Employment Details to be filled and attested by Corporate (All Details are Mandatory))

Date of Joining d d / m m / y y y y Date of Retirement d d / m m / y y y y

Employee ID

Corporate Regd. No Allotted by CRA CBO No. allotted by CRA

Certified that the details provided in this subscriber registration form by ________________________________________________________ employed with us, including

the employment details provided above are as per the service record of the employee maintained by us. Also, it is further certified that he / she has read the entries / entries

have been read over to him / her by us and got confirmed by him / her.

Date d d / m m / y y y y

Place

Signature of the Authorized Person (In the box above)

Rubber Stamp of the Corporate

(In the box above)

Designation of the Authorized Person:

TobefilledbyPOP-SP(OnlyincaseofAllCitizenModelorCorporatesubscribers)

Receipt No. (17 digits)

POP-SP Registration Number

Document accepted for date of Birth Proof:

Copy of PAN card submitted YES

NO KYC Compliance YES NO

 ExistingBankCustomer:

I/we hereby certify/confirm that Shri/Smt/Kum …..…………..........................................…………….......... is an existing customer of the Bank having fully operative Saving

Bank account no ...………......…....................................at ………......………..... branch and KYC norms required for opening Bank Account which match the requirements

for opening NPS account have been fully complied with. We further confirm that the S. B. a/c of Sh/Smt/Kum ……........….............................................................…..........

is not a ‘Basic Savings Bank Deposit Account’.

Adhaar Based KYC Certificate:

I/we hereby certify that Aadhaar Number ...………......…....................................of Sh/Smt/Kum………………….......................................................................…..has been

checked and the name and address mentioned on the original Aadhaar card are matching with that mentioned on NPS application form.

To be filled by POP-SP

Name:

Designation: Place:

POP-SP Seal Signature of Authorized Signatory

Date d d / m m / y y y y

DeclarationbytheAggregator(OnlyincaseofNPSLite/SwavalambanSubscribers)

 AuthorisationbyAggregator’soffice(NL-AO)

Certified that the subscriber is registered with the aggregator and he/she has opted to join NPS. I hereby declare that the subscriber is eligible to join NPS and the above

declaration has been signed /thumb impressed before me by ...................................................after (s)he has read the entries/ entries have been read over to her/him by me.

Signature of the Authorised person (In the box above) Rubber Stamp of the Aggregator (In the box above)

Name of the Aggregator

NPS Lite Account Office (NL-AO) Registration Number

NPS Lite - Collection Centre (NL - CC) Registration Number

Membership No. allotted by Aggregator (if any)

Place Date d d / m m / y y y y

[TobefilledbyCRA-FacilitationCentre(CRA-FC)]

Received by CRA-FC Registration Number

Received at Date d d / m m / y y y y

Acknowledgement Number (by CRA-FC)

PRAN Alloted

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INSTRUCTIONS FOR FILLING THE SUBSCRIBER REGISTRATION FORM

General Guidelines

(a) Please fill the form in legible handwriting so as to avoid errors in your application processing. Please do not overwrite. Corrections should be made by cancelling and re-writing

and such corrections should be countersigned by the applicant. Each box, wherever provided, should contain only one character (alphabet / number / punctuation mark) leaving

a blank box after each word.

(b) Applications incomplete in any respect and/or not accompanied by required documents are liable to be rejected. The application is liable to be rejected if mandatory fields are

left blank or the application form is printed back to back

(c) The subscriber should not sign across the photograph. The photograph should not be stapled or clipped to the form. If there is any mark on the photograph such that it hinders

the clear visibility of the face of the subscriber, the application shall not be accepted.

(d) Copies of all the documents submitted by the applicant should be self-attested and accompanied by originals for verification by the nodal office.

(e) Name and Address of the applicant mentioned on the form, should match with the documentary proof submitted.

(f) The subscriber’s thumb impression should be verified by the DDO/PAO/DTO/designated officer of POP-SP/Aggregator

(g) Government employees (mandatorily covered under NPS) may submit their application for Tier II to any POP-SP of their choice. The list of POP-SPs rendering services under

NPS is available on CRA website http://www.npscra.nsdl.co.in

S.No Item No. Item Details Instructions

1 1

Date of Birth Please ensure that the date of birth matches as indicated in the document provided in the support.

Father's Name

i. If father's name has more than 30 digits, you may fill Annexure II for the same.

ii. Father’s name is mandatory. However, if applicant does not want to provide father’s name, he/she has an option to provide

mother’s name on Annexure II and the mother’s name will be printed on PRAN card

iii. If the applicant wants mother’s name to be printed instead of Father’s name on PRAN Card, he/she must fill Annexure II

2 2, 3 & 4

Identity,

Correspondence &

Permanent address

details

S.No ProofofIdentity(Copyofanyone) S.No ProofofAddress(Copyofanyone)

1 Passport issued by Government of India. 1 Passport issued by Government of India

2 Ration card with photograph. 2 Ration card with photograph and residential address

3 Bank Pass book or certificate with Photograph. 3

Bank Pass book or certificate with photograph and

residential address

4 Certificate of the POP bank for an existing Bank customer. 4 Certificate of the POP bank for an existing Bank customer.

Voters Identity card with photograph and residential

address.

Voters Identity card with photograph and residential

address

6 Valid Driving license with photograph 6

Valid Driving license with photograph and residential

address

Certificate of identity with photograph signed by a Member

of Parliament or Member of Legislative Assembly

Letter from any recognized public authority at the level

of Gazetted officer like District Magistrate, Divisional

commissioner, BDO, Tehsildar, Mandal Revenue Officer,

Judicial Magistrate etc.

8 PAN Card issued by Income tax department 8

Certificate of address with photograph signed by a Member

of Parliament or Member of Legislative Assembly

Aadhar Card / letter issued by Unique Identification

Authority of India

Aadhar Card / letter issued by Unique Identification

Authority of India clearly showing the address

Job cards issued by NREGA duly signed by an officer of

the State Government

Job cards issued by NREGA duly signed by an officer of

the State Government

Identity card issued by Central/State government and its

Departments, statuary/ Regulatory Authorities, Public

Sector Undertakings, Scheduled commercial Banks, Public

Financial Institutions, Colleges affiliated to universities

and Professional Bodies such as ICAI, ICWAI, ICSI, Bar

Council etc.

The identity card/document with address, issued by

any of the following: Central/State Government and its

Departments, Statuary/Regulatory Authorities, Public

Sector Undertakings, Scheduled Commercial Banks,

Public Financial Institutions for their employees.

Photo Identity Card issued by Defence, Paramilitary and

Police departments.

Latest Electricity/water bill in the name of the Subscriber

showing the address (less than 3 months old)

Ex-Service Man Card issued by Ministry of Defence to their

employees.

Latest Telephone bill in the name of the Subscriber showing

the address (less than 3 months old)

14 Photo Credit card.

Latest Property/house Tax receipt (not more than one

year old)

Existing valid registered lease agreement of the house on

stamp paper ( in case of rented/leased accommodation)

Note:

(i) If the address on the document submitted for identity proof by the prospective customer is same as that declared by him/her in

the account opening form, the document may be accepted as a valid proof of both identity and address.

(ii) If the address indicated on the document submitted for identity proof differs from the current address mentioned in the account

opening form, a separate proof of address should be obtained. All future communications will be sent to correspondence

address. If correspondence & Permanent address are different, then proof for both have to be submitted.

(iii) In case of Government subscribers, the KYC documents may be submitted within a period of 30 days after generation of PRAN.

3 6

Other Details

(Occupation Details)

An NRI subscriber would need to furnish an Indian address for communication and bank details within India. Fund transfers by NRIs

would be subject to regulatory requirements as prescribed by RBI from time to time and FEMA requirements.

Politically Exposed

Person

Politically Exposed Persons’ (PEPs) are individuals who are or have been entrusted with prominent public functions in a foreign

country, for example heads of state or of the government, senior politicians, senior government, judicial or military officials, senior

executives of state-owned corporations, important political party officials.

4 7

Subscriber’s Bank

Details

For Tier I, bank details are optional. For activation of Tier II, bank details are mandatory. Please attach a Cancelled cheque (containing

Subscriber Name, Bank Account Number and IFS Code) or Bank Certificate containing Name, Bank Account Number and IFS code,

for direct credit or electronic transfer. In case if the cheque is not preprinted with name, additionally, a copy of the bank passbook or

bank certificate containing Name, Bank Account Number and IFS code should be submitted.

5 8

Subscriber’s Nomination

Details

In case of more than one nominee, percentage share value for all the nominees must be integer. Decimals/Fractional values shall

not be accepted in the nomination(s). Sum of percentage share across all the nominees must be equal to 100. If sum of percentage

is not equal to 100, entire nomination will be rejected.

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Declaration by

Subscriber

Signature / Thumb impression should only be within the box provided in the form. Thumb impression, if used, should be attested

by the nodal officer with the official seal and stamp. Left Thumb Impression in case of male and Right Thumb Impression in case of

female.

General Information for Subscribers

a) The Subscriber can obtain the status of his/her application from CRA and their designated nodal officer.

b) Subscribers are advised to retain the acknowledgement slip signed/ stamped by the designated nodal officer where they submit the application.

c) For more information / clarifications, contact CRA:

Website: https://www.npscra.nsdl.co.in

Call: 022-2499-4200

e-mail: [email protected]

Address: Central Recordkeeping Agency, NSDL e-Governance Infrastructure Limited, 1st Floor, Times Tower, Kamala Mills Compound, Senapati Bapat Marg,

Lower Parel (W), Mumbai - 400 013.