NATIONAL PENSION SYSTEM (NPS) - SUBSCRIBER REGISTRATION FORM

Central Recordkeeping Agency (CRA) - NSDL e-Governance Infrastructure Limited

Please select your category*: Central Govt. State Govt. All Citizen Model Corporate

To,
National Pension System Trust,

Dear Sir/Madam,

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

Affix recent colour photograph of 3.5 cm x 2.5 cm size

* indicates mandatory fields. Please fill the form in English and BLOCK letters with black ink pen.

2. PROOF OF IDENTITY (PoI)*:

Passport	Passport Expiry Date:
Voter ID Card	PAN Card
Driving License	Driving License Expiry Date:
NREGA JOB Card	UID (Aadhaar)

4. ADDRESS DETAILS*:

4.1 CORRESPONDENCE ADDRESS DETAILS*

Flat/Room/Block no.:

Premises/Building:

Road/Street/Lane:

Area/Locality/Taluk:

City/Town/District:

State/U.T.:

PIN Code:

4.2 PERMANENT ADDRESS DETAILS*

Tick if same as Correspondence Address.

Flat/Room/Block no.:

Premises/Building:

Road/Street/Lane:

Area/Locality/Taluk:

City/Town/District:

State/U.T.:

PIN Code:

5. CONTACT DETAILS:

Tel. (Off):

Tel. (Res):

Mobile:

Email ID:

7. SUBSCRIBER BANK DETAILS:

Account Type:Savings A/c Current A/c

Bank A/c Number:

Bank Name:

Branch Name:

Branch Address & PIN:

IFS Code:

MICR Code:

8. SUBSCRIBERS NOMINATION DETAILS*:

(You can nominate up to 3 nominees. If you wish to nominate more than one, please fill a separate Annexure.)

Nominee Name:

Relationship:

Date of Birth (if minor):

Nominee's Guardian Details (in case of a minor):

Guardian's Name:

9. NPS OPTION DETAILS:

I would like to subscribe for Tier II Account also:YES NO

I would like my PRAN to be printed in Hindi:YES NO

10. PENSION FUND (PF) SELECTION AND INVESTMENT OPTION:

(i) PENSION FUND SELECTION (Tier I): (Please select only one)

LIC Pension Fund Limited

SBI Pension Funds Private Limited

UTI Retirement Solutions Limited

ICICI Prudential Pension Funds Management Co. Ltd.

(ii) INVESTMENT OPTION: (Please select only one)

Active Choice Auto Choice

(iii) ASSET ALLOCATION (for 'Active Choice' only)

Asset Class	E (Equity <=50%)	C (Corporate Debt)	G (Govt. Bonds)	A (Alternative <=5%)	Total
Specify %					100%

(iv) AUTO CHOICE OPTION (for 'Auto Choice' only)

LC 75 LC 50 LC 25

11. DECLARATION BY SUBSCRIBER:

I have read and understood the terms and conditions of the National Pension System and hereby agree to the same along with the PFRDA Act, regulations framed thereunder 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 of any change in the above information. 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.

Date:

Place:

Signature/Thumb Impression of Subscriber

12. DECLARATION ON FATCA COMPLIANCE:

Section I: Are you a US Person?* Yes No

Section II: For the purposes of taxation, I am a resident in the following countries and my Tax Identification Number (TIN) is set out below:

Particulars	Country (1)	Country (2)
Country of tax residency
Tax Identification Number (TIN)
Address in jurisdiction

Date:

Place:

Signature/Thumb Impression of Subscriber

13. DECLARATION BY EMPLOYER (Applicable to Government Subscribers only)

Date of Joining:

Date of Retirement:

Employee Code/ID:

Group of Employee:A B C D

Office:

Department:

Ministry:

DDO Registration No:

DTO/PAO Reg. No:

It is certified that the details provided are as per the service record of the employee.

Signature (DDO)

Rubber Stamp (DDO)

Signature (DTO/PAO)

Rubber Stamp (DTO/PAO)

14. DECLARATION BY EMPLOYER/CORPORATE (Applicable to Corporate Subscribers only)

Date of Joining:

Date of Retirement:

Employee ID:

Corporate Regd. No (CHO):

Date:

Signature (Authorised Person)

Rubber Stamp of Corporate

16. TO BE FILLED BY POP-SP:

POP-SP Registration Number:

Receipt No:

Date:

Name:

Designation:

Signature of Authorized Signatory

POP-SP Seal

ACKNOWLEDGEMENT

[To be filled by CRA - Facilitation Centre (CRA-FC) / POP-SP]

Name of the Subscriber:

Contribution Amount Remitted: ₹

Date of Receipt:

Acknowledgement No:

PRAN Allotted:

Place:

Stamp and Signature of the Employer/PoP

NATIONAL PENSION SYSTEM (NPS) - SUBSCRIBER REGISTRATION FORM

1. PERSONAL DETAILS:

2. PROOF OF IDENTITY (PoI)*:

4. ADDRESS DETAILS*:

4.1 CORRESPONDENCE ADDRESS DETAILS*

4.2 PERMANENT ADDRESS DETAILS*

5. CONTACT DETAILS:

6. OTHER DETAILS:

7. SUBSCRIBER BANK DETAILS:

8. SUBSCRIBERS NOMINATION DETAILS*:

Nominee's Guardian Details (in case of a minor):

9. NPS OPTION DETAILS:

10. PENSION FUND (PF) SELECTION AND INVESTMENT OPTION:

(i) PENSION FUND SELECTION (Tier I): (Please select only one)

(ii) INVESTMENT OPTION: (Please select only one)

(iii) ASSET ALLOCATION (for 'Active Choice' only)

(iv) AUTO CHOICE OPTION (for 'Auto Choice' only)

11. DECLARATION BY SUBSCRIBER:

12. DECLARATION ON FATCA COMPLIANCE:

13. DECLARATION BY EMPLOYER (Applicable to Government Subscribers only)

14. DECLARATION BY EMPLOYER/CORPORATE (Applicable to Corporate Subscribers only)

16. TO BE FILLED BY POP-SP:

ACKNOWLEDGEMENT