Acknowledgement No.:

Permanent Retirement Account Number:

(To be filled by FC)

Application for Allotment of Permanent Retirement Account Number (PRAN)

(To avoid mistake(s), please follow the accompanying instructions and examples carefully before filling up the form)

Sir/Madam,

I hereby request that a permanent retirement account number be allotted to me. I give below necessary particulars:

To affix recent Coloured photograph (3.5 cm x 2.5 cm)

Section A - Subscriber's Personal Details (* Indicates Mandatory Field)

Please Tick as applicable: Shri Smt. Kumari

1. Full Name (Full expanded name: initials are not permitted)

First Name*: Middle Name: Last Name:

Signature/Left Thumb Impression

2. Gender*: Male Female

3. Date of Birth*:

4. PAN:

5. Father's Full Name:

First Name*: Middle Name: Last Name:

6. Present Address:

Flat/Unit No, Block no.*:

Premise/Building/Village:

Area/Locality/Taluka:

District/Town/City:

State/Union Territory:

Country:

Pin Code*:

7. Permanent Address:

If same as above, Please Tick

Flat/Unit No, Block no.*:

Premise/Building/Village:

Area/Locality/Taluka:

District/Town/City:

State/Union Territory:

Country:

Pin Code*:

8. Phone No:

9. Mobile No:

10. Email ID:

11. Subscriber's Bank Details:

Account Type: Savings A/c Current A/c

Bank A/c Number:

Bank Name:

Bank Branch:

Bank Address & Pin:

Bank MICR Code:

12. Value Added Services:

i) SMS Alert:Yes No

ii) Email Alert:Yes No

I, the applicant, do hereby declare that what is stated above is true to the best of my information & belief.

Date:

Signature/Left Thumb Impression of Subscriber

Section B - Subscriber's Employment Details to be filled and attested by DDO (All Details are Mandatory)

1. Date of Joining:

2. Date of Retirement:

3. PPAN:

4. Group of the Employee: Group A Group B Group C Group D

5. Office:

6. Department:

7. Ministry:

8. DDO Registration Number:

9. DTO Registration Number:

10. Basic Salary:

11. Pay Scale:

Certified that the above declaration has been signed/thumb impressed before me after he/she has read the entries. Also certified that the date of birth and employment details is as per employee records available with the Department.

Signature of the Authorised Person

Designation:

Date:

Rubber Stamp of the DDO

Name of the DDO:

Department/Ministry:

Section C - Subscriber's Nomination Details (* Indicates Mandatory Field for nominee)

Details	1st Nominee	2nd Nominee	3rd Nominee
1. Name*
2. Date of Birth (minor)*
3. Relationship*
4. Percentage Share*
5. Guardian's Name (minor)*

Section D - Subscriber Scheme Details

	1st Scheme	2nd Scheme	3rd Scheme
Pension Fund Manager Name
Scheme ID No./Name
Percentage Share

Section E - Declaration

I understand that there would be PFRDA approved Terms and Conditions for Subscribers on the CRA website governing I-Pin & T-pin. I agree to be bound by the said terms and conditions and understand that CRA may, as approved by PFRDA, amend any of the services completely or partially without any new Declaration/Undertaking being signed.

I, the applicant, do hereby declare that what is stated above is true to the best of my information & belief.

Date:

Signature/Left Thumb Impression of Subscriber