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i ~ A'i'!ON.AL PENSION SYSTEM (NPS) - SUBSCRIBER REGISTRATION FORM .I ~~ r,:;-:=:-:-~~~ra:-:-!_R_·_e_co~rd_k_s_e_p_Ti_n--:g:--A-g_e_n_c_y_(C_· _R_A_)=-=N=_s_o,L_e_-_G_o_v_e_r_n_a_n_c_e_l_n_fr_a_s--,tr,-u_c_t_u_re_L_im_it_ed __ ~ p;~,se select your category Central Govt. State Govt.
[ Please tick{ ✓)] All Citizen Model Corporate Sector NPS Ute (GOS) I ro, ~ ~\ a:icna! Pension System Trust.
~ u,,2r Sir/Madam, ~ I h,=reoy request that an NPS account be opened in my name as per the particulars given below:
I •;ncl_it:a!'.es. manda.{?"J fields. P~se fiU the fonn in En.-,··;;ti and BLOCK letters with black ink pen. (Refer general guidelines at instruclions page i .j ~ hlumoer, Retirement Adv,ser Code and Spouse Name fields are not applicable for Government & NPS Lit~ fubscribers r', r;I K YC Number {if applicable) I Retirement Adviser Code (If appLicable) '.' I 1. PERSOMAL DETAILS: (Please refer to Sr. No.1 of the inslructlons) N2me of Applicant in full Shri CJ Smt. [J Su:;scriber's Maiden Name (if any) Father's Name"' (Ri:le;: Si. No. 1 ot instructions) tAot11er·s i\lam,e"" \R.afer Sr. No. 1 of 1nstruc.tioris) Generated from Central KYC Registry Kumari [J Fn!<,~r's n~me will be pnnled on PRAN card . In case~ mother's name to be prin!€d inslead of father 's name j Please tick ( ✓ )] Affix rnc.ent colour photcgraph cf
3.5 cm x 2.5 cm size i Pass.port size I I Date of Birtn' I (Dale of Birth should be supported by relevant documentary proof) f, I "I l i . i ~ I : I '' : i City of Birth' Country of Birth ' Gender' [ Please iick ( ✓) J Marital Siatus* Sp:iuse Name' 1 J /Refer Si. Mo. 1 nf instructions} l . Residential Status' , 1 ___ _ ~ ' Maie [:J Married [J Indian Femaie [J Unmarried [J Others Natioriality• Others [] ! : ,', PROCF OF IDENTITY (Pol)' (Any one of the documents need to he provided along with the idenHication number) '' i Ve -er iC Card Dr;v:ng License l·IPEGA JOB Card Name of the ID Passport Expiry Data PAN Card Driving License Expiry Date In-Indian Please reft!r Sr. No. 2 of the instrurlh)nS.
l r-- ---------------------------------- --- ------- - ---- - ---------~ j ! UID (Aad~aar) i 1' [-7 I hereby aurhoriza CRA registered wilh Pension Fund Regulatory and Deveiopment Author,ty (PFRDA) to use my Aadhaar details for National Pension System (NPS) l , and authenticate my identity thrcugh the Aadhaar Authenticarion system /Aadhaar based e-KYC services of UIDAI) in accordance with the provisions of the Ar,<1haar · 1 /Targeted Delille')' of Financial and other Subsidies, Benefits and Se,vices) Acl, 2016 and tile allied rules and regulations notified thereunder I understand that the .
:l,, Aadhaar details {physical and I or digital. as the case mayf)e) submiited for availing services under NPS will be maintained in NPS till /he time lhe account ,s nol ! inactive in NPS or the timeframe decided b}' PFRDA, the regulator of NPS .. whichever is later. I understand that Security and confidentiality of personal iden!ity data i I provided, for the purpose of Aadhaar based authentication is enswred by CRA registered with PFRDA ti/i suc/J time it is acting as CRA for my NPS account.
; ; As per !he amendments made under Prevention of Money-Laundering /Maintenance of Records) Second Amendment Rules, 2017 Aadhaar and PAN ar, mandatory under 1 i /,1PS. If y,;u cio not have Asdhaar and I or PAN at present, please ensure that these details are provided witM~ six months of submission of this Subscriber Registraticn Form.
,j ;::-===================================================-====~ J r-3. PROOF Of ADOL::tESS (PoA)* Correspondence Address Permanent Address •~• j 1 [ P:ease tick ( ✓), as applicable J . Passport /Driving license/UID (Aadhaar)Noter ID card/NREGA Job Passport /Driving License/UID \A.adhaarjNoter ID card/NREGA Job ;/~ 01 ,m,e toan 3 moo1hs old. Card/Rat_ion Card/Others Card/Ration Card/Others ;, ! P•ease refer Sr. No. 2 af the instructions Registered Lease/Sale agreement cf residence Regislered Lease/Sal~ agreement of residence i : #Latest Gas/E~ril:ity/Telephone[Landline] Bnl #la lest Gas/Eleclriciiy/Tetepnone[Landlinel Bill 1 J l 4 .~ CORRESPONDENCE ADDRESS DETAILS• l ;
~ I . , Address Type• F:a t/RoorniDoor/Block no .
-~ P·r,rnises/BuildingNil!age ' j i , {oad/Street/La ne Residential/Business Residential Business Registered Office Landmark Unspecified 7 A,ea/l_ac;ality/Tall•k !
1 City!Town/D1strict PIN Code g J 1 1 '·1.I'' ~ I Stme!U.T.
!! = ============================:====i i I c; .• 2 PERMANENT ADDRESS DETAILS• [] Tick (✓) in the box in case the address is same as above ' i Address Type· Resideritial/Buslness Residential Business Registered Office Unspecified 11 l ! r. ,aVRoom 10 0or/Block no. Landmark I i ' ~.>,emises/Building/Vi!lage II i ;
1 : :::::oad/Slreet/Lane i t , Areailocaiity/Ta!uk i !
~ l City[fow~,/Oistrict PIN Code i ~ ,, ! j' ~ 1 ' ! c: ·1atc/U -r a ~ I ~ • • , . =•"''~ ~"!i,V?..:!lrJ'5~£~~~~ffl' _,...,..,,,..,,,.. cm-,- 1 Gf 5 r ~-...,r l .i ,~-·~ {!----~ -!:_ [ 5. ~ONTACT DETAILS t ·l - -· 1!'
I I I I L_ 7, I Tel. ~ (wilh STD code) ..- Tel. (Res): (with STD code) + "!:>Jil ":' ('vlandatory) + 9 1 (Mobile Number is requireri for comm,mication and to get SMS alerts) ·-·' c,il ID OThER DETAILS ( Please refer lo Sr no. 3 of the instructions) ,>- O ccupation Deta ils' [ please tick( ✓) ] Private Sector U Public Sector [J Government Sector [J Professional [J Self Employed O Homemaker O Student O Others (Please Specify) L; -----•-··- --··•·------ i ~ l ncome Range (per annum) Upto 1 ,.,c [J 1 lac to 5 lac [J 5 lac to 10 lac O 10 lac to 25 lac [J 25 lac and above [J ~ Educalional Qualifications Below SSC O SSC U HSC Ci Graduate [; M asters lJ Professionals ( CA. CS, CMA, etc.) [J '>' Please Tick lf Applicable Politically exposed person O Related to Politically exposed Person [-J (Please refer instruction no.3) SUBSCRiBER .BANK DETAILS• { Please refer ~Sr no, 4 of the instructions) !All tl'le bank details are mandatory except MICR Code. ) AcGount Type [ please tick(✓)] Savings Ale D Sa:1k Ale Number Bank Na1r,e Branch Name bfrlnCh Address Sa,.k M~CR Cods Curren t Ale CJ IFS Code PIN Code f f ,' -Sll BSCRIBERS NOMINATION DETAILS* -{Please referto Sr. No . 5 of the instructions) Na·';e ci the Nominee (You can nominate up to a ma~imum of 3 nominees and if you desire so please fill in Annexure Ill (Additicnal Nomination Form) provided separately) First Name Middle Na me Last Name ~~r~ 1t:1tionship with the Nominee f----------------·----··---·----·------·-·i .__ _____________ .... , __ i Date of Birth (In case of Minor) ',cn, inee's Guardi.an Details (in case of a m.inor) First Name Middle Name Last Name j '! i,;. t l r--S OIPTIOI\J Df;IAILS (Please tick { ✓) as applic,,ble) ~ l .would i ike to subscribe for Tier II Account also YES [j NO 1-i If Yes, ple~se submit details in Annexure I.
) 1 (,f you wish to activate Tier II account subsequenUy, you may submit separate application (Annexure S10) to the associated Nodal Office or to POP/POP-SP of your choice. The list of j i POP/PO?-SPs rendering ser,ices under NPS and Annexure S 10 Is available on CRA website) '. I I wculd iike my f>li:AN to be printed In Hindi YES [J NO Cl If Ves, please submit details on Annexure II 'j j1!!. Pi, 1S!ON FUND (PF) SELECTION AND INVESTMENT OPTION• 1 Please re fer to Sr no. 6 of the instructions) ~ 1 (i) PENSION FUND SELECTION (Tier I): Ple21se read below conditions before opting for the choice of Pension Funds:
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1. ·Government Sec!or: For Government Subscribers, the following PFs act as default PFs as per the guidelines issued by the Government:
(a) UC Pension Fund Limited (b) SBI Pension Funds Pvt. Limited (c) UTI Retirement Solutions Ltd .
2. All Citizen Model: Subscribers under All Citizen model have the option to choose the available PFs as per their choice in the table below.
3. Corporate Model: Subscribers shall have the option to choose the available PFs as per the below table In consultation with their respective Employer.
4. NPS Lite : NPS Lite is a group choice model where subscriber has a choice of PF and investment option as available with Aggregator.
' Name of the Pension Fund !Please select cmv onel Please Tick r ✓\ Availabitltv of the Pension Funds ' UC Pens10n Fund Limited --------<- - I I I Available to 1-SBI Pension Funds Private L1mi1ed --f"~tFGovernment ' -~-=-=--- Sector 1 IJT! Retirement Solutoons Limited : :
~ •~IC:! P;:;:;-denllal Pension Funds Management Company L,m1!e<l -- --=~-I~:~)~---- -.. _ ·- : Kotak Mahindra Pension Fund Limited , , l Retliance Capit,,I Pension Fund Limited l·----------- -------- - ----+--:::=:c.=:_.c-, -4 ! HDFC Pension Management Company Limited !
Available to NPS Lite Available to All Citizen Model" Avai iable lo C,:,rporate Model' ~ I I Bir/a Sun!ite Pension Management limited r i L=--=----=-,_';_-'------~ --·-.. -----"'----- - - ~------~ • Selection of Pansion Fund is mandatory both in Active and Auto Cnoice' ,
(ii) INVESTMEN ( OPtlON (fOlease Tick(•· ) in the box given below showing your investment option).
Acti,•e Choke [_.=] Auto Choice , __ ] Plea;;e note·
1. h ca-;;, yoo select Active Choice fill up section (iii) beiow and if you select Auto Choice fi ll up section (iv) below.
2. In case you do not indicate any investment option, your funds will be irwested in Auto Choice (LC 50). . . . . . . . ,
3. Ir, case you have opted for Auto Choice and fill up section (iii ) below relating to Asset Allocahon, the ,11,sset Allocat1on instructions will be ignored and investment w1I, be made as per Auto Choice (LC 50).
(iii) ASSET ALLOCATION (to be filled up only in case you have selected the 'Active Choice' investment option) -·--, I I c i G A Note: 1. The total allocation across E, C , G and ,A, asset cl8sses must be equal to 100%. In i I Ass,,1 Class , (Ca~not (Mas up to (Max ui; to (Cannot Total case, the allocation is left blank and/or does not equal 100%. the applicati~n shall be rejectedd l , _ ! esceed SO¾) 1oo¾) 100%) exceed 5%) 2. Asset class E-Equity and rela1ed instruments; Asset class C-Corporate debt and recla I 1e !
~ - i inslrumems; Asset class G-Govarrnent Bonds and related instrumenls; Asset ass · l __ :~~r~-•~ _ ! ______ .. L ___ .. ,_ .. _, - - '-----~ ... - ............. -----·-·- A-Alternat ive Investment Funds includin\l.insrruments like CMBS, MBS, REITS, A'.Fs, :nvlts etc. , /i, \ A uto Choice Option (to be filled up only in c..1s e you have selec ted the 'Auto Choice' investment vption). In case, you do not indicate a · c hoice of LC, yt;ur funds will be invested as per LC 50.
i Life CycIa (LC)Funds I Please Tick ( ✓) Only One I LC 75 l Note:
I LC 50, I I LC 25 I
1. LC 75. It is the Life cycle fund where the Cap '.o Equi.1y investments is 75:k of the total assei 2 LC 50- It is the Life cycle fund where the Cap to Equity investments 1s 50 1/a of the total asset 3: L.C 25- It is the Life cycle fund IA~iere the Cap to Equity investments is 25% of the total asset -------- ----- -- :~ .• 2 CSRF J· \. - -~' -~ · j ' 1' .. DECLARATION BY SUBSCRIBER* ( Please refer to Sr no. 7 of the inslruclio<'.s) ' I :~;:v:n~~:,.~:d:::~:::~~:::s 5 ::::::;i~i:ns of the National Pension System and hereby agree to the same along with the PFRDAAcl regulations framed thereunder f and oedare that the information and documents furnished by me are true and correct, to the best of my knowledge and belief. I undertake to 0 inform immediate ly the Centr"I ;,.'' ~ Reco,d Keepmg 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.
0 1 ,nderstanc that I shall be fully liable for submission of any false or incorrect inforrnafon or documents.
~ fun.her agree to be bound by the tenns and conditions of provision of services by CRA, from time lo lime and any amendment thereof as approved by PF ROA, whether 01 :o,nplete or partial without any new declaration being furnished by me. 1 shall be bound by the terms and conditions for the usage of I-PIN (to access CRA website and view I :,eta1ls) & T-l"IN.
--=----------------- ----- ---- Os-clarat ien under the Prevention of Money Laundering Act, 2002 , .-,.,eby declare lhat the contribution paid by melon my behalf has been derived from legally declared and assessed sources of inome. I understand that NPS Trust has 1 •11~ <,shl to peruse my financial profile or share the information, with other government autho1ities. I further agree that NPS Trust has the right to close my PRAN in case I am o,Jr l v,o:<1t1ng the provisions of any law relating to prevention of money laundering.
~------------•N>ON•--••••••N----•---~ Signature/Thumb Impression* of Subscriber in black ink I i ! \ _ =:==== = ===== = = =================== = :'.:::==~(*~L~T~l ~in~ca~s~e~o~f~m~a::'.le~a~"::d~R~T~l ~in~c~a~s::'.e~o~f~f~em~a~le::'.s~)= = ~ j 12. DECLARATION ON FATCA* (Foreign Account Tax Compliance Act) COMPLIANCE (Please refer to Sr no. 8 of the instructions):
1 1 S:,ct!on i ,.
LS Farson• Yes L_J No L __ _J j i 1 Section !l" i i I c• the purposes of taxation, I am a resident in the following countries and my Tax Identification Number (TIN)/functional equivalent in each country is set !. i 1 . out beiow or I have indicated that a TIN/functional equivalent is unavailable (kindly fill details of all countries of tax res idence if more than one):
l I l i l' Particula rs ro •,;try/countries of tax residency /.dd,css in the jurisdiction for Tax Residence Address Line 1 City/Town/Village State ZIP/Post Code Country (1 ) Country (2) Country (3) H i ·•ax Identification Number (TIN )/Functional equivalent Number l1 J 1 ... hi, Functional equivaient Number Issuing Country ll ,I 1 s'aiic,ity of documentary evkJence provided (Wherever applicable) 'l :i "! o=;nify that:
a) 11 shall be my responsibility to educate myself and to comply at al! times with all re levant laws relating to reporting under section 2858A of the Act read vAh the Rules 114F to 114H of the Income tax Rules, i 962 thereunder and the information provided in the Form is in accordance with the aforesaid 1! I it I i i b) the informat1011 provided by me in the Fann, its supporting Annexures as well as in the documentary evidence are, to the best of my knowledge and I , betief, true, correct and complete and that I have not withheld any material information that may affect the assessment/categorization of the account as j I a Reportable account or otherwise.
~ I c) ! ,,erm:t/authorise the NPS Trust to collect. store, communicate and process infom1ation relatin6 to the Account and all transactions therein, by the NPS ~ 11 T:usi and any of NPS intennediaries wherever situated including sharing, transfer and disclosure between them and to the authorities in and/or outside , ~: l:.Jia of any confdential information for compliance with any law or regulation whether domestic or foreign.
Y, i u,,de:-take thu responsibility to declare and disclose within 30 days from the date of change, any changes that may take place in the information p1o✓ided in the Form, its supporting Annexures as well as in the documentary evidence provided by me or if any certification becomes incorrect and to u:o;ide fresh self-certification along with documentary evidence.
;, I i "I , 3(so agree that in case of my failure to disclose any material fact known to me, now or in fu ture, the NPS Trust rnay report to any regulator and/or any a,,t",ori ly designated by the Government of India (GOI) /RBI/IRDA/PFROA for the purpose or take any other action as may be deemed appropriate by :h NPS Trust if the deficiency is not remedied by me, within the stipulated period.
• I nereby accept and acknowledge that the NPS Trust shall have the right and authority to carry out investigations from the information available in public , domain for confirming the information provided by me to the NPS Trus!
g) I 31so agree to furnish such information and/or documents as the NPS Trust may require from time to time on account of any change in law eithP.r in ,'1o ic1 or abroad in the subject matter herein. · ~) I ~hall indemnify N?S Trust for any loss that may arise to the NPS Trust on acco:.mt of providing incorrect or incomplete information.
D.;te Sign~ture/Thumb Impression• of Subscriber in black ink (• LTI in·case of male and RTI in case of females) / ,:
i .J ~.itt 0~1) SRF r - .. .. ..
' t.~ DECLARATION BY EMPLOYER ---i- Appl icable to Government Subscribers 011ty (Subscribers Employment Details to be filled and attested by the Deptt. (All Details are Mandatory) : ·f P. oi Joining I I Date of Retirement I I E,~.p,oyee Code/ID (If applicable) Employee Code/ID and PPAN are optional. If you intend I F?AN {If applicable) to provide, mention any one_ l Group of Employee (Tick as app!icable) Group A [~] Group B r- J Group C c=] Group D !__J ' Office i De~,artment I " ' Ministry I· DDO Regislration Number I I 11 DYO/PAOICDDO/DTA/PrAO Registration Number 11 Basic P2y ~ Pay Scale 1: 11 is certified tnat the details provided in this subscriber registration form by employed with us. including I I \!le address and employment details provided above are as per lhe service record of the employee maintained by us. Also, it is further certified that I' '.1·1~-:r·e h~_"._ rear:l entries/entries have been.read over to him/her by us and got confirmed by him/her.
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•·•· •n-"n - -....... -·-· · i ..• 3ignature of the Autho<ised person Rubber Stamp of the DDO Signature of the Authorised person Rubber Stamp of the DTO/PAO/CDDO/ (In the box above) (In the box above) (In the box above) DTA/PrAO (In the box ~iloVe) --I 'Jesignat,on of the Authorised Person Designation of the Authorised Person i ' ' ! tJa rn~ cf the ODO Na,11e of DTO/PAOICDOOIDTAIPrAO l ' !
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i 1 I i ..
~-~~pttH.Ji:1l:::.tr>1 Oa!e I , II ... .. , 1- - ,.
! ·j~j t ECLAP.ilff!ON BY EMPLOYER/ CORPORATE ...
l Applicable to Corporate Subscribers only ! (Subscribers Employment Details lo be filled and attested by Corpon,te (All Details are Mandatory)) i[ ..
\ .•at~ o" Jo1n1ng I I Date of Retirement I i !
;t-.r.pbyee Co::fe'ID ..
,:_orporate Regd. Number (CHO No.) Allotted by CRA -eo No. a!!otted by CRA _·,,r:it:H'. th.11 the details provided in this subscriber registration form by _ _ employed with us, including the s-:- :llo,. rnent details provided above are as per the service record of the employee maintained by us. Also , it is furthe~ certified that he/ she has read the ',•,ies I entr'es have been read over to him/ her by us and got confirmed by him/ her.
f C ,, I I Place - '" .w•-••• ••• l ;
i: ., i h -- Signature ot the Authori£ed person (In the box above) i " ·-···- --J ;\ __ ---- -.. ·--~---· I II Rubber Stamp of the Corporate (In the box above ) C:?~.,;nr, s~ion of t1e Authorised Person L - - !:;. OECLARAT10lJ ev THE AGGREGATOR Apj:>licable to NPS Lita Subscribers A~thori,s.ition by A.ggregator 's office (NL -AO) I Ceriified that the subscriber is registered with the aggregator and he/she has opted to join NPS. I hereby dedare that the subscriber is eligible to join NPS I and tf-se above declaration has been signed /thumb impressed before me by ...................... .... ................ ... ..... after (s}he has read the entries/ entries have i bP.er. read over to her/him by me. I I -----· --- ••-n••• ••••• • · ·-••• • • •• I ;
I I ····- ------- -- . -· Rubber Stamp of the Aggr.,gator (In the box above) _ . -·-·- - --·-·· Signature of the Authorised person (In the box above) ,. ... - - ·, ""'" of the Aggregate, ··-· ··-- ··-··· ... --·-·· .....
i NPS Ure - Collection Centre (NL - CC) Registration Numbe1 ' I >,PS Lite Account Office (NL-AO) Reg istration Number I ..... · ·--· -·-- ' ~•9mbersnir• l•o. allotted by Aggrega:or (if any) i - __ J _____ \---- -•···· --·= -~--·---•~···--· .......... ........... ··-· ·· -·-··· ···-·-··-·--·--·-.-•-··· ! Face Date : ' _I ! ,, I i ..... · ·· • ..
----· •~.1,.1;:m:~• .... ....,.. I ■ ff!fl'l',W 4 of 5 fer I 2 f.-~- I' Hi. TO "BE FILLED BY POP.SP ~ ece, No. (1 7 digits) I;
PO P-SP Registration Number . I i I j Document accepted for dale of Birth Proof :
Copy ,::>f PAN card submitted Docc;ments Received :
dentity Verification :
-':~isting Bank Customer:
YES [ J NO (Originals Verified) Self Certified KYC Compliance (Attested) True Copies .wi: '>ereby certify/confirm that Shri/Smt/Kum .... . ............ .. .. .. .... ..... ...................... .. .... .is an existing customer of the Bank having fully operative ·savi:1g Bank account no ............... ... .......................... at.. .... .... .. .. ............. .... ......... .. ... branch and KYC nomls required for opening Bank Account •·Jt-k'i match the requirements for opening NPS account have been fully complied wit:,. We further conform that the S. B. ale of Sh/Smt/Kum .... .. ........ .. .... .. .. ... . .. . is not a 'Basic Saving1c--8ank Deposit Account' '\clhaar Bas.id KYC Certificate :
!we hereby certify that Aadhaar Number ... ... ........ .............. .. of Sh/Smt/Kum ..... ... . . . . . . . . . . . . . .. ...... . . , .. .... .. .. ... has been checked and the name a · nd address mentioned on the original Aadhaar card are matching with that mentioned on NPS application form.
•---· Name:
Desig~ation: Place:
POP-SP Seal Signature of Authorized Signatory Date I I L ,i [To be filled by CR.&. - Faci litation Ceotre (CRA·FC)] CRA-FC Registration Number :c:: .:ved at Date ·, o.viecgeme:-it Number (by CRA·FC} '-'Rf N Alloted --- . -•· -- . -·-· .... - ·-· ... ------ .. ·-·-······· - ·------·- . ···· ···· ··· .. · ·-· · -· -·- ··· ··· ·· ........... -. -· ···· ---· ··········· · ·· ·· · ·--· ···· ··-·· ··· ··· -·· ··- ·- ·-- · · - ACKNOWLEDGEMENT :'Jame of the Subscriber:
Cor,!rib ution Arncunt Remitted:
uate of Receipt of Applica tion and Contribution Amcun!:
Stamp and Signature of the Employer/PoP:
csrran - 5 of 5 nin '-: ,,;.,,.;;......,,.....,. .. ,..,,..,..,,,.,..._..., ... ""':~=:':'~~~~~'".'."'"""...,. ___ ....,_.,.....,_, ______ ...., ______________ _;,:;----------C;;;;;;J.~S1R!,j· ~F,.
1t.ilNSTRUCTIONS FOR FILLING THE SUBSCRIBER REGISTRATION FOl-{M ~:
ii ,, '1 1 i 'J l l • i ' j 1 l '-!
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i Ii ;j i I ~ ~ I ~ ,, f f' ~ ~ 5 6 7 r.} 6, General Guidelines -~•.e~~ - 1 .. 1 :'"' for~\ in legible handwriting_ so as lo avoid errors in your application processing . Please do not overwrite. Corrections should be made by cancelling and re-wnting '" b'" ~,,,,hb corrections should be countersigned by the applicant Each box, wherever provided, should contain only one character (alphabet/ number/ punctuation mark) leaving -. ,,in, oo aft,er each word.
'n ca~e. ,you mention the_ KYC number submission of proof ior the same is necessary.
~,ppli<::9t,ons incompl_ete _,n any r~specl and/or not accompanied by required documents are liable to be rejected. The application is liable ta be rejected if mandatory field~ are ,dr blank or the appltcahon form ts pnnted back to back :r:e "subscriber. should not sign across the_pholograph .. Th~ photograph should not be stapled or clipped to the form . If there is any mark on the photograph such that it hinders r:' ~ clear v1s1b11ity of 1he face o f the subscriber, tt\e application shai! not be accepted.
l..~p,es of/II th~ ~oc~ments submitted by the applicant should be self-attes1ed and accomparned by originals for verification by the nodal office.
~ "me anu Add '.e,,_s a, t~e _applicant mentioned on the form, should match with the documentary proof submitted.
r he su oscnber s tr,umo s 1mpress1on snould be verified by the desig r,eted officer of POP-SP / Nodal Office.
tem l·!o.
2, 'l & 4 6 10 11 12 !!em Details Personal Details Spouse Name Father's Name Mother's Name Date of Birth Identity, Correspondence & Permanent address details Politically Exposed Person Subscriber 's BanK Details Subscriber's Nomination Del3ils Pension Fund (PF) Selection and Investment Option Declar.;_ lion by Svbscriber Declaration by subscri 1er on FATCA C:,ompl iance lns truct~ons i. This Form is applicable to Resident Indians and there is a separate Form for Non Resident Indians.
ii: Currently, Foreign Nationals/ Other Country Individuals (OCI) and Persons of Indian Origin (PIO) are not allowed to open PRAN.
111. The appltcant shall mention fa ther's name and mother's name and shall select the option to be printed on PRAN Card.
If married, spouse name is l'f'..indatory.
i. Father's name is mandatory.
ii. If father's name ha.~cnore than 30 digits. you may fi ll Annexure II for the same.
i. Mother's name is mandate,")!
ii. If Mother's name has more than 30 digrts. you rnay fill Annexure ti fer the same.
Please ensure that th~ate of birth matches as indicated in the document provided in the supper!.
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 priotograph and residential address 3 Bank Pass book or certificate with Photograph. 3 Bank Pass book or ~ertificate with photograph and residential address 4 5 6 7 8 :Certificate of the POP bank for an existing Bank customer.
Voters identity c,,rd with photograph and ,esideritial address.
Va!id Driving license with photograph Certificate.of identity witl1 photograph signed by a Mernber of Par1iament or M~mber of Legislative Assembly PAN Ca;d issued by Income tax department 9 Aadhar Card / letter issued by Unique Identifica tion Authority of!ndia 10 Job cards issued by NREGA duly signed by an officer of t~.e State Government ·11 Identity. card issued by Central/State government and its Departmer.ts, statuary/ Regulatory Aut11orities, Public Sectar Unde11akings, Scheduled commercial Banks, Public Financial Institutions, Col!eges affiliated to un iversities and Professional Bodies such as ICAI, ICWAI, ICSI, dar Council elc.
12 Photo. Identity Card issued by Defence, Paramilitary and Police departme,11·s 13 Ex-Service Man Card issued by Ministry of Defence to !heir employees.
14 Photo Credit card .
Note:
4 Certificate of the POP bank for an existing Bank customer.
5 Voters Identity card with photograph and residential address 6 7 8 Valid Driving license with photograph and residential address Letter from any recognized public authority al the level of Gazetted officer like District Magistrate, Divisional mmmissioner, BOO, Tehsildar, Manda! Revenue Officer, Judicial Mag,slrate etc.
Certificate of address w ith pl1otograph signed by a Member of P3rliament or Member of Legislative Assembly 9 Aadhar Card / letter issued by Unique Identification Authority of India clearly showing the address 10 Joh cards issued by NREGA duly signed by an officer of the State Government 11 The identity card/document with address. issued by any of the fo llowing: Central/State Government and its Departments, Statuary/Regulatory Authorities, Public Sector Undertakings, Scheduled Commercial Banks, Public Financial Institutions for their employees.
12 Latest Electricity/water bill in the name of the Subscriber I Claimant and showing the acid ress (less than 3 months old) '. 3 Laiest Teleohone bill in the name of the Subscriber I Claimant and showing the address (less than 3 months old) 14 Latest P1opertyihouse T,x receipt (not more than one year old) 15 Exist ing valid regislered lease agreemenl of the house on stamp paper ( in case of rented/leased acccmmodat,on)
(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 !orm, the document may be accepted as a valid proof of br;th identi ty and address.
{ii) If the address indicated on the document submiited for identity proof differs from the current address mentioned in the account opening form, a separate proof of address should be obtained. All future ccrr;munications w il! be sent to correspondence address. If correspondence & Permanent address are d ifferent, then proof for both have lo be su[)n,itted.
(iii) The KYC documents may be submitted within a period of 30 days after generation of PRAN. (Only for Government Subscribers) Politically Exposed Persons' {PEPs) are ind ividuals who are or have been entrusted with prominent public functions in a foreig n country. for example heads of state or of the government, senior politicians, senior government. judicial or milit,ry officials. senior f'-Xecut ives of slate owned corporations, irnportant political party officials.
For Tier I & Tier II , bank details are mandatory and it should be supported by cance!led cheque. Please attach a Cancelled cl1eque (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 lhe bank passbook or bank cerlificale cor1ta!nirig Name, BanX Accou!1t l'-Jumber and IFS code should be submitted.
In case of more th.an one nominee, percentage share value for all the nominees must be integer. Decimals/Fractional values shall not be accepted in the nomirution(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 reject~ .
For more details on 'Investment Option', you may visit CRA website.
Subscribers from Government sector are currently not allowed to exercise 111e investment option . As mentioned, your contribution will be invested by defau!t PF s as per the guidelines issued by the Government.
Signature / Thumb impression should on ly be within the box provided in the form. Thumb impression, if used, should be attested by the designated officer of POP/POP-SP/Nodal office wrth the official seal and siamp. Left Thumb lmpre~sion in case of males and Right Thumb Impression in case of femaies.
Clarification/ Guidelines on filling details ii appli~.ant residence for tax purposes in jurisdiction(s) outside India . . . .
, Jurisdiction(s) of Tax Residence: Since US taxes the global income of its citizen, every US citizen of whatever nattonahty, 1s also a resident for tax purpose in USA. . _ . . . . . . .
TaK identif,cation Number (TIN): TIN need not be reported if it has nor been issued by the junsdtc!ton. However, 1f the said JUnsd1c~on h;as issued a high integrity number with an equ ivalent level of identification (a "Functional equivaler,t"). the. same may be reported . Examples of that type of number for ind11iidual include, a social security/insurance number, citizen/personal 1dent1fication/serv1ces code/number and resident registration number) . . . .
If applicant residence for tax purpose in jurisdiclion(s) within India, Permanent Account N·Jmber (PAN) to be prov,deo as Tax ldent1ficat1on Number {TIN) . . . 'd · R \ · I f In case applicant is declaring US person s!ah,s as 'No' but his/her CDuntry of Birth 1s US, document ev1 enc1ng e 1nqu1s 1ment o Citizenship s.houlC be provictea o r reasons tor not having relinquishment certificate is to be provided Gener~! Information for Subscribers Tne S'.lbscnbar can obtain the status of his/her 2;:,::)licat ion from CRA and therr designated nodal officer. . . . .
s"t,s:.ibers a,e advised to retain the acknowledgement slip signed/ stamped by the designated nodal officer where they submit the app l1cat1on.
;::?; '°nore informoticr. l clarifications, contact CRA:
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