NATIONAL PENSION SYSTEM (NPS)

eNPS Form
SUBSCRIBER REGISTRATION FORM (All Citizen Model)
Aadhaar based registration

√ Non Aadhaar based registration

Affix recent colour
To, photograph of 3.5
cm X 2.5 cm size
National Pension System Trust.
Dear Sir/Madam,
I hereby submit my eNPS subscriber registration form

* indicates mandatory fields.

1. PERSONAL DETAILS:
Name of Applicant in full Shri √ Smt Kumari

First Name * A M A N D E E P
Middle Name

Last Name K A U R

Date of Birth * 2 7 / 0 4 / 1 9 7 8

Gender * Male √ Female Others

Father's Name*

2. IDENTITY DETAILS*

PAN A T N P K 0 5 1 7 E Aadhaar 2 5 3 1 5 6 9 9 5 7 6 5 Voter ID Y U S 0 6 0 0 5 8 5

Passport L 1 0 6 1 1 5 6 Others

3. CORRESPONDENCE ADDRESS DETAILS*

Flat/Room/Door/Block no. HOUSE NO 1440-A

Landmark NEAR DS BODY BUILDER

Premises/Building/Village VILLAGE LAMBAPIND, PO CHOGITTI

Road/Street/Lane GT ROAD BYE PASS

Area/Locality/Taluka NEAR GURUDAWARA 6TH PATSHAHI

City/Town/District JALANDHAR PIN Code 144009
State/U.T. PUNJAB
Country INDIA

4. PERMANENT ADDRESS DETAILS: √ Tick ( √ ) in the box in case the address is same as above.
Flat/Room/Door/Block no. HOUSE NO 1440-A

Landmark NEAR DS BODY BUILDER

Premises/Building/ VILLAGE LAMBAPIND, PO CHOGITTI
Road/Street/Lane GT ROAD BYE PASS

Area/Locality/Taluka NEAR GURUDAWARA 6TH PATSHAHI

City/Town/District JALANDHAR PIN Code 144009

State/U.T. PUNJAB
Country INDIA
Proof of Address (Correspondence/Permanent)
Aadhaar 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)

5. CONTACT DETAILS
Landline Phone (with STD Code) Mobile + 9 1 9 8 1 5 5 7 6 0 7 1
Email ID DRAMANTHIND@YAHOO.CO.IN
Do you want to subscribe to SMS Yes √ No Mobile number is essential for receiving sms alerts regarding your NPS account

6. OTHER DETAILS
Occupation Details

Private Sector Government √ Public Sector Self Employed Professional Agriculture

Homemaker Student Other (please specify)

Please Tick If Applicable Politically exposed Related to Politically exposed

Income Range (per annum) Upto 1 lac 1 lac to 5 lac 5 lac to 10 √ 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:

Account Type Savings A/c √ Current A/c

Bank A/c Number 10992690396

Bank Name* STATE BANK OF INDIA
Branch Name JALANDHAR MAIN BRANCH
Branch Address CIVIL LINES, JALANDHAR, PUNJAB

Pin Code * 144001

State/U.T. PUNJAB
Country INDIA
Bank MICR 144002002 IFS Code SBIN0000660

8. SUBSCRIBER NOMINATION DETAILS*

Name of the Nominee provided

Nominee Name

Relationship with the Nominee Date of Birth (In case of Minor)

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

Nominee’s Guardian

9. NPS OPTION DETAILS

I would like to subscribe for Tier II Account YES NO √ (Please tick () as applicable).

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

(i) PENSION FUND SELECTION (Tier I) :

Name of the Pension Fund PFM Selected

LIC Pension Fund Limited

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

(ii) INVESTMENT OPTION

Active Choice Auto Choice √

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

(iii) ASSET ALLOCATION

Asset Class E C G A Total

(Cannot exceed 50%)

% share 63 13 24 100%

11. DECLARATION BY SUBSCRIBER*

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.

√ I agree to take a printout of the registration form from eNPS portal, paste photograph, affix signature and send it to CRA. I understand that my PRAN will be
‘frozen’ temporarily if the form is not sent to CRA within 90 days from the date of allotment of PRAN. (Applicable only for Aadhaar based Subscriber
Registration).
√
I understand that my initial contribution will be credited in my PRAN but I will not be able to make any further contribution till the KYC compliance is confirmed
by the Bank selected by me during registration. Once the KYC compliance is confirmed by Bank, I agree to take a printout of the registration form from eNPS
portal, paste photograph, affix signature and send it to CRA. I understand that my PRAN will be ‘frozen’ temporarily if the form is not sent to CRA within 90

√ I hereby declare that I am the bonafide subscriber of NPS and the contribution being paid for this transaction pertains to my PRAN. I further declare that
I will make payment from my bank account.
Declaration under the Prevention of Money Laundering Act, 2002
√ I hereby declare that the contribution paid by me has been derived from my 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 of Registration: 1 4 / 0 3 / 2 0 1 7

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: AMANDEEP KAUR
Acknowledgement 1 1 2 4 4 3 5 3
PRAN Allotted 1 1 0 1 8 1 1 3 0 7 4 2
Contribution Amount Remitted: 50000.00

Receipt Number 1 2 6 3 9 6 9 5 0 1 9 0 2 4 8 3 7

TO BE FILLED BY CRA
Received by

Received at Date

The subscriber is supposed to submit the physical form along with photograph and signature to CRA at the earliest. If forms are not received within
90 days of PRAN generation, the account will be frozen.

Physical form to be dispatched to the following Address:

Central Recordkeeping Agency (eNPS),

NSDL e-Governance Infrastructure Limited,
1st Floor, Times Tower, Kamala Mills Compound,Senapati Bapat Marg
Lower Parel (W), Mumbai - 400 013.
 Annexure II to eNPS Form

ADDITIONAL REQUEST DETAILS

1. Name of Father

First Name

Middle Name

Last Name

2. Name of Mother

First Name K U L W A N T

Middle Name

Last Name K A U R

3. Request for Printing Permanent Retirement Account Number (PRAN) card in Hindi (required only if applicant wants
PRAN card in Hindi)

Father/Mother’s Full Name in Hindi

Subscriber’s Full Name in Hindi (As selected in the Subscriber Registration form
Please refer Sr. No. 1 of the instructions.

First Name

Middle Name

Last Name

Name:

Place:

Signature/Thumb Impression* of Subscriber in black ink Date:

(* LTI (Left Thumb Impression) in case of male and RTI (Right Thumb Impression) in case of female)
 Annexure III to eNPS Form
ADDITIONAL NOMINATION FORM - TIER I

The details of nominees to whom the outstanding pension wealth of the subscriber is payable in case of the demise of the subscriber before entire
are withdrawn is to be provided hereunder. Also, please note that in case of demise of the subscriber after opting for deferred withdrawal,all the
pension wealth present in the NPS account of the subscriber shall be withdrawn upon receiving the request and paid to the nominees as mentioned
form and the same would be treated as full and final discharge of the obligation.

I, AMANDEEP KAUR hereby nominate the person (s) mentioned below who is/are
of my family to receive the amount in my PRAN account under National Pension System in the event of my death.

1. Name of the Nominee:

1st Nominee 2nd Nominee 3rd Nominee

First Name First Name First Name

MANMOHAN NAVLEEN

Middle Name Middle Name Middle Name

Last Name Last Name Last Name

SINGH
KAUR

2. Present Communication address of the nominees:

Address of 1st Nominee Address of 2nd Nominee Address of 3rd Nominee

H.NO 1440A, GT ROAD BYE PASS H.NO 1440A, GT ROAD BYE PASS

LAMBAPIND, P.O CHOGITTI LAMBAPIND, P.O CHOGITTI

NEAR DS BODY BUILDER NEAR DS BODY BUILDER

3. Date of Birth* (Only in case of a minor):

1st Nominee 2nd Nominee 2 7 / 1 2 / 2 0 0 7 3rd Nominee

4. Relationship with the Nominee:

1st Nominee 2nd Nominee 3rd Nominee

H U S B A N D D A U G H T E R

5. Percentage Share:

1st Nominee 7 5 % 2nd Nominee 2 5 % 3rd Nominee %

6. Nominee’s Guardian Details (Only in case of a minor):

1st Nominee 2nd Nominee 3rd Nominee

First Name First Name First Name

AMANDEEP

Middle Name Middle Name Middle Name

Last Name Last Name Last Name

KAUR

Signature/ Thumb Impression* of the Subscriber

Date of Registration: 1 4 / 0 3 / 2 0 1 7

*Note: Left thumb impression in case of illiterate male Subscriber and Right thumb impression in case of illiterate female subscriber must be obtained.