1.

(NPS A/c Opening ) Duplicate

Page 1
Application for Allotment of Permanent Retirement Account Number (PRAN)
(To avoid mistake(s), please follo t!e accompan"ing inst#uctions and e$amples ca#efull" %efo#e filling up t!e fo#m)
Acknoledgement No.
(To %e filled %" &')

Pe#manent (eti#ement Account Num%e# )
(To %e filled %" &' afte# P(AN gene#ation )
To affi$ #ecent
'olou#ed p!otog#ap!
(*.+ cm , -.+ cm)
Si#/.adam,
/ !e#e%" #e0uest t!at a pe#manent #eti#ement account num%e# %e allotted to me.
/ give %elo necessa#" pa#ticula#s )

Section A - Subscribers Personal Details ( 1 /ndicates .andato#" &ield) Signatu#e/2eft T!um% /mp#ession
of Su%sc#i%e# in %lack ink
1. &ull Name (&ull e$panded name) initials a#e not pe#mitted)
Please Tick as applica%le, S!#i Smt . 3uma#i
&i#st Name 1
.iddle Name
2ast Name 1

-. 4ende# 1 Please Tick as applica%le, .ale &emale

*. Date of 5i#t! 1 6. PAN
D D . . 7 7 7 7 (Date of 5i#t! to %e 'e#tified %" DDO)
+. &at!e#8s &ull Name)
&i#st Name 1
.iddle Name
2ast Name 1
9. P#esent Add#ess)
&lat/:nit No, 5lock no. 1
Name of P#emise/5uilding/;illage
A#ea/2ocalit"/Taluka
Dist#ict/Ton/'it" 1
State / :nion Te##ito#" 1
'ount#" 1
Pin 'ode 1
<. Pe#manent Add#ess) /f Same as a%ove, Please Tick else,
&lat/:nit No, 5lock no. 1
Name of P#emise/5uilding/;illage
A#ea/2ocalit"/Taluka
Dist#ict/Ton/'it" 1
State / :nion Te##ito#" 1
'ount#" 1

Pin 'ode 1

=. P!one No.
STD 'ode P!one No.

>. .o%ile No.

?P(AN file@ Duplicate (>)
1A. Bmail /D
11. Su%sc#i%e#s 5ank Details) Please #efe# inst#uction no. f (6) Savings A/c 'u##ent A/c
5ank A/c Num%e#
5ank Name
5ank 5#anc!
5ank Add#ess
Pin 'ode
5ank /&S' 'ode (/f /&S' code is not availa%le t!an p#ovided ./'()
5ank ./'( 'ode
1-. ;alue Added Se#vices) i) S.S Ale#t 7es No
ii) Bmail Ale#t) 7es No
/ CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC , t!e applicant, do !e#e%" decla#e t!at
!at is stated a%ove is t#ue to t!e %est of m" info#mation D %elief.

Date )
D D . . 7 7 7 7
Section B - Subscribers Employment Details to be filled and attested by DD (All Details a#e .andato#")
1. Date of Eoining -. Date of (eti#ement

D D . . 7 7 7 7 D D . . 7 7 7 7

*. PPAN (Please #efe# to inst#uctions No.+.)
6. 4#oup of t!e Bmplo"ee (Please Tick) 4#oup A 4#oup 5 4#oup ' 4#oup D
+. Office

9. Depa#tment
<. .inist#"

=. DDO (egist#ation No >. DTO (egist#ation No

(Please #efe# to inst#uctions No.9.)

1A. 5asic Sala#"

11. Pa" Scale
'e#tified t!at t!e a%ove decla#ation !as %een signed / t!um% imp#essed %efo#e me %" CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
afte# !e / s!e !as #ead t!e ent#ies / ent#ies !ave %een #ead ove# to !im / !e# %" me and got confi#med %" !im / !e#. Also ce#tified t!at t!e date of %i#t! and
emplo"ment details is as pe# emplo"ee #eco#ds availa%le it! t!e Department!

Signatu#e of t!e Aut!o#ised Pe#son

Designation of t!e Aut!o#ised Pe#son ) CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
Name of t!e DDO CCCCCCCCCCCCCCCCCCCCCC
Date )
D D . . 7
7 7 7 Depa#tment / .inist#" CCCCCCCCCCCCCCCCCCCCCCC
Signatu#e/2eft T!um%
/mp#ession of Su%sc#i%e#
(u%%e# Stamp of t!e DDO
*. (NPS A/c Opening ) Duplicate
Section " - Subscriber#s Nomination Details (1 /ndicates .andato#" &ield fo# nominee)
1. Name of t!e Nominee 1)
1st Nominee -nd Nominee *#d Nominee
&i#st Name 1 &i#st Name 1 &i#st Name 1
.iddle Name .iddle Name .iddle Name
2ast Name 1 2ast Name 1 2ast Name 1
-. Date of 5i#t! (/n case of a mino#)1)
1st Nominee -nd Nominee *#d Nominee
*. (elations!ip it! t!e Nominee1)
1st Nominee -nd Nominee *#d Nominee

6. Pe#centage S!a#e 1)
1st Nominee F -nd Nominee F *#d Nominee F

+. Nominee8s 4ua#dian Details (in case of a mino#)1)
1st Nominee8s 4ua#dian Details -nd Nominee8s 4ua#dian Details *#d Nominee8s 4ua#dian Details
&i#st Name 1 &i#st Name 1 &i#st Name 1
.iddle Name .iddle Name .iddle Name
2ast Name 1 2ast Name 1 2ast Name 1
9. 'onditions #ende#ing nomination invalid)
1st Nominee -nd Nominee *#d Nominee
Section D - Subscriber Sc$eme Details
1st Sc!eme -nd Sc!eme *#d Sc!eme
Pension &und .anage#s Name/'ode Pension &und .anage#s Name/'ode Pension &und .anage#s Name/'ode
Sc!eme /D No./Name
Pe#centage S!a#e
F
Sc!eme /D No./Name
Pe#centage S!a#e
F
Sc!eme /D No./Name
Pe#centage S!a#e
F
Section E - Declaration
/ unde#stand t!at t!e#e ould %e P&(DA app#oved Terms and Conditions fo# Su%sc#i%e#s on t!e '(A e%site governing I-
Pin (to access CRA / NPSCAN and view details) & T-pin. / ag#ee to %e %ound %" t!e said te#ms and conditions and unde#stand
t!at '(A ma", as app#oved %" P&(DA, amend an" of t!e se#vices completel" o# pa#tiall" it!out an" ne
Decla#ation/:nde#taking %eing signed.

/ CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC , t!e applicant, do !e#e%" decla#e t!at
!at is stated a%ove is t#ue to t!e %est of m" info#mation D %elief.
Date )
D D . . 7 7 7 7
Anne%ure S1 Page &
'NS(R)"('NS *R *'++'N, PRAN *R-
a) &o#m to %e filled legi%l" in 52O'3 2BTTB(S and in 52A'3 /N3 onl".
b) Details -ar.ed /it$ (0) are t$e mandatory fields!
c) Bac! %o$, !e#eve# p#ovided, s!ould contain onl" one c!a#acte# (alp!a%et/num%e#/punctuation ma#k) leaving a %lank %o$ afte# eac! o#d.
d) G/ndividualG Su%sc#i%e# s!ould affi$ a #ecent colou# p!otog#ap! (siHe *.+ cm $ -.+ cm) in t!e space p#ovided on t!e fo#m. T!e p!otog#ap! s!ould not
%e stapled o# clipped to t!e fo#m. (T!e cla#it" of image on P(AN ca#d ill depend on t!e 0ualit" and cla#it" of p!otog#ap! affi$ed on t!e fo#m.)
e) Signatu#e /2eft t!um% imp#ession s!ould onl" %e it!in t!e %o$ p#ovided in t!e fo#m. T!e signatu#e s!ould not %e on t!e p!otog#ap!. /f t!e#e is an"
ma#k on t!e p!otog#ap! suc! t!at it !inde#s t!e clea# visi%ilit" of t!e face of t!e Su%sc#i%e#, t!e application ill not %e accepted.
f) ($umb impression1 if used1 s$ould be attested by a -agistrate or a Notary Public or a ,a2etted fficer under official seal and stamp!
Sr!
No!
'tem No 'tem Details ,uidelines for *illing t$e *orm
Section A - Subscribers Personal Details
1 *. Date of 5i#t! All Dates S!ould %e in IDD..7777J &o#mat
- 9. P#esent Add#ess All futu#e communications ill %e sent to p#esent add#ess.
* =, >, 1A
P!one No., .o%ile No,
D Bmail /D
/t is advisa%le to mention eit!e# ITelep!one num%e#J o# I.o%ile num%e#J o# IBmail
idJ so t!at Su%sc#i%e# can %e contacted in futu#e fo# an" disc#epanc".
6 11
Su%sc#i%e#8s 5ank
Details
/f Su%sc#i%e#s mentions an" of t!e %ank details, e$cept ./'( 'ode all t!e %ank
details ill %e mandato#".
Section B - Subscribers Employment Details
/t is mandato#" to fill t!e Su%sc#i%e#8s Bmplo"ment details in t!e application. T!e emplo"ment details s!ould %e filled %" t!e #espective DDO of t!e
Su%sc#i%e# and s!ould %e ve#ified %" t!e Aut!o#ised Signato#".
DDO s!ould #atif" Ove##iting / St#iking off of an" of t!e emplo"ment details.
+ *. PPAN
3indl" p#ovide t!e PPAN (Pe#manent Pension Account Num%e#), if it !as %een
allotted to t!e su%sc#i%e# %" t!e conce#ned PAO.
9 = D >
PAO/'DDO . o. /D D
DDO /D. o.
PAO/'DDO . o./D and DDO . o. /D is t!e uni0ue identification num%e# allotted %"
'ent#al (eco#d 3eeping Agenc".
Section " - Subscriber#s Nomination Details
< 6. Pe#centage S!a#e
Su%sc#i%e# can nominate ma$imum of t!#ee nominees.
Su%sc#i%e# can not fill t!e same nominee details mo#e t!an once.
Pe#centage s!a#e value fo# all t!e nominees must %e intege#. &#actional value ill not
%e accepted.
Sum of pe#centage s!a#e ac#oss all t!e nominees must %e e0ual to 1AA. /f sum of
pe#centage is not e0ual to 1AA, enti#e nomination ill %e #eKected.
= +.
Nominee8s 4ua#dian
Details
/f a nominee is a mino#, t!en nominee8s gua#dian details ill %e mandato#".
Section D - Subscriber sc$eme details
/f t!e Su%sc#i%e# is una%le to mention t!e Sc!eme details i.e. P&. Name, Sc!eme Name D Pe#centage Allocation !e can contact t!e nea#est
&acilitation 'ent#e (&') fo# info#mation o# t!e Su%sc#i%e# can also sea#c! fo# t!e sc!eme details on !ttp)//.npsc#a.nsdl.co.in
> Sc!eme
Su%sc#i%e# can select ma$imum t!#ee sc!emes. Details of t!e sc!emes a#e availa%le on
!ttp)//.npsc#a.nsdl.co.in
Su%sc#i%e# can not fill t!e same sc!eme details mo#e t!an once.
/f a sc!eme name is filled in t!e fo#m fo# sc!eme setup t!e#e must %e a P&. name and pe#centage cont#i%ution
filled fo# t!at sc!eme.
/f t!e Sc!eme details a#e not filled, default sc!eme as app#oved %" P&(DA ill %e applica%le.
1A Pe#centage S!a#e
Sc!eme 'ont#i%ution ;alue ill %e in te#ms of pe#centage. /t cannot %e in te#ms of amount.
Pe#centage cont#i%ution value fo# all t!e sc!emes must %e intege#. &#actional value ill not %e accepted.
/f t!e sum of cont#i%utions (in pe#centage) ac#oss all t!e sc!emes is not e0ual to 1AA, t!e %alance ill %e allotted
to t!e default sc!eme app#oved %" P&(DA.
,ENERA+ 'N*R-A('N *R PRAN S)BS"R'BERS
a) Su%sc#i%e#s can o%tain t!e application fo#m fo# P(AN in t!e fo#mat p#esc#i%ed %" P&(DA (Pension &und (egulato#" D Development Aut!o#it")
f#om DDO o# can f#eel" donload f#om t!e '(A e%site ($ttp344///!npscra!nsdl!co!in)!
%) ($e re5uest for a reprint of PRAN card /it$ t$e same PRAN details or4and c$anges or correction in PRAN data can be made by filling up
6Re5uest for c$ange4correction in subscriber master details and4or re-issue of '-Pin4(-Pin4PRAN card# or4and 7Re5uest *or c$ange in
signature and4or c$ange in p$otograp$#! ($e form is a8ailable from t$e sources mentioned in (a) abo8e!
c) T!e Su%sc#i%e# can o%tain t!e status of !is/!e# application f#om t!e '(A e%site o# t!#oug! t!e #espective PAO/'DDO.
d) &o# mo#e info#mation
;isit us at !ttp)//.npsc#a.nsdl.co.in
'all us at A--L-6>>6-AA
eLmail us at info!cra9nsdl!co!in
M#ite to) 'ent#al (eco#dkeeping Agenc", National Secu#ities Deposito#" 2imited, 6t! &loo#, NA8 Ming, T#ade Mo#ld, 3amala .ills
'ompound, Senapati 5apat .a#g, 2oe# Pa#el (M), .um%ai L 6AA A1*.

Signatu#e/2eft T!um%
/mp#ession of Su%sc#i%e#