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*.