Annexure CS-S1 Page 1

APPLICATION FORM FOR SUBSCRIBER REGISTRATION
( * Indicates Mandatory Field)

(To avoid mistake(s), please follow the accompanying instructions before filling up the form)
Acknowledgement Number (by CRA-FC)
Permanent Retirement Account Number :
(To be filled by CRA-FC after PRAN generation)
To affix recent
Coloured photograph
(3.5 cm × 2.5 cm)
Note: This form is to be used by a subscriber working for a Organization registered under Corporate model of NPS for the opening up of a Tier I account
Sir/Madam,
I hereby request that a NPS account be opened in my name and Permanent Retirement Account number (PRAN) be allotted as per particulars given below:
Section A – Subscriber‟s Personal Details
1. Full Name (Full expanded name: Initials are not permitted)
Please Tick as applicable Shri Smt. Kumari
First Name *
Middle Name
Last Name
I would like my PRAN card to be printed in HINDI: Yes No (If Yes, please provide the details in the annexure CS-S1 on Page No6)
2. Gender * Male Female
3. Date of Birth * 4. PAN *
D D M M Y Y Y Y (for PAN, please refer to Sr. No. 3 of the instructions)
5. Father‟s Full Name:
First Name *
Middle Name
Last Name
6. Present Address* (Fields marked with* are mandatory):
Flat/Unit No, Block no. *
Name of Premise/Building/Village
Area/Locality/Taluka
District/Town/City *
State / Union Territory*
Country *
Pin Code *
7. Permanent Address*: If same as above, Please Tick else, {Fields marked with* are mandatory}:
Flat/Unit No, Block no.*
Name of Premise/Building/Village
Area/Locality/Taluka
District/Town/City *

I hereby request that a NPS account be opened in my name and a Permanent Retirement Account Number (PRAN) be allotted as per particulars given below:
Section A – Subscriber‟s Personal Details
Section A - Subscribers Personal Details ( * Indicates Mandatory Field)
Signature/Thumb Impression* of Subscriber in black ink
Annexure CS-S1 Page 2
State / Union Territory *
Country *
Pin Code*
8. Phone No.
STD Code Phone No.
9. Mobile No.
10. Email ID
11. Do you want to subscribe to SMS Alerts Yes No
12. Subscriber‟s Bank Details*: (MANDATORY - please refer to Sr. No. 6 of the instructions)
Savings A/c Current A/c
Bank A/c Number*
Bank Name*
Bank Branch*
Bank Address*
Pin Code*
Bank MICR Code *
IFS code (Wherever applicable)
Section B - Subscribers Employment Details to be filled and attested by Corporate (All Details are Mandatory)
1. Date of Joining*
D D M M Y Y Y Y
2. Employee ID* :
3. Corporate Registration Number (allotted by CRA)*:
Certified that the above declaration has been signed before me by _______________________________________________________
after he / she has read the entries / entries have been read over to him / her by me and got confirmed by him / her. Also certified that the date of birth and employment details is as per employee records available with the Corporate.
Rubber Stamp of the Corporate
Signature of the Authorised Person
Designation of the Authorised Person : _________________________________
Name of the Corporate ______________________
Date :
D D M M Y Y Y Y
Annexure CS-S1 Page 3
Section C - Subscriber‟s Nomination Details (OPTIONAL - please refer to Sr. No 7 & 8 of the instructions)
1. Name of the Nominee:
1st Nominee 2nd Nominee 3rd Nominee
First Name*
First Name*
First Name*
Middle Name
Middle Name
Middle Name
Last Name
Last Name
Last Name
2. Date of Birth (In case of a minor):
1st Nominee
2nd Nominee
3rd Nominee
3. Relationship with the Nominee:
1st Nominee
2nd Nominee
3rd Nominee
4. Percentage Share:
1st Nominee
%
2nd Nominee
%
3rd Nominee
%
5. Nominee‟s Guardian Details (in case of a minor Nominee):
1st Nominee‟s Guardian Details 2nd Nominee‟s Guardian Details 3rd Nominee‟s Guardian Details
First Name*
First Name*
First Name*
Middle Name
Middle Name
Middle Name
Last Name
Last Name
Last Name
Section D - Subscriber Scheme Preference (Please refer the instructions of Section D on Page No. 5 for further details):
(Applicable, only if your corporate has given option to the subscriber to select the scheme details. Kindly Contact your Employer for further details)
(i). PFM Selection for Active and Auto Choice*
PFM Name (in alphabetical order)
Please tick only one
(Select only one PFM)
ICICI Prudential Pension Funds Management Company Limited
IDFC Pension Fund Management Company Limited
Kotak Mahindra Pension Fund Limited
Reliance Capital Pension Fund Limited
SBI Pension Funds Private Limited
UTI Retirement Solutions Limited
(Selection of PFM is mandatory both in Active and Auto Choice. In case you do not indicate a choice of PFM, your application form shall be summarily rejected).
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(ii). Investment Option
Active Choice Auto Choice
(For details on Auto Choice, please refer to the PFRDA website www.pfrda.org.in)
Note:-
1. In case you do not indicate any investment option, your funds will be invested in Auto Choice
2. In case you have opted for Auto Choice, DO NOT fill up section (iii) below relating to Asset Allocation. In case you do, the Asset Allocation instructions will be ignored and investment made as per Auto Choice.
(iii)4. Asset Allocation (to be filled up only in case you have selected the „Active Choice‟ investment option)
Note:-
1. The allocation across E, C and G asset classes must equal 100%. In case, the allocation is left blank and/or does not equal 100%, the application shall be rejected.
Section E – Declaration & Authorization
I understand that there would be PFRDA approved Terms and Conditions for subscribers on the CRA website governing I-pin (to access CRA and view details) & 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.
Declaration under the Prevention of Money Laundering Act, 2002 I hereby declare that:
1. The contribution paid has been derived from legally declared and assessed sources of income.
2. I understand that the PFRDA/NPS Trust has the right to peruse my financial profile and also agree that the PFRDA/NPS Trust has the right to close the NPS account in case I am found guilty of violating the provisions of any Law, directly or indirectly, by any Competent Court of Law, having relation to the laws governing prevention of money laundering in the country.
I _________________________________________________________________, the applicant, do hereby declare that the information provided above is true to the best of my knowledge & belief.
Date : (DD/MM/YYYY)
Signature/Thumb
Impression* of Subscriber
To be Filled by POP
A. POP Registration No.
B. Submitted Cancelled Cheque: Yes No
Signature of Authorised Signatory
Name : ___________________________________ Place : __________________
Designation : ________________________________ Date : - -
D D M M Y Y
Department : ________________________________
POP Seal
Asset Class
E
(Cannot exceed 50%)
C
G
Total
% share
100%
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[To be filled by CRA - Facilitation Centre (CRA-FC)]
Received by: __________________________________ CRA-FC Registration Number: _______________________
Received at:_____________________________________ Date:______________
Acknowledgement Number (by CRA-FC)
INSTRUCTIONS FOR FILLING THE FORM
a) Form to be filled legibly in BLOCK LETTERS and in BLACK INK only. Please fill the form in legible handwriting so as to avoid errors in your application processing. Please do not overwrite. Corrections should be made by cancelling and re-writing and such corrections should be counter-signed by the applicant.
b) Each box, wherever provided, should contain only one character (alphabet/number/punctuation mark) leaving a blank box after each word.
c) The subscriber should affix a recent colour photograph (size 3.5 cm x 2.5 cm) in the space provided on the form. The photograph should not be stapled or clipped to the form. (The clarity of image on PRAN card will depend on the quality and clarity of photograph affixed on the form.)
d) Signature /Thumb impression (LTI in case of males and RTI in case of females) should only be within the box provided in the form. The subscriber should not sign across the photograph. If there is any mark on the photograph such that it hinders the clear visibility of the face of the subscriber, the application shall not be accepted.
e) Applications incomplete in any respect and/or not accompanied by required documents are liable to be rejected. The application is liable to be rejected if mandatory fields are left blank or the application form is printed back to back.
f) The subscriber‟s thumb impression should be verified by the designated officer of the employer accepting the form.
g) Subscribers are advised to retain the acknowledgement slip signed / stamped by the employer where they submit the application.
Sr. No.
Item No.
Item Details
Guidelines for Filling the Form
Subscriber‟s Personal Details
1.
1
Full Name
Please state your name as mentioned in the Proof of Identity failing which the application is liable to be rejected. If the Proof of identity has a name by which the applicant has been known differently in the past, than the one provided in this application form, then requisite proof should be provided e.g. marriage certificate, or gazetted copy of name change.
2.
3
Date of Birth
Please ensure that this matches with the Date of Birth as indicated in the document provided in support.
3.
4
PAN
Please provide copy of the your PAN card.
4.
6, 7
Present Address
All future communications will be sent to present address.
5.
9, 10, 11
Phone No., Mobile No, & Email ID
It is advisable to mention either “Telephone number” or “Mobile number” or “Email ID” so that Subscriber can be contacted in future.
6.
12
Bank Details
The subscribers shall provide a cancelled cheque, the details of which should match the bank details provided.
Subscriber‟s Nomination Details - Section C
7.
Percentage Share
1) Subscriber can nominate a maximum of three nominees.
2) Subscriber cannot fill the same nominee details more than once.
3) Percentage share value for all the nominees must be integer. Decimals/Fractional values shall not be accepted in the nomination(s).
4) 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 rejected.
8.
Nominee‟s Guardian Details
If a nominee is a minor, then nominee‟s guardian details shall be mandatory.
Illustrative list of documents acceptable as proof of identity and address
No.
Proof of Identity (Copy of any one)
No.
Proof of Address (Copy of any one)
1
School Leaving Certificate
1
Electricity bill^
2
Matriculation Certificate
2
Telephone bill^
3
Degree of Recognized Educational Institution
3
Depository Account Statement^
4
Depository Account Statement
4
Credit Card Statement^
5
Bank Account Statement / Passbook
5
Bank Account Statement / Passbook^
6
Credit Card
6
Employer Certificate^
7
Water Bill
7
Rent Receipt^
8
Ration Card
8
Ration Card
9
Property Tax Assessment Order
9
Property Tax Assessment Order
10
Passport
10
Passport
11
Voter‟s Identity Card
11
Voter‟s Identity Card
12
Driving License
12
Driving License
13
PAN Card
13
Certificate of address signed by a Member of Parliament or Member of Legislative Assembly or Municipal Councillor or a Gazetted Officer.
14
Certificate of identity signed by a Member of Parliament or Member of Legislative Assembly or Municipal Councillor or a Gazetted Officer.
Note: 1) Proof of Address mentioned in Sr. No. 1 to 7 (^) should not be more than six months old on the date of application.
2) You are required to bring original documents & two self-attested photocopies (Originals will be returned over-the-
counter after verification)
GENERAL INFORMATION FOR SUBSCRIBERS
a) The Subscriber can obtain the status of his/her application from the CRA website or through the respective employer.
b) For more information
Visit us at http://www.npscra.nsdl.co.in
Call us at 022-24994200
e-mail us at info [dot] cra [at] nsdl [dot] co [dot] in
Write to: Central Record keeping Agency, National Securities Depository Limited, 4th Floor, „A‟ Wing, Trade World, Kamala Mills
Compound, Senapati Bapat Marg, Lower Parel (W), Mumbai - 400 013.
Subscriber Scheme Preference - Section D
Kindly do not fill this section if your organisation has selected the scheme preference details for its subscribers.
Active choice
1. PFM selection is mandatory. Kindly make a choice from Option A. The form shall be rejected if a PFM is not opted for.
2. Allocation under Equity (E) cannot exceed 50%
3. A subscriber opting for active choice may select the available asset classes (“E”, “G”, & “C”). However, the sum of percentage allocation across all the selected asset classes must equal 100. If the sum of percentage allocations is not equal to 100%, or the asset allocation table at Sr. No. (iii) is left blank, the application shall be rejected.
Auto choice
4. A subscriber opting for Auto Choice must also select a PFM from “Option A” of PFM Selection. The application shall be rejected if the subscriber does not indicate his/her choice of PFM
5. In case both investment option and the asset allocation at Sr. No. (ii) and Sr. No. (iii) are left blank, the subscriber‟s funds will be invested as per Auto Choice
For more details on investment options and asset classes, please refer to the PFRDA website www.pfrda.org.in‟
Annexure CS-S1 Page 6