Annexure UOS-S1 National Pension System Page 1

COMPOSITE APPLICATION FORM FOR SUBSCRIBER REGISTRATION

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
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 (If Yes, please provide the details in the annexure UOS-SH1 on Page No. 9)
I would like to subscribe for a Tier II Account: Yes (If Yes, please provide the details on Page No. 4)
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)
(Date of birth should be supported by relevant documentary proof).
5. Category: Government Private Sector Self Employed NRI Others (Please tick (√) any one)
6. Father’s Full Name:
First Name *
Middle Name
Last Name
7. Present Address* (NRIs may please refer to Sr. No. 4 of the instructions):
Flat/Unit No, Block no.
Name of Premise/Building/Village
Area/Locality/Taluka
District/Town/City
State / Union Territory
Country
Pin Code
8. Permanent Address*: If same as above, Please Tick else,
Flat/Unit No, Block no.
Name of Premise/Building/Village
Area/Locality/Taluka
District/Town/City
Personal Banking Business Unit, Corporate Centre, Floor-6, State Bank Bhavan, Madame Cama Road, Mumbai - 400021.
COMPOSITE APPLICATION FORM FOR SUBSCRIBER REGISTRATION
( * Indicates Mandatory Field)
(To avoid mistake(s), please follow the accompanying instructions before filling up the form)
Receipt No.
(To be filled by POP-SP)
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:
1. This form is to be used by a subscriber opening a fresh Tier I and Tier II account
2. Pre-existing NPS account holders with a valid PRAN card need to fill up only the NPS Tier II form (Annexure UOS-S10)
Sir/Madam,
Signature/Thumb Impression* of
Subscriber in black ink
Annexure UOS-S1 Page 2
State / Union Territory
Country
Pin Code
9. Phone No.
STD Code Phone No.
10. Mobile No.
11. Email ID
12. Do you want to subscribe to SMS Alerts (To be made available later, on a chargeable basis): Yes No
13. Subscriber’s Bank Details: (OPTIONAL - please refer to Sr. No. 7 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 - Subscriber’s Nomination Details (OPTIONAL - please refer to Sr. No 8 & 9 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):
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
Personal Banking Business Unit, Corporate Centre, Floor-6, State Bank Bhavan, Madame Cama Road, Mumbai - 400021.
Annexure UOS-S1 Page 3
Section C - Subscriber Scheme Preference (Please refer to the instructions on Page No. 8 for further details):
(i). PFM Selection for Active and Auto Choice (Select only one PFM)
PFM Name (in alphabetical order) Please tick only one
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).
(ii). Investment Option
Active Choice Auto Choice (For details on Auto Choice, please refer to the Offer Document)
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). Asset Allocation (to be filled up only in case you have selected the ‘Active Choice’ investment option)
Note:-
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 by the POP.
Personal Banking Business Unit, Corporate Centre, Floor-6, State Bank Bhavan, Madame Cama Road, Mumbai - 400021.
Asset Class E
(Cannot exceed 50%) C G Total
% share 100%
Annexure UOS-S1 Page 4
TIER II DETAILS
I hereby submit the following details for activation of Tier – II account under NPS.
1. Subscriber’s Bank Details: (MANDATORY - please refer to Sr. No. 7 of the instructions)
If same as Tier I, Please Tick else, fill in the details below:
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)
2. Subscriber’s Nomination Details (OPTIONAL - please refer to Sr. No. 8 & 9 of the instructions)
If same as Tier I, Please Tick else,
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
Date of Birth (In case of a minor)*:
1st Nominee * 2nd Nominee * 3rd Nominee *
Relationship with the Nominee:
1st Nominee 2nd Nominee 3rd Nominee
Percentage Share:
1st Nominee % 2nd Nominee % 3rd Nominee %
Nominee’s Guardian Details (in case of a minor):
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
3. Subscriber Scheme Preference (Please refer the instructions on Page No. 8 for further details):
If same as Tier I, Please Tick else,
(i). PFM Selection for Active and Auto Choice (Select only one PFM)
PFM Name (in alphabetical order) Please tick only one
ICICI Prudential Pension Funds Management Company Limited
IDFC Pension Fund Management Company Limited
Personal Banking Business Unit, Corporate Centre, Floor-6, State Bank Bhavan, Madame Cama Road, Mumbai - 400021.
Annexure UOS-S1 Page 5
PFM Name (in alphabetical order) Please tick only one
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).
(ii). Investment Option
Active Choice Auto Choice (For details on Auto Choice, please refer to the Offer Document)
Note:-
• In case you do not indicate any investment option, your funds will be invested in Auto Choice
• 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). Asset Allocation (to be filled up only in case you have selected the ‘Active Choice’ investment option)
Note:-
• 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 by the POP.
Section D – Declaration & Authorization
I hereby declare and agree that (a) I have read and understood the Offer Document, terms & conditions or the same was
interpreted to me, and the answers entered in the application are mine. (b) I am a Citizen of India. (c) I have not been found or
declared to be of an unsound mind under any law for the time being in force. (d) I am not an undischarged insolvent. (e) I do
not hold any pre-existing account under NPS.
I understand that there would be PFRDA approved Terms and Conditions for subscribers on the CRA website governing I-pin
(to access CRA/NPSCAN 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 for availing of Swavalamban benefit (Please strike off if not applicable)
I have read the Swavalamban guidelines and I meet the prescribed eligibility criteria for assistance under the scheme. I also
undertake to adhere to the prescribed contribution limit of minimum Rs. 1000/- and maximum of Rs. 12000/-, failing
which the Central Government contribution credited to my account may be forfeited along with such interest rates as may
be prescribed.
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 : ( D D / M M/YYYY) Signature/Thumb
Impression* of Subscriber
Personal Banking Business Unit, Corporate Centre, Floor-6, State Bank Bhavan, Madame Cama Road, Mumbai - 400021.
Asset Class E
(Cannot exceed 50%) C G Total
% share 100%
Annexure UOS-S1 Page 6
To be filled by POP-SP
POP-SP Registration Number :
KYC Compliance : Yes
KYC document accepted for identify proof : _____________________________________
KYC document accepted for address proof : _____________________________________
Document accepted for date of birth proof : _____________________________________
Copy of PAN card submitted : Yes No
PAN Compliance : Yes
[To be filled by CRA - Facilitation Centre (CRA-FC)]
Received by: __________________________________ CRA-FC Registration Number: _______________________
Received at:_____________________________________ Date:______________
Acknowledgement Number (by CRA-FC)
Personal Banking Business Unit, Corporate Centre, Floor-6, State Bank Bhavan, Madame Cama Road, Mumbai - 400021.
Signature of Authorized Signatory
To be filled by POP-SP
POP-SP Seal
Name : ___________________________________ Place : __________________
Designation : ________________________________ Date : __________________
Annexure UOS-S1 Page 7
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 countersigned
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 POP- SP accepting the form.
g) Subscribers are advised to retain the acknowledgement slip signed/ stamped by the POP-SP where they submit the application.
Sr.
No. Item No. Item Details Guidelines for Filling the Form
Subscriber’s Personal Details - Section A of Tier I and Point No.1 of Tier II
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 IF you are having PAN, please provide copy of the same. Copy of PAN card is
mandatory in case of cash contribution of Rs. 50,000 and above.
4. 5 Category
An NRI subscriber would need to furnish an Indian address for communication and
bank details within India. Fund transfers by NRIs would be subject to regulatory
requirements as prescribed by RBI from time to time and FEMA requirements.
5. 7 Present Address All future communications will be sent to present address.
6. 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 for any discrepancy.
Bank Details
Tier 1
For Tier I, bank details are optional, however, if a subscriber mentions any of the
bank details (except MICR code), all the bank details shall become mandatory.
7. 13 of Tier I
Point No.1 of Tier II
Bank Details
Tier II
For activation of Tier II, bank details are mandatory. The subscribers shall
provide a cancelled cheque, the details of which should match the bank details
provided for Tier II.
Subscriber’s Nomination Details - Section B of Tier I and Point No.2 of Tier II
8. 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.
9. 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
14
Certificate of identity signed by a Member of Parliament or
Member of Legislative Assembly or Municipal Councillor or a
Gazetted Officer.
13
Certificate of address 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-thecounter
after verification)
Personal Banking Business Unit, Corporate Centre, Floor-6, State Bank Bhavan, Madame Cama Road, Mumbai - 400021.
Annexure UOS-S1 Page 8
GENERAL INFORMATION FOR SUBSCRIBERS
a) The Subscriber can obtain the status of his/her application from the CRA website or through the respective POP-SP.
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 Recordkeeping Agency, National Securities Depository Limited, 4th Floor, ‘A’ Wing, Trade World, Kamala Mills
Compound, Senapati Bapat Marg, Lower Parel (W), Mumbai - 400 013.
Personal Banking Business Unit, Corporate Centre, Floor-6, State Bank Bhavan, Madame Cama Road, Mumbai - 400021.
Subscriber Scheme Preference - Section C of Tier I and Point No.3 of Tier II
Active choice
1. PFM selection is mandatory. 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. C (iii) and 3 (iii) respectively is left blank, the application shall be rejected.
Auto choice
4. A subscriber opting for Auto Choice must also select a PFM. The application shall be rejected if the subscriber does not indicate
his/her choice of PFM
In case both investment option and the asset allocation at Sr. No. (ii) and Sr. No. (iii) of Section C and point number 3 (ii) and (iii)
respectively 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 Offer Document.
Annexure UOS-SH1 Page 9
Details for printing PRAN card in Hindi (please provide the details in Devnagri script):
Please note that the manner in which the names are provided in this annexure will be displayed on the
PRAN card. However, date of birth will be printed in English only.
Subscriber’s Full Name:
First Name * : __________________________
Middle Name : ___________________________
Last Name : ___________________________
Father’s Full Name:
First Name * : __________________________
Middle Name : ___________________________
Last Name : ___________________________
(* indicates Mandatory Field)
Signature/Thumb
Impression* of Subscriber
________________________________________________
Name of the Subscriber: ____________________________
Personal Banking Business Unit, Corporate Centre, Floor-6, State Bank Bhavan, Madame Cama Road, Mumbai - 400021.