Annexure NCIS To be used for subscribing under NPS
New Pension System (NPS)

NPS Contribution Instruction Slip (NCIS) -

All fields marked with * are mandatory.
Subscriber Details:
Subscriber’s PRAN*: / New Application
Name of the Subscriber* : _____________________________________________________
Are you a Govt. Employee with date of joining pre-1-1-2004 (See instructions at Sr. No 1 & 2) Yes No
Phone No/ Mobile No.: ___________________
Payment Details*:
Amount to be invested :
Amount (in words): _______________________________________________________________________________________
Cheque/
DD/Cash
Cheque/DD
No.
Bank Name, Branch & City
(mandatory in case of
Cheque/DD)
Amount to be
invested in Tier 1
Amount to be
invested in Tier 2
Total Amount to
be invested
Instructions:
1. Post 01.01.2004 Govt. employees can contribute only for Tier 2 vide this NCIS.
2. Pre 1st Jan, 2004 Govt. employees , can contribute for both Tier 1 and Tier 2 vide this NCIS
3. Please quote your 12 digit PRAN allotted by Central Recordkeeping Agency (CRA) also on the reverse of the
cheque/DD. In case of new application, please mentioned “New Application” on the reverse of the cheque/DD.
4. Cheque/DD should be drawn in favor of “POP (Name of the POP) Collection Account - NPS Trust” and
crossed A/c payee only. Please ensure sufficient balance is available in the bank account, before submitting the
Cheque.
5. Copy of PAN should be enclosed in case of cash contribution of Rs. 50,000 and above.
6. Each contribution i.e. contribution under Tier I and Tier II will be treated as a separate transaction and will be
charged separately. For details of the charge structure, please refer to the PFRDA offer document at
www.pfrda.org.
(To be filled by POP/POP-SP)
Received by: __________________________ POP-SP Registration Number: _______________________
Received at:____________________________ Date:______________ Time Stamp:__________________
Receipt Number
(To be provided by POP-SP)
------------------------------------------------------------------------------------------------------------------------------------------------------------
(Perforation) - NCIS Acknowledgement to the Subscriber
(To be filled by POP/POP-SP)
POP-SP Registration Number: ______________________ PRAN:
Name of the Subscriber: __________________________________________ Date: __/__/____ Time Stamp: __________
Cheque/DD Number: ______________ Cheque/DD date: ________________ Drawn on: ___________________________
Receipt Number
(To be provided by POP-SP)
1. Amount received Tier I: 2. Amount received Tier II:
3. POP Registration Charges (one time): 4. POP Transaction Charges:
5. Service Tax (as applicable) :
6. Amount invested:
[(1+2)-(3+4+5)]
Each contribution i.e. contribution under Tier I and Tier II will be treated as a separate transaction and will be charged separately. For details of the charge
structure, please refer to the PFRDA offer document at www.pfrda.org.
Signature/Left Thumb Impression
of Subscriber
Signature/Stamp of POP/POP-SP/Place
Rs. Rs.
Rs. Rs.
Rs.
Rs.