New Pension System

Subscriber Declaration for Swavalamban Yojana
(To be used by Subscribers of NPS –All Citizens of India)

_____________________________________________
Sir/Madam,
I ___________________ _ (Name of the subscriber as in PRAN card) would like to opt for Swavalamban Scheme. A photocopy of my PRAN card is attached. My NPS related details are provided below:
Permanent Retirement Account Number*:
(As allotted by CRA)
Declaration & Authorization
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.
I _________________________________________________________________,
the applicant, do hereby declare that the information provided above is true to the best of my knowledge & belief.
Date:
__________________________________
Signature/Thumb
Impression* of Subscriber
To be filled by POP-SP
Signature of Authorized Signatory
Name : ___________________________________ Place : __________________
Désignation : ________________________________ Date : __________________
POP-SP Seal