Annexure UOS-N2
CENTRAL RECORDKEEPING AGENCY
Points of Presence Service Providers (POP-SP) Registration Form
(Please fill all the details in CAPITAL LETTERS & in BLACK INK only. All Fields mark with are mandatory)
POP-SP Registration Number :
(To be allotted by CRA)
Sir/Madam,
We hereby submit a request to be registered as a Point of Presence - Service Provider (POP-SP). The necessary details are provided below:
1. Name of the POP-SP :
2. POP Registration Number (Allotted by CRA):
3. PFRDA Approval Date:
D D M M Y Y Y Y
4. POP-SP Address :
Flat / Unit No, Block no.
Name of Premise/Building/Village
Area / Locality / Taluka
District/Town/City
State / Union Territory
Country
Pin Code
5. Authorised Contact Person’s Name & Designation :
6. Phone No. :
STD Code Phone Number
7. Alternate Phone No. :
STD Code Phone Number
8. Fax No.:
STD Code Phone Number
9. Email ID :
(Email ID should be official Email ID)
10. Mobile No.:
11. POP-SP Bank Details:
Type of Account: Savings A/c Current A/c
Bank A/c Number
Bank Name
Bank Branch
Bank Branch Address
Pin Code
Bank MICR Code
Bank Branch IFSC (Indian Financial Systems Code)
We hereby agree and declare that the information supplied in the application, is complete and true.
AND we further agree that, we will notify Central Recordkeeping Agency (CRA) immediately about any change in the information provided in the application.
Signature of Authorised Signatory
Name : ___________________________________ Place : __________________
Designation : ________________________________ Date : - -
D D M M Y Y
Department : ________________________________
POP-SP Seal
Authorization by POP:
Signature of Authorised Signatory
Name : ___________________________________ Place : __________________
Designation : ________________________________ Date : - -
D D M M Y Y
POP Seal
Following Documents to be submitted along with the form:
Certified Copy of PFRDA Approval Letter.
Form should be accompanied with the covering letter of POP duly signed by authorised signatory.
Details of two Digital Signature Certificates (DSC) as per Annexure UOS-N2-A
Please note that any change in the information provided should be intimated to CRA with proper authorization.