SPECIMEN OF NPS REGISTRATION FORM

CSRF 1
NATIONAL PENSION SYSTEM (NPS) Affix recent colour
photograph of
SUBSCRIBER REGISTRATION FORM 3.5 cm x 2.5 cm size

To, Government Sector Corporate Sector

National Pension System Trust. All Citizen Model NPS Lite/Swavalamban

SAMPLE COPY
Dear Sir/Madam,
I hereby request that an NPS account be opened in my name as per the particulars given below:
* indicates mandatory fields. Please fill the form in English and BLOCK letters with black ink pen. (Refer general guidelines at instructions page)

1. PERSONAL DETAILS:
Name of Applicant in full Shri Smt. Kumari
First Name* N A R E S H
Middle Name K U M A R
Last Name T O P A R A P U
Date of Birth* 0
d 4d 0 m
/ m 4 / y1 9y 7y 9y (Date of Birth should be supported by relevant documentary proof)

Male Female Others

Father's Name* TF Oi Pr As Rt A P U B U G M
G iA dI A
d H
l e L a s t
(Refer Sr. No. 1 of instructions)

2. IDENTITY DETAILS* (Any one of the documents need to be provided)

PAN Aadhaar 9 2 3 4 5 6 7 8 9 X X X Voter ID

Passport Others Name of the ID I D N u m b e r Please refer Sr. No. 2 of the instructions.

3. CORRESPONDENCE ADDRESS DETAILS*

Flat/Room/Door/Block no. H N O 1 - 1 7 Landmark
Premises/Building/Village K O N D A P U R
Road/Street/Lane M E D I P A L L Y
Area/Locality/Taluk K A R I M N A G A R
City/Town/District PIN Code 5 0 5 4 5 3
State/U.T. A N D H R A P R A D E S H I No Du In A t
C r y

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4. PERMANENT ADDRESS DETAILS Tick ( ) in the box in case the address is same as above.

Flat/Room/Door/Block no. Landmark

Premises/Building/Village
Road/Street/Lane
Area/Locality/Taluk
City/Town/District PIN Code
State/U.T. C o u n t r y

Proof of Address (Correspondence/Permanent)

Aadhar card Passport Voter ID card Driving License Ration Card Registered Lease Sale agreement of residence
Latest Gas Bill# Electricity Bill# Telephone[Landline] Bill # Others (please specify)
#
Not more than 3 months old. Please refer Sr. No. 2 of the instructions

5. CONTACT DETAILS
Landline Phone (with STD Code) Mobile + 9 1 9 9 9 9 8 8 8 8 X X
Email ID n a r e s h t @e m a i l . c om
Do you want to subscribe to SMS Alerts : Yes No Mobile number is essential for receiving sms alerts regarding your NPS account

6. OTHER DETAILS ( Please refer to Sr no. 3 of the instructions )

}Occupation Details [ please tick( ) ]
Private Sector Government Sector Public Sector Business Professional Agriculture
Homemaker Student NRI Other (please specify)

}Please Tick If Applicable Politically exposed person Related to Politically exposed Person
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}Income Range (per annum) Upto 1 lac 1 lac to 5 lac 5 lac to 10 lac 10 lac to 25 lac 25 lac and above
}Educational Qualifications Below SSC SSC HSC Graduate Masters Professionals ( CA, CS, CMA, etc.)

7. SUBSCRIBER BANK DETAILS ( Please refer to Sr no. 4 of the instructions )

Account Type [ please tick( ) ] Saving A/c Current A/c
Bank A/c Number 0 0 3
8 4 6 9 1 2 X X X
Bank Name H DC B A N K
F
Branch Name N AP A M
L L U
Branch Address E -6 4
C L U B R O A D PIN Code 5 0 0 0 2 9
State/U.T. H Y D E R A B A D CI N
o D u In At r y
Bank MICR Code 5 0 5 2 4 0 5 2 3 IFSC Code H D F C 0 0 2 X X X X
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 SPECIMEN OF NPS REGISTRATION FORM
CSRF 1
8. SUBSCRIBERS NOMINATION DETAILS* (Please refer to Sr. No . 5 of the instructions)
Name of the Nominee (You can nominate up to a maximum of 3 nominees and if you desire so please fill in Annexure III (Additional Nomination Form) provided separately)
Nominee Name K
F Ii R
r A
s N
t R
M A
i O
d d l e K
L U
a M
s tA R
Relationship with the Nominee WIFE Date of Birth (In case of Minor) d d / m m / y y y y
Nominee’s Guardian Details (in case of a minor)
Nominee’s Guardian F i r s t M i d d l e L a s t

SAMPLE COPY
9. NPS OPTION DETAILS (Please tick ( ) as applicable)
I would like to subscribe for Tier II Account also YES NO If yes, please submit details in Annexure I. (Tier II account is not available for NPS Lite/
Swavalamban subscribers).
I would like my PRAN to be printed in Hindi YES NO If Yes, please submit details on Annexure II

10. PENSION FUND (PF) SELECTION AND INVESTMENT OPTION*

(i) PENSION FUND SELECTION (Tier I): The names of the all PFs are mentioned in the instructions page and are available to the all sector
subscribers with following conditions:
(i) Government Sector: For Government Subscribers, the following PFs act as default PFs as per the guidelines issued by the Government:
(a) LIC Pension Fund Limited (b) SBI Pension Funds Pvt. Limited (c) UTI Retirement Solutions Ltd.
(ii) NPS Lite/Swavalamban: NPS Lite Swavalamban is a group choice model where subscriber has a choice of PF and investment option as available with Aggregator.
(iii) All Citizen Model: Subscribers under All Citizen model has the option to choose the available PFs as per their choice in the table below.
(iv) Corporate Model: Subscribers shall have the option to choose the available PFs as per the below table in consultation with their respective Employer.

Name of the Pension Fund PleaseTick( ) Availability of the Pension Funds

LIC Pension Fund Limited
Available to
SBI Pension Funds Private Limited Government
Sector
UTI Retirement Solutions Limited
Available to Available to
Available to All
ICICI Prudential Pension Funds Management Company Limited NPS Lite/ Corporate
Citizen Model*
Swavalamban Model*
Kotak Mahindra Pension Fund Limited
Reliance Capital Pension Fund Limited
HDFC Pension Management Company Limited
* Selection of Pension Fund is mandatory both in Active and Auto Choice. In case, you do not indicate a choice of PF, please note that it is deemed that you have consented
for the default PF specified by PFRDA. Currently, SBI Pension Funds Private Limited is the default PF.

(ii) INVESTMENT OPTION (Available for All Citizen Model and Corporate Model Subscribers)
( Please Tick ( ) in the box given below showing your investment option).
Active Choice Auto Choice

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For details on Auto Choice, please refer to the Offer Document. Please 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 below relating to Asset Allocation. In case you do, the Asset Allocation instructions will be ignored
and investment will be made as per Auto Choice.
(iii) ASSET ALLOCATION (to be filled up only in case you have selected the ‘Active Choice’ investment option)
E
Asset Class C G Total Note:- The total allocation across E, C and G asset classes must be equal to
(Cannot exceed 50%)
100%. In case, the allocation is left blank and/or does not equal 100%, the
application shall be rejected.
% 50 30 20 100
11. DECLARATION BY SUBSCRIBER* ( Please refer to Sr no. 6 of the instructions )
Declaration & Authorization by all subscribers
I have read and understood the terms and conditions of the National Pension System and hereby agree to the same and declare that the information and documents furnished
by me are true and correct, to the best of my knowledge and belief. I undertake to inform immediately the Central Record Keeping Agency/National Pension System Trust,
of any change in the above information furnished by me. I do not hold any pre-existing account under NPS. I understand that I shall be fully liable for submission of any false
or incorrect information or documents.
I further agree to be bound by the terms and conditions of provision of services by CRA, from time to time and any amendment thereof as approved by PFRDA, whether
complete or partial without any new declaration being furnished by me. I shall be bound by the terms and conditions for the usage of I-pin (to access CRA/NPSCAN and view
details) & T-pin on the CRA website.
Additional declaration by Swavalamban subscriber
I have read/explained to me and understood 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 the contribution paid by me/on my behalf has been derived from legally declared and assessed sources of income. I understand that NPS Trust has the
right to peruse my financial profile or share the information, with other government authorities. I further agree that NPS Trust has the right to close my PRAN in case I am
found violating the provisions of any law relating to prevention of money laundering.

Date 0 2
d d / 0 7
m m / 2y 0
y y1 y5

Place :
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Signature/Thumb Impression* of Subscriber in black ink

(* LTI in case of male and RTI in case of female)

ACKNOWLEDGEMENT
Name of the Subscriber:
Contribution Amount Remitted: `

Date of Receipt of Application and Contribution Amount: d d / m m / y y y y

Stamp and Signature of the Employer/PoP/Aggregator:

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 SPECIMEN OF NPS REGISTRATION FORM
CSRF 1
INSTRUCTIONS FOR FILLING THE SUBSCRIBER REGISTRATION FORM
General Guidelines
(a) 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. Each box, wherever provided, should contain only one character (alphabet / number / punctuation mark) leaving
a blank box after each word.
(b) 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

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(c) The subscriber should not sign across the photograph. The photograph should not be stapled or clipped to the form. 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.
(d) Copies of all the documents submitted by the applicant should be self-attested and accompanied by originals for verification by the nodal office.
(e) Name and Address of the applicant mentioned on the form, should match with the documentary proof submitted.
(f) The subscriber’s thumb impression should be verified by the DDO/PAO/DTO/designated officer of POP-SP/Aggregator
(g) Government employees (mandatorily covered under NPS) may submit their application for Tier II to any POP-SP of their choice. The list of POP-SPs rendering services under
NPS is available on CRA website [Link]

[Link] Item No. Item Details Instructions

Date of Birth Please ensure that the date of birth matches as indicated in the document provided in the support.
i. If father's name has more than 30 digits, you may fill Annexure II for the same.
1 1 ii. Father’s name is mandatory. However, if applicant does not want to provide father’s name, he/she has an option to provide
Father's Name
mother’s name on Annexure II and the mother’s name will be printed on PRAN card
iii. If the applicant wants mother’s name to be printed instead of Father’s name on PRAN Card, he/she must fill Annexure II
[Link] Proof of Identity (Copy of any one) [Link] Proof of Address (Copy of any one)
1 Passport issued by Government of India. 1 Passport issued by Government of India
2 Ration card with photograph. 2 Ration card with photograph and residential address
Bank Pass book or certificate with photograph and
3 Bank Pass book or certificate with Photograph. 3
residential address
4 Certificate of the POP bank for an existing Bank customer. 4 Certificate of the POP bank for an existing Bank customer.
Voters Identity card with photograph and residential Voters Identity card with photograph and residential
5 5
address. address
Valid Driving license with photograph and residential
6 Valid Driving license with photograph 6
address
Letter from any recognized public authority at the level
Certificate of identity with photograph signed by a Member of Gazetted officer like District Magistrate, Divisional
7 7
of Parliament or Member of Legislative Assembly commissioner, BDO, Tehsildar, Mandal Revenue Officer,
Judicial Magistrate etc.
Certificate of address with photograph signed by a Member
Identity, 8 PAN Card issued by Income tax department 8
of Parliament or Member of Legislative Assembly
Correspondence &
2 2, 3 & 4 Aadhar Card / letter issued by Unique Identification Aadhar Card / letter issued by Unique Identification
Permanent address 9 9
Authority of India Authority of India clearly showing the address

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details
Job cards issued by NREGA duly signed by an officer of Job cards issued by NREGA duly signed by an officer of
10 10
the State Government the State Government
Identity card issued by Central/State government and its The identity card/document with address, issued by
Departments, statuary/ Regulatory Authorities, Public any of the following: Central/State Government and its
Sector Undertakings, Scheduled commercial Banks, Public Departments, Statuary/Regulatory Authorities, Public
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Financial Institutions, Colleges affiliated to universities Sector Undertakings, Scheduled Commercial Banks,
and Professional Bodies such as ICAI, ICWAI, ICSI, Bar Public Financial Institutions for their employees.
Council etc.
Photo Identity Card issued by Defence, Paramilitary and Latest Electricity/water bill in the name of the Subscriber
12 12
Police departments. showing the address (less than 3 months old)
Ex-Service Man Card issued by Ministry of Defence to their Latest Telephone bill in the name of the Subscriber showing
13 13
employees. the address (less than 3 months old)
Latest Property/house Tax receipt (not more than one
14
year old)
14 Photo Credit card.
Existing valid registered lease agreement of the house on
15
stamp paper ( in case of rented/leased accommodation)
Note:
(i) If the address on the document submitted for identity proof by the prospective customer is same as that declared by him/her in
the account opening form, the document may be accepted as a valid proof of both identity and address.
(ii) If the address indicated on the document submitted for identity proof differs from the current address mentioned in the account
opening form, a separate proof of address should be obtained. All future communications will be sent to correspondence
address. If correspondence & Permanent address are different, then proof for both have to be submitted.
(iii) In case of Government subscribers, the KYC documents may be submitted within a period of 30 days after generation of PRAN.
Other Details An NRI subscriber would need to furnish an Indian address for communication and bank details within India. Fund transfers by NRIs
(Occupation Details) would be subject to regulatory requirements as prescribed by RBI from time to time and FEMA requirements.
3 6 Politically Exposed Persons’ (PEPs) are individuals who are or have been entrusted with prominent public functions in a foreign
Politically Exposed
country, for example heads of state or of the government, senior politicians, senior government, judicial or military officials, senior
Person
executives of state-owned corporations, important political party officials.
For Tier I, bank details are optional. For activation of Tier II, bank details are mandatory. Please attach a Cancelled cheque (containing
Subscriber’s Bank Subscriber Name, Bank Account Number and IFS Code) or Bank Certificate containing Name, Bank Account Number and IFS code,
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Details for direct credit or electronic transfer. In case if the cheque is not preprinted with name, additionally, a copy of the bank passbook or
bank certificate containing Name, Bank Account Number and IFS code should be submitted.
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In case of more than one nominee, percentage share value for all the nominees must be integer. Decimals/Fractional values shall
Subscriber’s Nomination
5 8 not be accepted in the nomination(s). Sum of percentage share across all the nominees must be equal to 100. If sum of percentage
Details
is not equal to 100, entire nomination will be rejected.
Signature / Thumb impression should only be within the box provided in the form. Thumb impression, if used, should be attested
Declaration by
6 12 by the nodal officer with the official seal and stamp. Left Thumb Impression in case of male and Right Thumb Impression in case of
Subscriber
female.

General Information for Subscribers

a) The Subscriber can obtain the status of his/her application from CRA and their designated nodal officer.
b) Subscribers are advised to retain the acknowledgement slip signed/ stamped by the designated nodal officer where they submit the application.
c) For more information / clarifications, contact CRA:
Website: [Link]
Call: 022-2499-4200
e-mail: [Link]@[Link]
Address: Central Recordkeeping Agency, NSDL e-Governance Infrastructure Limited, 1st Floor, Times Tower, Kamala Mills Compound, Senapati Bapat Marg,
Lower Parel (W), Mumbai - 400 013.