(Administered by Pension Fund Regulatory and Development Authority)
Application for Modification/Addition of details in APY & Change of APY Service Provider (APY-SP)
To,
The Branch Manager, Bank Name , Bank Branch
Sir/Madam,
I would like to change/modify my details in APY PRAN under APY scheme as per the details given below:
PRAN is mandatory. Fill only the field (s) which is/are to be modified. PRAN is mandatory to be Mentioned.
Permanent Retirement Account Number*:
I hereby request for the following change:
A) Changes or Correction in other Personal Details B) Changes or Correction in Bank Details
C) Changes or Correction in Nomination details D) Changes or Correction Frequency of Deduction of Contributions
E) Changes or Correction in Date of Birth F) Request for Pension Upgrade
G) Request for Pension Downgrade H) Request for Re-issue of ePRAN/e-SoT/Subscriber Information
Boucher by Bank Branch (Free of Cost)
I hereby submit the following details for change:
Section A: Change/Correction in Personal Details
1. Subscriber Name (Initials are not permitted)
Please Tick as applicable: Shri Smt. Kumari
Subscriber Name:
2. Gender Male Female
3. PAN
5. Father Name
6. Correspondence Address: (supported by relevant documentary proof asked by bank)
PIN :
7. Mobile Number:
8. Email id:
9. Income Tax Payer Flag: Yes No
No
Note: Point 9 &10 is applicable only for those who have joined APY prior to 31/03/2016
Section B: Change/Correction in Bank Details:
11. Subscriber Bank Details Change:
Type of Account: Savings
Bank Account Number :
Bank Name
Bank Branch
Bank lFS Code:
(Bank detail changes should be supported by relevant documentary proof
Section C: Change/Correction in Nominee /Spouse details:
12. Change/Correction in Nominee/Spouse details
Name of Spouse
Marital status Married Unmarried
Major Yes No Minor Yes No (Date of birth and Guardian Name is mandatory in case of minor]
Nominee Name:
Nominee Date of Birth: d d / m m / y y y y
Relationship with subscriber:
Guardian Name:
13. Declaration:
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 / y y y y
Signature/Thumb Impression* of Subscriber
(* LTI in case of male and RTI in case of female)
Section D : Change / Correction in Frequency:
14. Change/Correction in Frequency of deduction of APY contribution:
Update/Correct the frequency to (Tick the relevant Box):
Monthly Quarterly Halfyearly
Section E: Change/ Correction in Date of Birth:
15. Change/Correction in Date of Birth:
Update/Correct the Date of Birth to (Tick the relevant Box):
Correct Date of Birth* d d / m m / y y y y
(Date of Birth should be supported by relevant documentary proof)
16. Declaration:
I hereby authorize the bank to debit my bank account for making payment under APY as applicable based on correction in date of birth If the transaction is delayed or
as a result of correction in date of birth. In case of excess amount contributed by subscriber, amount will be deposited in subscriber savings account by NSDL-CRA.
Date: d d / m m / y y y y
Signature/Thumb Impression* of Subscriber
(* LTI in case of male and RTI in case of female)
Section F : Request for Pension Amount Upgrade:
17. Pension Amount Upgrade: Tick the relevant Box:
2000 3000 4000 5000
Section G : Request for Pension Amount Downgrade:
18. Pension Amount Downgrade: Tick the relevant Box:
1000 2000 3000 4000
19. Declaration:
I hereby authorize the bank to debit my bank account for making payment under APY as applicable based on my age and the pension amount selected by me. If the
overdue interest thereon. I also authorise the bank to debit my bank account (registered under APY) for additional contribution to be paid for upgraded pension amount.
In case of downgrade of pension amount, the differential amount would be refunded to the subscriber through direct credit to Bank Account (Registered under APY)
Date: d d / m m / y y y y
Signature/Thumb Impression* of Subscriber
(* LTI in case of male and RTI in case of female)
Section H : Request for Reissue:
E-PRAN by bank branch (Free of Cost)
E-Statement of Transaction by bank branch (Free of cost)
Subscriber Information Boucher (Free of cost)
ACKNOWLEDGEMENT - MODIFICATION UNDER ATAL PENSION YOJANA (APY)
Name of the Subscriber:
PRAN:
Bank Name:
Branch Name:
Date of Receipt: d d / m m / y y y y
of birth and change/Correction in frequency/Pension amount.
Please do not overwrite.
contain only one character.