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NPSLite Subscriberr Registration Form

1) This document is an application form for opening an NPS Lite retirement account and being allotted a Permanent Retirement Account Number (PRAN). 2) It requests personal details of the applicant such as name, gender, date of birth, father's name, contact details, address, bank account details, and nominee details. 3) The applicant must declare that they have read and understood the terms, are a citizen of India, have provided legally obtained income sources, and authorize the aggregator office to process the application.

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Subhash Tantuvay Dhavarya
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71 views4 pages

NPSLite Subscriberr Registration Form

1) This document is an application form for opening an NPS Lite retirement account and being allotted a Permanent Retirement Account Number (PRAN). 2) It requests personal details of the applicant such as name, gender, date of birth, father's name, contact details, address, bank account details, and nominee details. 3) The applicant must declare that they have read and understood the terms, are a citizen of India, have provided legally obtained income sources, and authorize the aggregator office to process the application.

Uploaded by

Subhash Tantuvay Dhavarya
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 4

Annexure NL-S1

Page 1

Application for Allotment of Permanent Retirement Account Number (PRAN) under NPS Lite
(To be filled by FC)
Acknowledgement No.

To affix recent
Coloured photograph of
the subscriber
(3.5 cm 2.5 cm)

Permanent Retirement Account Number : (To be filled after PRAN generation )

Sir/Madam,
I hereby request that a NPS-Lite account be opened in my name and Permanent Retirement Account number
(PRAN) be allotted based on the particulars given below:

(To avoid mistake, please follow the accompanying instructions carefully before filling up the form. * indicates
Mandatory Field)

1. Full Name (Full expanded name: initials are not permitted): Shri
First Name *

Smt.

Kumari

Signature/Left Thumb Impression


of Subscriber in black ink

(Please Tick as applicable)

Middle Name
Last Name
I would like my PRAN card to be printed in HINDI:
2. Gender * Please Tick as applicable,

Male

Female

Yes

No

(If Yes, please provide the details on Page No. 2)


3. Date of Birth *

(DD/MM/YYYY)

4. Fathers Full Name:


First Name *
Middle Name
Last Name
5. Subscriber Mobile Number:

6. Membership Number
allotted by Aggregator (if any):
7. Subscribers Address (OPTIONAL. If provided details marked with * are mandatory):
Flat/Unit No, Block no. *
Name of Premise/Building/Village
Area/Locality/Taluka
District/Town/City *
State / Union Territory*
Country *
Pin Code *

8 Subscribers Bank Details: (OPTIONAL. If provided details marked with * are mandatory)
Bank A/c Number *
Bank Name *
Bank Branch *
Bank Address *

Pin Code
Bank MICR Code

Bank Branch IFSC


(Indian Financial Systems Code)

Savings A/c

Current A/c

Annexure NL-S1

Page 2

9. Subscribers Nomination Details: (OPTIONAL please refer to Sr. No. g of the instructions)
1. Name of the Nominee:
1st Nominee
2nd Nominee
First Name
First Name

3rd Nominee
First Name

Middle Name

Middle Name

Middle Name

Last Name

Last Name

Last Name

2. Date of Birth (In case of a minor):


1st Nominee

2nd Nominee

3rd Nominee

3. Relationship with the Nominee:


1st Nominee

2nd Nominee

3rd Nominee

4. Percentage Share:
1st Nominee

% 2nd Nominee

5. Nominees Guardian Details (in case of a minor):


1st Nominees Guardian Details
First Name

3rd Nominee

2nd Nominees Guardian Details


First Name

3rd Nominees Guardian Details


First Name

Middle Name

Middle Name

Middle Name

Last Name

Last Name

Last Name

Declaration & Authorization


I hereby declare and agree that (a) I have read and understood the Offer Document, terms & conditions or the same was interpreted to me,
and the answers entered in the application are mine. (b) I am a Citizen of India. (c) I have not been found or declared to be of an unsound
mind under any law for the time being in force. (d) I am not an undischarged insolvent. (e) I do not hold any pre-existing account under NPS.
Declaration under the Prevention of Money Laundering Act, 2002
I hereby declare that:
1. The contribution paid has been derived from legally declared and assessed sources of income.
2. I understand that the PFRDA/NPS Trust has the right to peruse my financial profile and also agree that the PFRDA/NPS Trust has
the right to close the NPS account in case I am found guilty of violating the provisions of any Law, directly or indirectly, by any
Competent Court of Law, having relation to the laws governing prevention of money laundering in the country.

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

(DD/MM/YYYY)

Authorization by Aggregator Office (NL-AO) :


Certified that the subscriber is registered with the aggregator and he/she has opted to join NPS. I hereby declare that subscriber is eligible to join NPS and the
above
declaration
has
been
signed
/
thumb
impressed
before
me
by
_____________________________________________________________________________ after (s)he has read the entries / entries have been read over to him
/ her by me.

__________________________________________
Signature of the Authorised Person

(Rubber Stamp of the Aggregator)

Name of the Aggregator:___________________________________ NPS Lite- Account office (NL-AO) Registration Number:
Date : ____/____/________ Place : _____________

NPS Lite- Collection Centre (NL-CC ) Registration Number :

Annexure NL-S1

Page 3

INSTRUCTIONS FOR FILLING THE FORM


a)

b)
c)
d)

e)
f)
g)

Form to be filled legibly in BLOCK LETTERS (English only) and in BLACK INK only. 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 canceling 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.
The subscriber should affix a recent colour photograph (size 3.5 cm x 2.5 cm) in the space provided on the form. The photograph should not be stapled or
clipped to the form. (The clarity of image on PRAN card will depend on the quality and clarity of photograph affixed on the form.)
Signature /Thumb impression (LTI in case of males and RTI in case of females) should only be within the box provided in the form. The subscriber
should not sign across the photograph. If there is any mark on the photograph which hinders the clear visibility of the face of the subscriber, the
application shall not be accepted.
The application is liable to be rejected if the mandatory fields are left blank or the application is incomplete.
The subscribers thumb impression should be verified by the designated officer of the Aggregator accepting the form.
Subscribers Nomination Details
Percentage Share:
1)
Subscriber can nominate a maximum of three nominees.
Subscriber cannot fill the same nominee details more than once.
2)
3)
Percentage share value for all the nominees must be integer. Decimals/Fractional values shall not be accepted in the nomination(s).
4)
Sum of percentage share across all the nominees must be equal to 100. If sum of percentage is not equal to 100, entire nomination will be rejected.
Nominees Guardian Details:
5) If a nominee is a minor, then nominees guardian details shall be mandatory.

GENERAL INFORMATION FOR SUBSCRIBERS


a) The Subscriber can obtain the status of his/her application from the respective Aggregator.
For more information - Visit us at http://www.npscra.nsdl.co.in or Call us at 022-24994200 or e-mail us at info.cra@nsdl.co.in or write to Central
Recordkeeping Agency, NSDL e-Governance Infrastructure Limited, Times Tower, 1st Floor, Kamala Mills Compound Senapati Bapat Marg, Lower Parel
(W), Mumbai - 400 013.

Annexure NL-S1

Page 4

Details for printing PRAN card in Hindi (please provide the details in Devnagri script):
(* indicates Mandatory Field)
Please note that the manner in which the names are provided in this annexure will be displayed on the PRAN card. However,
date of birth will be printed in English only.
Subscribers Full Name:
First Name *

__________________________

Middle Name

___________________________

Last Name

___________________________

First Name *

__________________________

Middle Name

___________________________

Last Name

___________________________

Fathers Full Name:

Signature/Thumb
Impression of the subscriber
________________________________________________
Name of the subscriber:

____________________________

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