Ver 1.

2 Annexure - 52

NATIONAL PENSION SYSTEM (NPS)

KFin Technologies Private Limited
Reguest For Change/Correction in Subscriber Master details And/Or Reissueof PRAN Card
[ To avoid mistake(s), please read the accompanying instructions carefully before filling up the form]

For POP-SP/DDO/NL-CC use: For POP/POP-SP/PAO/DTO/DTA/PrAO/ NL-AO/NL-OO use:

Registration No. Registration No.:
Date of Receipt:
Date of Receipt : POP/POP-SP/PAO/DTO/DTA/PrAO/NL-AO/
NL-00 Stamp:

Signature and Stamp of POP-SP/ODO/NL-CC Entered By: Date:

Verified By: Date:

Receipt No.: (Mandatory for POP/POP-SP) I I I I I I I I I I I I I I I I I I

Acknowledgement No.
(To be filled by Nodal Office as generated by CRA system)
I I I I I I I I I I I I I I I I I I
I hereby request for the following details for the change ( Please tick ). [ In case of change/correction in employment details, please contact your employer/Nodal Office. J
A) Change or Correction in Subscriber Master Details D B) Reissue of PRAN Card D
C) Employment Details D
Permanent Retirement Account Number*: ����-�1-����-���-���-���
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I hereby submit the following details of change. [Please tick ( ✓) the box on /eh margin of appropriate row where change/correction is required and provide the details in the
corresponding rows.]

Section A - Change or Correction in Subscriber Master Details ( * Indicates Mandatory Field)

D 1. PERSONAL DETAILS: (Please refer to Sr. No.1 of the instructions) *Reason for Change/Correction (Mandatory)_______________________________________
Name of Applicant in full Shri D Smt. D Kumar D
First Name* I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
Middle Name I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
Last Name I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
Subscriber's Maiden Name I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
Father's Full Name:
First Name I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
Middle Name I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
Last Name I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
Mother's Full Name:
First Name I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
Middle Name I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
Last Name I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
Date of Birth I I I I I I I I I I
I I
(Date of Birth should be supporte by relevant documentary proof. Nodal Office shall verify the same before updating details in the CRA system.)
Would you like to re-issue PRAN card in case of change in details pertaining to Subscriber's Name,
Father's/Mother's Name or Date of Birth (This will be charged to Subscriber/employer by CRA):
Yes D No D
Gender* OMale D Female Drransgender
Marital Status* D Unmarried D Married D Widow/Widower D Dovorcee
Spouse Name I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
I I I
(Refer Sr. No. 1 of instructions)
CKYC Number Generated from Central KYC Registry. Submission of proof for the same is necessar,\
Retirement Adviser Code
KYC Number, Retirement Adviser Code and Spouse Name fields are not applicable for Government & NPS Lite Subscribers

D 2. PROOF OF IDENTITY (Pol) (Any one of the documents need to be provided along with the identification number)

Passport Passport Expiry Date

I I I I
Voter ID Card PAN Card
I I I
Driving License Driving License Expiry Date I I I
NREGA JOB Card
Others Name of the ID
I I I I I I I I I I Please refer Sr. No. 2 of the instructions. I
UID (Aadhaar)
D through
I hereby authorize CRA registered with Pension Fund Regulatory and Development Authority (PFRDA) to use my Aadhaar details for National Pension System (NPS) and authenticate my identity
the Aadhaar Authentication system {Aadhaar based e-KYC services of UJOAJ) in accordance with the provisions of the Aadhaar (Targeted Delivery of Financial and other Subsidies,
Benefits and Services) Act, 2016 and the allied rules and regulations notified thereunder. I understand that the Aadhaar details (physical and I or digital, as the case maybe) submitted for availing
services under NPS will be maintained in NPS till the time the account is not inactive in NPS or the timeframe decided by PFRDA, the regulator of NPS, whichever is later. I understand that
Security and confidentiality of personal identity data provided, for the purpose of Aadhaar based authentication is ensured by CRA registered with PFRDA till such time it is acting as CRA for
my NPS account.

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