rll ·i.:__lj_ CSRF NATIONAL PENSION SYSTEM (NPS) - SUBSCRIBER REGISTRATION FORM

Select your Central Recordkeeping NSDL e-Governance Karvy Computershare Agency (CRA) [ Please tick(•)] Infrastructure ltd. Pvt. ltd.

Please select your category Central Govt. State Govt. [ Please tickt-") ] All Citizen Model Corporate Sector NPS Lite (GOS) To. Nationa: Pension System Trust Oear Sir/Madam I here:f)y request that an NPS account be opened in 111y name as per ll1e particulars given below·

• indicates mandatory fields. Please fill the form in English and BLOCK letters with black ink pen. (Refer ge11Rral tnndehnes at mstn.ction-, p,19Pi KYC Number,f

~YC Nunber {1t a~1;)l:u1bie ·; Generated from CP'.llra! KYC Reg1s1ry Retirement Adviser Corie .1pn!:c:zihle·i

1. PERSONAL DETAILS: (Please refer to Sr No. 1 of the instructions; Name of Applicant in full Shrr Smt. Kuman First Name" Middle Name Last Name Suoscnbers Haiden Nnme (if any) Father's Name'

Mother's Name'

Fathe(s na111e \,vi!I lJe nrmteri on PRAN card In cast molber s name to he pr,nterl nstead of f;:,fhRrS name ! Please tick \ ,/ J J Date of Brrth: !Date of Birth should be supported by relevant documentary proof) City of Birth' Country of Birth· Gender' [ Please tick ( /) J Male Female Others Nationality' In-Indian Marilal Status· Married Unmarried Others Spouse Name·

Residential Status· Indian

2. PROOF OF IDENTITY (Pol)' (Any one of the documents need to be provided along with the identification number) Passport Passport Expiry Date Voter 10 Card PAN Card Driving License Driving License Expiry Date NREGA JOB Card Others Name of the ID

UID () I hereby euuvcrire CRA reoisteret! wit!, Regulato1y ancl Development Authonty (PFRDA) to use my Aaclhaar oetents for Natrona/ Pension System (NPS) and authent/r:atu identity thH Aadhaar Authentication (Aadhaar bnsed e-KYC services of UIDAI) in accordance vvith the provisions of the Aadhaar Qpl1vr,rv F1!:anr:1a/ nther Subsidie« Benefits Act. 2016 and the a/1,·ed rules c1nd regulations notified thereunder. I understand that the 1 1 rfet.:i,1. .c;, 1p/. ysw.11 and as the case mayfJP) subtvuuect for availing ,,;e,v,r:es uutlet NPS will be maintained m NPS till the time the account is not 1n3ct1ve NPS er the t.rnetron«: PFROA the regulator c! NPS. whichever is later I understand that Security and contidontiet.tv of persona, identity data oroviaec. lor ttH.' purpose of Aadhaa, eutt.enuceuon .s cnsuic«t by CRA reqistcrcc: with PF ROA t1/i such time ,t ts acting as CRA for rny NPS account As per tne amenc!ments mrJcfe under PrevfHl/1011 of Money-Laundenn9 (l'v!amtenance of Recorcls) Second AmencJmenl Rules_ 2017 Aaa·11aar and PAN are mandatory under NPS 1ry__9_~1-~o not have Aadhaar a!'.?' or PAN at present. olease ensure /hat these deta,ls are prov.1tfed within six monl!1s of subr!llss1on of this Sul;scrlber Reg_~s_f!!!_l1on Fann

3. PROOF OF ADDRESS (PoA)* Correspondence Address Permanent Address '. Please tick 10r1,m1g :_1rnn~f'·JIC, r.Aadhacirio\/ote1 ID c?irrt'NRE:~;µ, 1.6.adhacu,:,/\/oter ID card:NREGA Job Ol(J Registered Lease·Sale agreemen! of residence Please refer Sr \Jc 2 o; tho Registe:-ed Lease/Sale a~:eerrent of residenre EL~e_s_; __ ~?/Eiectr:c1ty:Telep_r,~~[b__a~_dline] Bill _ >Latesr Gas Electrrc1ty!Te1ep_oone[Landl1ne] Brll

4.1 CORRESPONDENCE ADDRESS DETAILS* Address Type' Reside n tra 1/8 usi ness Residential Business Registered Office Unspecified Flat/Room/Ooor/Block no. Landmark Premises!Builc1rng/VillacJe Road.Street/Lane Arealocality•Taluk City/Town/District PIN Code Stale/UT

4.2 PERMANENT ADDRESS DETAILS* Tick (./Jin the box in case the address is same' as above Adclress Type· Res1de11t1c1 l'Busrness Residential Business Registered Office Unspecrfred Flat'Room/Door/Block no Landmark Prem,ses!Bu riding/Village Road/Street/Lane Area/Locality1Taluk City'Town/District PIN Code State:U.T CSRF 5. CONTACT DETAILS

Tel (Offi (w,tc STD code, + 'e' .Res , 1w:th STD codeJ +

Mobile (Des.rabte i Y Mobile Number is required for cornmun.cauon and to get SMS alerts) Email ID

6. OTHER DETAILS ( Please refer to Sr 110 3 of the instructions ) Occupation Details· [ please tick(.;) J Privdte Sector Public Sector Government Sector Professional Self Employed Homemaker Student Others (Please Specify) 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.) Please Tick If Applicable Politically exposed person Related to Politically exposed Person -· -· - 7. SUBSCRIBER BANK DETAILS ! Please refer to Sr no. 4 of the instructions) (If Subscriber mentions any of the bank details. all the bank details will be mandatory except MICR Code ) Account Type [ please t1cki., ) i Sav:ngs Ac Current A/c Bank Ac Number

Bank Name

Branch Name

Branch Address PIN Code

Bank MICR Code IFS Code

8. SUBSCRIBERS NOMINATION DETAILS• !Please refer to Sr. Nu s of the instructions)

Narna of the Nornrnee (You r,1r: norrn11ate up to ;i maxrmurn of 3 nominees and 1f you desire so please fill in Annexure Ill (Additional Nomination Form) provided separately) Frrst Name Middle Name Last Name

Relationship with the Nominee Date of Birth (In case of Minor) Nominee's Guardian Details (in case of a minor) First Name Middle Name Last Name

9. NPS OPTION DETAILS (Please tick (v' i as applicable) I would like to subscribe for Tier ti Account also YES NO If Yes. please submit details in Annexure I. 1:11 you wtsb to activate Tier !I account s ubseque otlv you may suom t separate apptn.atom.annexure S1Cl to tne as soc.aleo Nodal Office or to POP.POP-SP of your choice. The 11st of POP POP-SPs rcndcrir:g under NPS anrl Annrixurr- S 10 .s available on CRA wchsuc : 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 Please refer to Sr no 6 of the instructions 1 (i) PENSION FUND SELECTION (Tier I) : Please read below conditions before opting for the choice of Pension Funds: 1 Government Sector: For Government Subscribers, the following PFs act as default PFs ns per the guidelines issued by the Government (al LIC Pension Fund Limited (b) SBI Pension Funcls Pvt Limited (cl UTI Retirement Solutions Ltd 2. All Citizen Model Subscribers under All C'tizen model have the opt.on to choose the available PFs as per their choice m the table below 3 Corporate Model: Subscribers shall have the option to choose the available PFs as per the below table 111 consultat,on with lheir respective Employer 4 NPS Ute: NPS Lite rs il group ~ho1ce model where subscriber has a choice of PF and mvestrnent option as available with Aggregator

Name of the Pension Fund 1Ple1N: sc1<•11 ootv one] Please Tick tv ) Availability of the Pension Funds UC Pens1011 Eunrt Li'TiitPd Available to SBI Pension Funds Private lirmted Government UTI Ret!rement Soluuons l. in1rled Sector Pr~ic1ential Available to ICICI Pension Funds t\1i1•1agernen· Cornpar.v L1n-11!ed Available to Available to All Corporate Kotak Mahindra Pension Fund Li1Y11tP.d NPS Lite Citizen Model• Model• Reliance Capita! Pension Fund L,rr,ted HDFC Pension Management Cornpar y l 1mited B1rla Surilrle Pension Management Lirrnted

· Selcct,or: of Pcns.c- Fune rs rr.a-icatcr , ooth .n .1-\cli1.te ano Auto Choice

(ii) INVESTMENT OPTION (Please Tick(") m the box 91·,en below showrnq your .nvestrr.ent option) Active Cho,ce Au1o Cho,ce Ple;ise note 1 In case vou select Act,ve Choice fill up section belo11v ;=wrJ it vou select Auto C!1oice fill up section :'iv) belovv 2 In case ;'Oll do not indic;:,te ;=rnv invPstrnent option. your fL1nds \,'\;ill be invested in Auto Choice (LC 50J 3 In ccisP voL1 havP. :)Oterl for .AuL> Choice ;::ind fil! c1p sectio·1 iiiiJ belmv rel.1ting to Asset Allocation the Asset Allocation instructio11s will t1e ignored and investment will he marie as 0er.t\11to Choice rLC 50,1 (iii) ASSET ALLOCATION (to be filled up only in case you have selected the 'Active Choice' investment option) E C G A Note: 1 The total allocation across E, C G and A asset classes must be equal to 100%. Asset Cl;_i'.-c:; (Cannot {.\lax c;p tu J.lc1x up to iCannot Total case. the allocation is left blank and/or does not equal 100% the application shall be re1ected c,xrccd 50'\,) 1 Oll'\,) 1 00%) exceed 5r;,:,) 2. Asset class E-Equ,ty and relaterJ instruments. Asset class C-Corporate debt and related 1rstrurnents · Asset class G-Goverment eonds and related instruments: Asset Class Specify .£\-Alternat,ve Investment Funds including instruments like CMBS. MBS. REITS. AIFs, lnvlts etc.

(iv) Auto Choice Option (to be filled up only in case you have selected the 'Auto Choice' investment option). In case, you do not indicate a choice of LC, your funds will be invested as per LC 50.

Life Cycle 1LC)Fu1°ds Please Tick (/)Only One LC 75 Nole LC 75- It 1s tile Life cycle fund where the Cap to Equity investments is 75% of the total asset 2 LC 50- It is the Life cycle fund where the Cap to Equity investments is 50% of the total asset LC 50 3 LC 25- It is the Life cycle fund where the Cap to Equity investments is 25% of the total asset LC 25

2 of 5 11. DECLARATION BY SUBSCRIBER* r Please refer to Sr no. 7 of the instructions 1

Declaration & Authorization by all subscribers

I nave read arid under siood tt~p ter rns ann conduro.rs of P,e rvauor a' Pens.on System and ~',erehy agree tc, the same aior'g ·Ai!l1 lhP PFROAAct r eqt.Iauons framed thereunder anrl declare that !hf· i.'lfnrm;Jtir:n and rlocl1:r:Pnt~ fL,rris'led hv rre arr- tr~1r, ar«t to the nest cf my knrnNIPrlgP arc! hPlipf I unrlPrtake to inform immediately the Central Record Keep1ng Accncv/Nat.onal Pensiun Svstcm Trust. of any change in thu above 1nformat1on furnished by ,nc I do not hold any prc-oxrstmq account under NPS_ I i understand that! shall he fully liahle for subrms sron of any false or incorrect mlorrnatron or oocur ier-ts I h,r!her agree le be bouno by the terms a:1d cundtions o! orovis.on of servces by CRA Ir om lrme lo t1rne and any amendment thereof as approved by PFRDA. whether! complete or partal without anv new rieclnrcltion being furnished by me I shall be bounCl by the terms and conoruor s for the usage of I-PIN (to access CRA website and view details; & T-PIN

Declaration under the Prevention of Money Laundering Act. 2002 I rereby rleclnre thnt the contnhution paid bv me/on my befinlf has been derived from legally declared and assessed sources of income I understand that NPS Trust has u·ie rig~ll to peruse :Y,v fi11ancia! profile or share the info11Y1ation. with other governn1ent authorities I further agree that NPS Trust has the right to close my PRAN in case I am found vrolatmq n~e provisions of any law relatino to prevention of money launderinq

Date

Place

Signature/Thumb Impression• of Subscriber in black ink (' L Tl in case of male and RTI in case of females)

12. DECLARATION ON FATCA* (Foreign Account Tax Compliance Act) COMPLIANCE (Ple ase refer to Sr no 8 of the instructions): Section I*

US Person' Yes No

Section II*

For the purposes of taxation I am a resident rn the following countries and my Tax Identification Number (TIN)/functional equivalent in each country is set out below or I have rndrcated that a TIN/functional equivalent is unavailable (kindly fill details of all countries of tax residence if more than one):

Particulars Country (1) Country (2) Country (3)

Country/countries of tax residency

Address Lrne 1

Address in the jurisdirtron for Tax City/Town/Village Residence State

ZIP/Post Code

Tax lrlentification Number (Tl NJ/Functional equivalent Number

TIN/ Functional equivalent Number Issuing Country

Valrdity of documentary evidence provided 1Wherever applicable)

"I certify that· a) It shall be my responsibility to educate myself and to comply at all times with all relevant laws relating to reporting under section 285BA of the Act read with the Rules 114F to 114H of the Income tax Rules. 1962 thereunder and the information provided in the Form rs in accordance with the aforesaid rules. b) the information provided by me rn the Form. its supporting Annexures as well as in the documentary evrdence are, to the best of my knowledge and belief. true. correct ano complete and that I have not withheld any material information that may affect the assessment/categorization of the account as a Reportable account or otherwise. c) I permrt/authorrse the NPS Trust to collect. store. communicate and process information relating to the Account and all transactions therein. by the NPS Trust and any of NPS intermediaries wherever situated including sharing. transfer and disclosure between them and to the authorities in and/or outside of any confidential rnformation for compliance with any law or regulation whether domestic or foreign.

I d) I undertake the responsibility to declare and disclose within 30 days from the date of change, any changes that may take place in the information provided in the Form. its supporting Annexures as well as in the documentary evidence provided by me or if any certification becomes incorrect and to provide fresh self-certification along wrth documentary evidence. e) I also agree that in case of my failure to disclose any material fact known to me. now or in future. the NPS Trust may report to any regulator and/or any authority designated by the Government of Indra (GOI) /RBI/IRDA/PFRDA for the purpose or take any other action as may be deemed appropriate by the NPS Trust if the deficiency is not remedied by me within the stipulated period I) I hereby accept ancl acknowledge that the NPS Trust shall have the right and authority to carry out rnvestigatrons from the information available in public domain for confirming ll1e information provided by me to the NPS Trust g) I also agree to furnish such information ancl/or documents as the NPS Trust may require from time to trme on account of any change in law either rn India or abroad rn the sub1ect matter herein.

h) I shall indemnify NPS Trust for any loss that may arise to the NPS Trust on account of providing incorrect or incomplete information.

Date

Place Signature/Thumb Impression• of Subscriber in black ink (' L Tl rn case of male and RTI rn case of females)

Name of subscriber

______J

3 of 5 Cl J. [ CSRF

13. DECLARATION BY EMPLOYER

Applicable to Government Subscribers only (Subscribers Employment Details to be filled and attested by the Dept!. (All Details are Mandatory)

Date of Joining Date of Retirement Employee Code/ID 1lf applicable) PPAN (If applicable)

Group of Employee (Tir.k as applicable) Group A Group B Group C Group D

Office Department Ministry ODO Registration Number DTO/PAO/CDDO!DTA/PrAO Reg1strat1on Number Basic Pay Pay Scale

It rs certified that the details provided in this subscriber reqistration form by employed with us. including the address and employment details provided above are as per the service record of the employee maintained by us. Also. it is further certified that he/she has read entries/entries have been read over to him/her by us and got confirmed by him.her.

Signature of the Aulhonsed person Rubber Stamp of the ODO Signature of the Authonsed person RutJber Stamp of lhe DTO/PAO/CODO/ (In the box above) (In the box above) (In the box above) DTA/PrAO (In the box above) Designation of the Authorised Person Designation of the Authorised Person

Name of the ODO Name of DTO,PAO!CDDO.DTA/PrAO

Deptt.Mm.strv Date

14. DECLARATION BY EMPLOYER/ CORPORATE

Applicable to Corporate Subscribers only (Subscribers Employment Details to be filled and attesterJ by Corporate (All Details are ManrJatory))

Date of Joining Date of Retirement

Employee Code/ID

Corporate Regd. Number (CHO No.) Allotted by CRA

CBO No. allotted by CRA

Certified that the details provided in this subscriber registration form by employed with us. including the employment details provided above are as per the service record of the employee maintained by us. Also. it is further certified that he/ she has read the entries/ entries have been read over to him/ her by us and got confirmed by him / her.

Date Place

Signature of the Authoriseci person (In the box above)

Designation of the Authorised Person Rubber Stamp of the Corporate (In the box above)

4 of 5 Ver i.i CSRF

15. TO BE FILLED BY POP-SP

Receipt No. ( 17 digits; POP-SP Registration Number

Document accepted for date of Birth Proof

Copy of PAN carcl subm,tteci YES NO KYC Compliance YES NO Documents Received· (Onqmals Verified) Self Certifieo (Attested) True Copies Identity Verification Done

Existing Bank Customer:

I/we hereby certity confirm that Sh,·, Smt.Kum ...... is an existing customer of the Bank having fully operative Saving Bank account no .. at .. branch and KYC norms required for opening Bank Account which match the requirements for opening NPS account have been fully complied with. We further confirm that the S B. a/c of Sh/Smt/Kum rs not a 'Basic Savings Bank Deposit Account Adhaar Based KYC Certificate: I/we hereby certify that Aadhaar Number ... of Sh1Smt!Ku111 ...... has been checked and the name and address mentioned on the original Aadhaar card are matching with that mentioned on NPS application form.

Name

Des1gnat,nn Place

Siqnaturo of Author1zeU Si~~natnry Date

[To be filled by CRA - Facilitation Centre (CRA-FC)]

Reco,vo,1 by CRA-FC Roqistrat,on Number

Received at Date

Acknowler1gemenl Number rtiy CRA-FCI

PRAN Allolec1

ACKNOWLEDGEMENT Name of the Subscriber Contribution Amount Remitted ' Date of Receipt of Application and Contribution Amount

Stamp and Signature of the Employer/PoP·

5 of 5 V ,,. 1.1 CSRF INSTRUCTIONS FOR FILLING THE SUBSCRIBER REGISTRATION FORM General Guidelines (a) Please fiil the torrn in leqible hnndwritin:;:1 so as k.: avoid errors .n your aµp!icat:on processmq Ple,1se no not overwrite. Corrections shouid be made Dy c<1nce!!i_ng and re-writing and such corrections shsould be countersigned by tt1e aopricant. Ead' box whe~ever p,0·,,11ded. shou!d contarn or:ly one character (alphabet .r number/ punctuation mark) leaving a blank box alter each word I (b) [n case. vou rnent1or; the KYC number suorn.ssion of proof for the same is necessary (c) wcornolete in anv respect and .. 'or not accompanied bv required documents are liable to be rejected The application. .s linble to be rejectad if mandatory fields are bln'lk or the ariPl:cation foim rs printed back to back (dJ The subscnber should not sig,, ac-oss 1!1e The pnotoqrapr- should cot be staoled or clipped to the form. If there rs any mark on the photograph such that ,t hinders the clear visih.htv of tr1e face of the the application shall not be accepted (e) Copies of all t'"'le documents submitted by the aupucant should be self-attested and accompanied by originals for veritication by the nodal office (f) Narne and Address of tl1e applicant ment.oneo on the form. should rnatch wrth the documentmy proof subrntted \9) The subscriber's thumbs impression should he verified hv thP designated officer of POP-SP I Nodal Office S. Item Item Details No No. Instructions -~his Form is applicable tc, Resident Indians and .there 1s a seporate Form for Non .Resicient Indians Person;1! Det;:liis Currently. Foreign Nationals OthP1 CoL;ntry !nd1v1rLials (OCI) anrl Persons of lrici1an Origin (PIO) are not allowed to open PRAN. The applicant st'1all mention fathP.r s 11ame and ·nother s name and shall select the option to be printed on PRAN Card

0 it n•arric~d. spuus8 narr,e 1s manciato. :/ hi:her·:, name mandatory If father's name t1as more than 10 dig1!s. vou may fill Annexure II for the same t'1..-1ott•er s namE--: 1s mandatorv If Mother~; 11arne h8S more i11cm 30 rligils. you may fill Annexure II ior the same D~te at Birth Please ensure that the date of birtt1 matches as indicated 1n the document provided :n the support S.No Proof of Identity (Copy of any one) S.No Proof of Address (Copy of any one) Passport issued by Government ot India 1 Passport ssued by 2 with photograph 2 Ration card with photograph and ros,dent,al address 3 Bank Pass hook or certificate w,11-, Photograph 3 Bank Pass book or cert,f,cate with photograph and residential address 4 Cert1f1cate of t11e POP bank for an ex1st1ng Bank customer. 4 Certificate of the POP bank for an existing Bank customer 5 Voters Identity card with photograph and res1rient1al address 5 Voters Identity carrl with photograph and res1dent1al address 6 Valid Driving license with photograph 6 Valid Driv,ng license with photograph and residential address Cerl,f,cate of 1de11t1ty with photograph s,gnerl by a Member or 7 Letter from any recogrnzed public authority at the level of Parliament or Merr1ber of LerJiSlat1ve Assembly Gazetted officer like D1stricl Magistrate Div,s,onal comm,ss,oner. BOO. Te~silaar. Manda! Revenue Officer. Jud1c1al Magistrate etc. 8 P,\N Card !Ssued by lnccw'.e tax departr--,en'. 8 ce,t,f,cate of address w,th photograph signed by a Member of Pc1r!,amec1 or Me,r,ber of Legislative Assen1bly ldent1tv Correspondence & 9 Aadhar Card letter issued by Unique lclentificatiori Authority 9 Aadhar Card I letter issued by Uniaue Identification Authority of Perm;:inen! address of India lnrlin clearly showing the address detnils 10 Job cards issucn by NREGA duly signed hv an officer of tro 10 .lob cards issued by NREGA duly signed by an officer of the State Governrne.11! 2. 3 & 4 State Government 11 lclentity card issued by Central/State government and its 11 The identity carcl/document with acldress. issued Dy any of Departments statuary! Regulatory Authorities. Public Sector the following CentraliSta•e Government and ,ts Depar1menls. Undertakings. Scheduled commercial Banks. Public Financial Statuary!Regulatory Authorities. Public Sector Undertakings, lnst,tutions. Colleges affiliated to universities and Pcofessional Scheduled Commercial Banks. Public F,nanc,al Institutions for Bodies such as ICAI. ICVVAI. ICSI. Bar Council etc their employees 12 Photo. Identity Card issued by Defence Paramilitary and 12 Lntest Electr,citviwater bill 1r1 the name of the Subscriber / Police departmenl's Claimant and sh-owing the address (less than 3 months old) 1 J Ex-Service ~vlan Card issued by Ministry of Defence to their 13 Latest Telephone bill ,n the name of the Subscriber / Claimant employees and sl1ow1ng the address (less than 3 months old) 14 Photo Credit card 14 Latest Property/house Tax receipt (not more than one year old) 15 Ex,sting valid registered lease agreement of the house on stamp paper ( in case of rented/leased accommodation) Note (1) If the address on the document submitted for identity proof by the prospective customer rs 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 (Iii If the address indicated on the document submitted for 1dent1ty proof differs from the current address mentioned in the account opening form. a separate proof of address should be obtained. All future commun,cations will be sent to correspondence address. If correspondence & Permanent adrlress are different then for hotn have to be suhmitled (iii/ The KYC docornen;s rnay be submitted a period of 30 days after generatio,~ of PRAN. (Only for Government Subscribers) Polil,caily ExposerJ Politrcallv Exposecl Persons (PEPsJ are indiviuuats who are or have Deen entrusted with prominen! public functions ,n a foreign country for Persu:1 heads of state or of the government. senior politrcrans. senior qovernment judicial or military officials, senior executives of state- corporations important political party officials For Tier 1. bank details are octional In case subscriher provides bank details ,t should be supported by cancelled cheque SL;hscr1bE::r s 6a11K For ac:ivat,011 of Tier II liank cieta,ls are mandalory. Please attacl1 a Cancelled cheque (conta,n,ng Subscriber Name. Bank Account Number De1a,ls am1 IFS Code) or Bank Cert,i,cate conta,ninq Name. Bank Account Numher and IFS code for direct credit or electronic transfer. In case if the cheque is not preprinted v,.,ith nar-r1e. additionally a copy of the hank passbook or hank certificate containing Name. Bank Account Number and IFS code s!wuld be submitted. Subscriber's !n case of more than one nominee. percentaqe share value for all the r1om;nees must be mteger. Oecimals.lFractional values shall not be Nomination Details accepted 1n the nomina!!on(s). Sum of percentage st1are across all ttw norrnnees mi.ls! be equal to 100 !f sum of percentage is not equal to 100 ent:re non11nat1on will be re1ected Pension Funrl (PFJ For more details on Investment Option· you rr1.1y visit CRA website 6 10 Selection and Subscribers from Government sector me currently not allowed to exercise the investment option As mentioned. your contribution will be Investment Option ,nvesterl by default PFs as per tl1e guidelines ,ssuecJ by me Government Signature Thumb 1mpress1on should only be within the box provided 1n the forrn. Thumb 1mpcess1on, ,, used. should be attested by the 11 Deciar;ition by Sub~.cnber des,gnated officer of POPiPOP-SP!Nodal office with the official seal and stamp. Left Thumb Impression rn case of males and Right Thumb 1rnpression in case of females Clarif1cot1on Guidelines on fillirg detods ,f Jppl1c0nt residence for tax purposes ,n Jurisdiction(s) outside India Junsd1ct1on(s I of Tax Res,dence Since US taxes the global income of ,ts citizen. every US citizen of whatever nationalitv. 1s also a resident for tax purpose ,n USA · · Tax ident1f1cat1on Number (TIN). TIN need not oe reported if it has not been issued by the Jurisdiction However. 1f the said 1urisd1ction has Declaration by issued il high integrity number with an equivalent level of 1dentificat1on (a ·Functional equivalent\ the same may be reported. Exarnples 8 12 subscriber on FATCA of thal type of number for inclividuc1I include a social securitv/insurance number. citizen/personal identification/services code/number and Complic1nce resident registration number) 11 applicant res,cience for tax purpose in 1urisdiction(s) within India. (PAN) to be provided as Tax Identification Nun1ber (Tl~,J! In case applicant 1s declaring US person status as No but hi.s/her Country of Birth is US, document evidencing Relinquishment of C1t1zensh1p should be provided or reasons for not having rel1nqu1shment certificate ,s to be provided General Information for Subscribers a) The Subscriber ca,, obtain the status of hiSil'er application from CRA and their designated nodal officer b) Subscribers c:1re ;1dvised to retnin tt1e nr.:knuwledgement sliw si~ned1 stamped bv the designated nodal officer where they submit the application c) For more informc1tio:1 c!ar:fic.?Jl!ons cont;ir:t CRA

Vv'ebsite \/Vebs1te ht!Qs_j/nps._karvy.c::0F11 Ceil! Call 1800 208 1516 Acidress Central Recordkeep,ng Agency 1CRAi Address Central Recordkeep,ng Agency (CRAJ NSDL e-Governance !nfr.1st:-ucture Limned Karvy Compu!ershare Pv! Ltd. 1st Floor T:mes rower Karnnla tvlrlls Compound. Senapati Bapa! Marg Karvy Selenium Tmver B. P!ol Nos. 31 & 32, Financial District Nanakramguda Lower PcHel (IN)_ iv1u:11tJCH - 400013 Seril,ngampally Manda!. Hyderabad - 500032 Annexure I to CSRF

TIER II DETAILS

I hereby submit the following details for activation of Tier - II account under NPS.

PAN card Number (Mandatory)

2. Subscribers Bank Details: (All bank details are mandatory except MICR Code) If same as Tier 1. Please Tick (, I else. provide the details below Savings Ale Current A1c

Bank A/c Number

Bank Name

Branch Name

Branch Address PIN CODE

Bank MICR Code IFS Code

Subscriber's Nomination Details

If same as Tier I. Please Tick (,) else. provide the details below. In case you desire to nominate more than one person, please fill Annexure 111. 3. Name of the Nominee:

First Name Middle Name Last Name

4. Date of Birth (In case of Minor;

5. Relationship with the Nominee

6 Norninees Guardian Details (in case of a minor)

First Name Middle Name Last Name

Subscriber Scheme Preference

7. If same as Tier I. Please Tick(,) else. provide the details below

(i) PENSION FUND SELECTION (Tier 11) : Please read below conditions before opting for the choice of Pension Funds:

• Name of the Pension Funds are given in alphabetical order.

Name of the Pension Fund (Please select only one) Please Tick t v) Only One Birla Sunlife Pension Management Limited

HDFC Pension Management Company Limited

ICICI Prudential Pension Funds Management Company Limited

Kotak Mahindra Pension Fund Limited

LIC Pension Fund Limited

Reliance Capital Pension Fund Limited

SBI Pension Funds Private Limited

UTI Retirement Solutions Limited

• Selection of Pension Fund is mandatory both .n Active and Auto Choice

(ii) INVESTMENT OPTION

(Please Tick ( ·,) in the box given below showing your investment option). Active Choice Auto Chorce Please note: 1 In case you select Active Choice fill up section ,iii) below and rf you select Auto Choice fill up section (rv) below. 2. In case you do not indicate any investment option. your funds will be invested rn Auto Choice (LC 50). 3. In case you have opted for Auto Choice and fill up section (iii) below relating to Asset Allocation. the Asset Allocation instructions will be ignored and investment will be made as per Auto Choice (LC 50)

1 of 2 Annexure I to CSRF

(iii) ASSET ALLOCATION (to be filled up only in case you have selected the 'Active Choice' investment option)

E G C Note: 1 The total allocation across E C and G asset classes must be equal to 100%. In Asset (Cannot !Max (Max up Total Class exceed up to case. the allocation is left blank and/or does not equal 100%. the application shall to 100%) be rejected 50%) 100%) 2. Asset class E-Equity and related instruments: Asset class C-Corporate debt and Specify% related instruments: Asset class G-Goverment Bonds and related instruments.

(iv) Auto Choice Option (to be filled up only in case you have selected the 'Auto Choice' investment option). In case, you do not indicate a choice of LC, your funds will be invested as per LC 50.

Life Cycle (LCJFunds Please Tick (,) 011ly One L-··-----···-- LC 75 LC 75- It is the Life cycle fund where lhe Cap to Equity investments is 75% of the total asset LC 50- It is the Life cycle fund where the Cap to Equity investments rs 50% of the total asset LC 50 3. LC 25- It is the Life cycle fund where the Cap to Equity investments is 25% of the total asset

LC 25

Declaration & Authorization by subscriber

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 National Pension System Trust. of any cnange 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.

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:

Signature/Thumb Impression• of Place: Subscriber in black ink (' LTI in case of male and RTI in case of female)

To be filled by POP/POP - SP/Nodal Office

POP-SP/Nodal Office Registration Number

Copy of PAN Carc1 Submitted YES NO

Name

Place

POP-SP/Nodal Office Seal Signature of Authorised Signatory Date

2 of 2 Annexure II to CSRF

ADDITIONAL REQUEST DETAILS

1. Name of Father (requirer: i' name exceeos 30 characters and not able to be covered on paqe 1 of the r1ppl1cr1tion form)

First Name

Mrddle Name

Last Name

2. Name of Mother (requrred 11 name exceeds 30 characters and not able to be covered 011 page 1 of the application form)

First Name

Middle Name

Last Name

3. Request for Printing Permanent Retirement Account Number (PRAN) card in Hindi (required only if applicant wants PRAN card in Hindi)

Please provide the following details in Devnagri script for printing the PRAN card in Hindi. Also. please note that the manner in which the names are provrded rn this annexure will be displayed on the PRAN card. However, date of birth will be printed 111 English only. All the given below fields are mandatory.

Subscriber's Full Name in Hindi Father/Mother's Full Name in Hindi (As selected rn the Subscriber Registration form) Please refer Sr. No 1 of the instructions First Name

Mrddle Name

Last Nar,,e

Name:

Place:

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

(' LTI tl.ett Thumb Impression) 1n case of male anr1 RTI (Right Thumb lrnpress.on) .n case of female/ \'n 1.1 Annexure III to CSRF

ADDITIONAL NOMINATION FORM

INSTRUCTIONS FOR FILLING IN THE FORM

The details of nominees to whom the outstanding pension wealth of the suhscr1ber is payahle in case of the demise of the sunscnbor before entire proceeds are withdrawn is to be provided hereunder (Please refer mstruction no: 5)_ Also. please note that ,n case of demise of the subscriber after opting for deferred wrthdrawal. all the outstanding pension ·Nealt11 present .n tl,e NPS account of the subscriber shall be withdrawn upon receiving the request and paid to the nominees as mentioned m this form and the same would be treated as full and final discharge of the obligation

I. hereby nominate the person(s) mentioned below who is/are member(s)/ of my family to receive the amount rn my PRAN account under National Pension System 1n the event of my death.

1. Name of the Nominee: ------~l

1st Nominee 2nd Nominee 3rd Nominee First Name First Name First Name

Middle Name Middle Name Middle Name

Last Name Last Name Last Name

2. Present Communication address of the nominees:

Address of 1st Nominee Address of 2nd Nominee Address of 3rd Nominee

3. Date of Birth* (Only in case of a minor):

1st Nominee · 2nd Nominee ' 3rd Nominee

4. Relationship with the Nominee:

1st Nominee 2nd Nominee 3rd Nominee

5. Percentage Share:

1st Nominee % 2nd Norrnnee % 3rd Nominee

6. Nominee's Guardian Details (Only in case of a minor):

1st Nominee's Guardian Details 2nd Nominee's Guardian Details 3rd Nominee's Guardian Details First Name First Name , First Name

: Middle Name Middle Name Middle Name

1 Last Name Last Name Last Name

Dated this day of 20 at

Signature/ Thumb Impression' of the Subscriber

! 'Note: Left thumb impression in case of illiterate male Subscriber and Right thumb impression in case of illiterate female subscriber must be obtained.

1 of 2 \',,, 11 Annexure III to CSRF

TO BE FILLED/ATTESTED BY POP-SP/ODO

Certified that the above declaration and norn.nauon details has been signed ! thumb impressed before me by Sh/Smt/Ms.

after he she have read the entries I entries have been read over to him / her by me and got confirmed by him/ her.

Rubber Stamp of the POP-SP!DOO Signature of the Authorised Person

, POP-SP/ODO Registration Number Designation of the Authorised Person . (Allotted by CRAJ

POP-SP/ODO Office Name

Date

TO BE FILLED/ATTESTED BY POP/POP-SP/PAO/DTO/DTA/PrAO POP!POP-SP/PAO!DTOIDTA/PrAO Registration Number (Allotted by CRA)

Rubber Stamp of the POP1POP-SP1PAO/DTOiDTA/PrAO Signature of the Authorised Person

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