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eNPS Form
To,
National Pension System Trust.
Dear Sir/Madam,
I hereby submit my eNPS subscriber registration form
* indicates mandatory fields.
1. PERSONAL DETAILS:
Shri
Smt
Date of Birth *
Gender *
Male
Father's Name*
First Name *
Kumari
Middle Name
Last Name
Female
Others
Aadhaar 5
2. IDENTITY DETAILS*
PAN A
Voter ID
Others
Passport
BIJAPUR
Landmark
Premises/Building/Village
Road/Street/Lane
Area/Locality/Taluka
PAREAK NAGAR
City/Town/District
BIJAPUR,,BIJAPUR
State/U.T.
KARNATAKA
Country
INDIA
PIN Code
586101
BIJAPUR
Landmark
Premises/Building/
Road/Street/Lane
Area/Locality/Taluka
PAREAK NAGAR
City/Town/District
BIJAPUR,,BIJAPUR
State/U.T.
KARNATAKA
Country
INDIA
Passport
Voter ID card
Electricity Bill
Driving License
Ration Card
Telephone[Landline] Bill
Registered Lease
5. CONTACT DETAILS
Landline Phone (with STD Code)
Email ID
Mobile +
9 1 9
ARUNSBAGI@GMAIL.COM
Yes
No
Mobile number is essential for receiving sms alerts regarding your NPS account
6. OTHER DETAILS
Occupation Details
Private Sector
Government
Public Sector
Homemaker
Student
Politically exposed
Below SSC
1 lac to 5 lac
SSC
HSC
Self Employed
5 lac to 10
Graduate
Professional
10 lac to 25 lac
Masters
Agriculture
Account Type
Current A/c
31425272202
Bank Name*
Branch Name
BIJAPUR TREASURY
Branch Address
Pin Code *
586101
State/U.T.
KARNATAKA
Country
INDIA
Bank MICR
586002101
IFS Code
SBIN0007225
SUJATA S BAGI
MOTHER
NO
PFM Selected
Auto Choice
% share
E
(Cannot exceed 50%)
50
30
20
Total
100%
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.
I agree to take a printout of the registration form from eNPS portal, paste photograph, affix signature and send it to CRA. I understand that my PRAN will be
frozen temporarily if the form is not sent to CRA within 90 days from the date of allotment of PRAN. (Applicable only for Aadhaar based Subscriber
Registration).
I understand that my initial contribution will be credited in my PRAN but I will not be able to make any further contribution till the KYC compliance is confirmed
by the Bank selected by me during registration. Once the KYC compliance is confirmed by Bank, I agree to take a printout of the registration form from eNPS
portal, paste photograph, affix signature and send it to CRA. I understand that my PRAN will be frozen temporarily if the form is not sent to CRA within 90
days from the date of allotment of PRAN. (Applicable to Subscribers registering with PAN and subsequent KYC verification by Bank).
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 of Registration: 3
Place :
Signature/Thumb Impression* of Subscriber in black ink
(* LTI in case of male and RTI in case of female)
ACKNOWLEDGEMENT
Name of the Subscriber:
ARUN BAGI
Acknowledgement
PRAN Allotted
1000.00
Receipt Number
TO BE FILLED BY CRA
Received by
Received at
Date
The subscriber is supposed to submit the physical form along with photograph and signature to CRA at the earliest. If forms are not received within
90 days of PRAN generation, the account will be frozen.
Physical form to be dispatched to the following Address:
Central Recordkeeping Agency (eNPS),
NSDL e-Governance Infrastructure Limited,
1st Floor, Times Tower, Kamala Mills Compound,Senapati Bapat Marg
Lower Parel (W), Mumbai - 400 013.
TIER II DETAILS
I hereby submit the following details for Tier II account .
1. PAN :
If same as Tier I
Account Type
Savings A/c
Current
31425272202
Bank Name
Branch Name
BIJAPUR TREASURY
Branch Address
Pincode
586101
State/U.T.
KARNATAKA
Country
INDIA
586002101
IFS Code
SBIN0007225
Middle Name
S
SUJATA
Last Name
BAGI
Middle Name
Last Name
If same as Tier I
Pension Fund Name
PFM Selected
Active Choice
Auto Choice
E
(Cannot exceed 50%)
Asset Class
50
% share
30
20
Total
100%
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.
I agree to take a printout of the registration form from eNPS portal, paste photograph, affix signature and send it to CRA. I understand that my PRAN will be
frozen temporarily if the form is not sent to CRA within 90 days from the date of allotment of PRAN. (Applicable only for Aadhaar based Subscriber
Registration).
I understand that my initial contribution will be credited in my PRAN but I will not be able to make any further contribution till the KYC compliance is confirmed
by the Bank selected by me during registration. Once the KYC compliance is confirmed by Bank, I agree to take a printout of the registration form from eNPS
portal, paste photograph, affix signature and send it to CRA. I understand that my PRAN will be frozen temporarily if the form is not sent to CRA within 90
days from the date of allotment of PRAN. (Applicable to Subscribers registering with PAN and subsequent KYC verification by Bank).
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.
I have opted for Tier II and I declare that I will submit copy of PAN Card and cancelled Cheque/Bank Certificate along with the Registration Form to CRA.
Date of Registration:
Place:
Signature/Thumb Impression* of
Subscriber in black ink
(* LTI in case of male and RTI in case of female)