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NATIONAL PENSION SYSTEM (NPS) - SUBSCRIBER REGISTRATION FORM SDL core Tay compar mene” [peta a | Central Govt. |] | State Govt o Shetgro of Sitinenmees EL [ Etewweeae ES [wes oo ol] aren, ve number Retroment rant spice for Govrnnatt ANPS Ute Sacto KYC Number opeabe Gerd fn areal VS Rape 1. PERSONAL DETAILS: (lsseefrio Ne othe mabuctone) Name ofAspleantin fal Shi (] Smt] Kumar C] First Name" idle Name Subserber's Maison Nare fan) (ten tom) Moves Namo" Fern it don PRAN cor nce, oes bpd ed aes are [Pease ck] Date o it : (Oa oie shout be supe y elvan dosti 0), ty ote ‘County of itn Gonder [Please tek(}] Male] Female C]_— Others CI Nationaty” Inatnian CD Movil Sas Morro] Unmanied [Others [] Spouse Namo" Reside Stata" tein ‘PROOF OF ENTITY (Pa) (ay ane ofthe anearisresa ob rove eng wih Morin nab) Passpoa Passport Expy Date Yer 1D Card PAN Card Dig License Ding License Exe Date Uo aasaar) Oo tera yy rhs the aadnoa Sarat oftar (tour ited 6 AVE sorcos CUBAN sceteanes whe posses oie ahaa? fee i reas (te once ce gee has ae Rearend ee a Froid th pron fia Ses tances oy iced ei PDA Sach oe sles CHA ay HS ca ‘pa earns matey Pree f Mone undeg Maranare of Res Scan Rept Rls 2077 Raa and PAN ese er Rei nt he hata eo Pel ase net ot se eal we pv ns mao a een he Scere apa Fa ‘PROOF OF ADDRESS (PoA)™ Conpondene Adin Permanent Address Pees tek), 8 poate aap et Bae ey ear Dean eis Nedaitenensen Ae Guster aerate at ‘es astral a ‘CORRESPONDENCE ADDRESS DETAILS" saves Type* ResidentatBusness Residential «Business. Registered Office Unspected Premiess using Vilage seoalLocaiyTabk CcyTawnbsatie PIN Code State. ‘PERMANENT ADDRESS DETAILS* ——[_] Tex()nsnesorn caso na across same above. sare Typo" ResidontatBusness Residontal——-Busnask-—-Rogsarod Office Unspocied FatRooniDoorBleck ne Lanamr Promises Busing vitage Road'SieetLane CyTownDiseet PIN Code Tar ‘CONTACT DETANS: Ta (om (win STD cede) + Ret vn STO cae) + Mobile Desirable) + 8 t (Mobile Nunborseguios for conmunicaton an to get SS alerts). Email 0 ‘OTHER DETAIS (Pause ie Srna Sethe abuses) > Occupation Deals" (please tck(“)] Private Sacter [1] Puble Sector [] Goverment Sector ] Professional SefEmployed|"] Homemeker [) Student a > Income Range (oer annum) Upto lac } tieinSie ——] Stacto Wise] Wiscto2Siec(] 2S lacandstove > Esucatonalualtcators Sebw SCZ} SSCL) HSC) Graduato asters [1 Proeesoras (CA, C8, CNA ee) CI > Pease TekiApplesbie __Polieally exposed peraan [] Related to Poltizally expoaed Person [] (ease refer instucion "23 “SUBSCRIBER BANK DETAILS (Phase seo tro. ane naive) (i Subscriber mentions any of he bank dl al he bank dts wil be mandatory except MICR Code) Account Type [phase ics(7}]_SavingsAle []_—_ Current Ale [1] Bank Name. Branch Name Bank MICR Coss IFS Code “SUBSCRIBERS NOMINATION DETAILS (sane roars Sr No. Sale raion) Nm ofthe Nominge Youce aii up oars 9 omnes and you dees eae iin Anat (adsonal Nannon Farm) owe apa) Rettortp be Nonines [a te (rent toon) Nominees Guarsan Data (in case of minor) Fist Name. Miao Name LastName: TNPS OPTION DETAILS (eave wx") aicaoe) ould the wo subscribe for Te Account also YES LINO [] t¥e, sos submit asin Aron youwan scan Treen aewserty ou Tay sso egwaseokeenimenee 1) the ect Nol is ts POPPOD-S youre, THe at POP Popts each sun dr WPS sees S18 me os ke) Toul ta my PRA be printed nnd) YES JNO [| Yen pease submit tal on Anna I 70, PENSION FUND (PF) SELECTION AND INVESTMENT OPTON® (laser Sno. otha etucons) {) PENSION FUND ELECTION (ter): Pte ead uo conacn ator opg lah chaos Prater Pua {Perna ter Seria gaat ts taeny toes agea enpeer ger tae tb rome NPS Lite: NPS Luo is 2 graup choice modelwhare sunscrber has achaice of PF‘ang swesimert apion a svailble with Aqgragalar soins Pca aaa CI Prudortal Pen6or Funes Manager Crean nod aba oA ak Matinor Person Fur ures anode (i) INVESTMENT OPTION (Peat Te (inthe toe gen tet ncn your evesiranl ton, sarectoce [—]Atechocs heave you selec Ate Cie up scion (i low end you sale la Cie pst eon 2 eave you goret aca any eaman spon, yur fee lle nested iv Ae Cie 5). 3. ewe youve opal Choc and lap toca) bw vein Ae Alea haet Alcon reels wise ted anneal emacs porate Chis (08). {li) ASSET ALLOCATION tobe file up only in case you have selected the ‘Active Choice’ investment option) ciao) | “ony” [ent | oat Sant don Ealy ores arn hse Gs Copal ees Auto Choice Option (tbe filed up only incase you have selected the ‘Auto Cholce' investment option). In ease, you donot indicate a ‘choles of LC, your funds will bo Invested as per L 50 is ee farce [lease Tek) Gn Ove oe Net: 1.16 75 tite Lice ard here th Capo uy resins 7% of te ta eat ea finders he a ty rosa ool eet a nd are he Ca uy mvosnan 25 foal est Tare [i, DECLARATION BY SUBSCRIBER®(Plsse feria Sina otha netuctons) Ihaereodandundestone He rn and endo fb Neral Penson Syst anhetey nae th sama log wt ha PFROAAGL elton aad atu dene al taraon and Gaur aha ty rae ve wl covet ete tel hry Kongo a be. nor nec the Gara Recor KeosrgAgeneyNatorl Penson Sysem Trt fan charge nthe above arms rane by me 0 Fat ay t-osing era unr NPS, “ncaa esa bay ate orks st any eo nentet arto ren "tater ape 9b bur bye a a carton ot pron anes by CRA, ton oi aN ny aman arts approved by PERO. whe ones perth ny now Gecaon br triste ym. Isha be Bean bye ns an ero th sae PN ens CAA abst ee ve at AP [heey dcr hal he consent ty ral my bea hat ae dee tom lgey alas asneed sauces aaa indent ht NPS Tt ae Place (CLT incase of male and Fin caso oforaes) 12, DECLARATION ON FATCA* (Foreign Account Tax Compliance Act) COMPLIANCE (hss rt Sra 8 fhe nso Section I" USPerson* Yes] No[] Section II* For the purposes of axation, 1am a resident inthe fllowing counties and my Tax Mention Number (TIN)unetonal aqua in each county set ‘ut Below or Ihave ndeatod that a INFunctonal oguivalent is unavalable (inf dota of ll courriesof ax residence more than one} Particulars ‘country (1) ‘county (2) ‘country (3) CCounrycounris of tax rosiéoncy Address inthe uration for Tax ——_*/Townitage Z Pest Cove “Tax Ientcalon Number (TINFunetionalequvalont Number TIN Functional equvatent Number losing County att of documenaryevence provides (Wherever applicable) "1 oority at: 8) I sa be my responsibilty to educate mysel and to comply ta es with ll relevant aw rotng fo reporting under section ZASBA of the Ac eas vith the Rules "HF to 14H of he Income tx Rules. 7982 thereunder and ie Inormason provided in tne Form en cordance wi the aforees ») the infrmaton provided by me in the Fom, ts supsoring Arnsxures as wall asin ho documenary evidence are, tothe bast of my knowledge and Del tect and camp raha wel ay meal oman at nay ae enema he aaa os )Ipermtvautnorse te NPS Tato calle store, communicate and process infxmation flan athe Account and alraneactons heel, by he NPS. “Trust and any of NPS ntermeciaos whrver sited ncuding sharing, raster and iclsurebatween them ant the anor in anlar otise India of any confidential formation for eompanee wth any wor equation wnether domes or foregr 4) Lundoake the responsi to delare and dle within 30 days from tre date of chango, any changes that may tke place Inthe information provided inthe Farm, ts supporing Amnexues as wol as nthe documentary evidonc provided by me or ay cerafcalon becomes incorrect and to provide fash setfericaon along wth docurentay evdence, 1) Falso agree thtin cate of talus to ccoee any mater ct koown ome, worn uur, te NPS Trust may reper any equator andor any ‘honky designated bythe Goverment onda (GOI) /RBLIRDAVPFRDA forthe purpose otke any ater acon as may be doomed appropiate By ‘ho NPS Trust thedofency i nol madd by me win tho sepuled pores, ‘1 hrabysecopl an aeleonledge thal he NPS Test shal have to igh and autor o cary out investigations Km he information ava in pul

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