Transcription of SUBSCRIBER REGISTRATION FORM - Home …
1 Bank A/c Number*dd/mm/yyyy91 YesNoFirstMiddleLastFirs tMiddleLastdd/mm/yyyyFirs tMiddleLastDateddmmyyyyPlacePeriodicity of ContributionMarriedAadhaarTo, The Branch Manager, _____ Bank_____Branch Dear Sir/Madam,I hereby request that an APY account be opened in my name under NPS as per the particulars given below: Signature/Thumb Impression* of SUBSCRIBER (* LTI in case of male and RTI in case of female)Guaranteed Pension Amount PRAN NumberContribution Amount (Monthly )(in Rs.)
2 (To be filled by the Bank) , additional amount together with penalty * Indicates mandatory fields. Please fill the form in English and BLOCK letters1. BANK DETAILS:ShriWhether beneficiary of other social security schemesYesNoMonthlyBank Branch*3. PENSION DETAILSBank Name*Date of Birth*KumariName of Spouse*Name of Applicant in full ATAL PENSION YOJANA (APY) - SUBSCRIBER REGISTRATION FORM (Administered by Pension Fund Regulatory and Development Authority) First Name*Pension Amount (Please tick( )) *2. PERSONAL DETAILS:Nominee's Name* AgeMiddle NameLast Name ID1000 Guardian's Name* Date of Birth*Additional Details in case nominee is a MinorRelationship with the subscriberReceiving Officer's Name:Date of Receipt of Application:Stamp and Signature of the BankName of the BankBank Branch:Mobile NoWhether Income Tax PayerNoYesDeclaration & Authorization by all , , , of services under the scheme as approved by PFRDA/Govt.
3 Of Contribution Amount under APY (in Rs.)ACKNOWLEDGEMENT - SUBSCRIBER REGISTRATION FOR ATAL PENSION YOJANA (APY)(To be filled by the Bank)Name of the SUBSCRIBER .
