Ver 1.1 Annexure - S2

NATIONAL PENSION SYSTEM (NPS)

Central Recordkeeping Agency (CRA) - Protean eGov Technologies Limited

Request For Change/Correction in Subscriber Master Details And/Or Reissue of I-PIN/T-PIN/PRAN Card

[ To avoid mistake(s), please read the accompanying instructions carefully before filling up the form ]
For POP-SP/DDO/NL-CC use:
Registration No. : ________________________
Date of Receipt : ________________________

Signature and Stamp of POP-SP/DDO/NL-CC
For POP/POP-SP/PAO/DTO/DTA/PrAO/NL-AO/NL-OO use:
Registration No. : ________________________
Entered By : ___________________ Date: _____________
Verified By : ___________________ Date: _____________
Receipt No.:
Acknowledgement No.:
I hereby request for the following details for the change [Please tick (тЬУ)]:
A) Change or Correction in Details
B) Reissue of I-PIN/T-PIN
C) Reissue of PRAN Card
Permanent Retirement Account Number * :
Section A - Change or Correction in Subscriber Master Details (* Indicates Mandatory Field)
1. PERSONAL DETAILS: (Please refer Sr. No.1 of instructions)
Name of Applicant in full
Shri
Smt.
Clarification
First Name *
Middle Name
Last Name
Subscriber's Maiden Name
Father's Full Name:
First Name *
Middle Name
Last Name
Mother's Full Name:
First Name *
Middle Name
Last Name
Date of Birth * (DD/MM/YYYY)
/
/
Gender [please tick (тЬУ)]
Male
Female
Others
Marital Status [please tick (тЬУ)]
Married
Unmarried
Others
PAN CARD *
Spouse Name:
First Name
Middle Name
Last Name
KYC Number
Retirement Adviser Code
2. PROOF OF IDENTITY (PoI)
Passport
Expiry Date:
/
/
PAN Card
Voter ID Card
Driving License
Expiry Date:
/
/
NREGA JOB Card
Others
ID Name:
I.D. Number:
UID (Aadhaar) [UID (Aadhaar) number not required.]
Ver 1.1 Annexure - S2
3. PROOF OF ADDRESS (PoA) [ Please tick (тЬУ), as applicable ] #Not more than 2 months old. Please refer Sr. No. 2 of instructions
Correspondence Address Permanent Address
Passport /Driving License/UID (Aadhaar)/Voter ID card/NREGA Job Card/Ration Card/Others Passport /Driving License/UID (Aadhaar)/Voter ID card/NREGA Job Card/Ration Card/Others
Registered Lease/Sale agreement of residence/Municipal Tax Receipt Registered Lease/Sale agreement of residence/Municipal Tax Receipt
#Latest Electricity/Gas/Water/Telephone/Landline or postpaid mobile Bill #Latest Electricity/Gas/Water/Telephone/Landline or postpaid mobile Bill
4.1 CORRESPONDENCE ADDRESS DETAILS
Address Type*
Res/Bus
Residential
Business
Reg Office
Unspecified
Flat/Room/Door/Block no.
Landmark
Premises/Building/Village
Road/Street/Lane
Area/Locality/Taluk
City/Town/District
PIN Code
State/U.T.
4.2 PERMANENT ADDRESS DETAILS [TICK (тЬУ) IN CASE ADDRESS IS SAME AS ABOVE]
Address Type*
Res/Bus
Residential
Business
Reg Office
Unspecified
Flat/Room/Door/Block no.
Landmark
Premises/Building/Village
Road/Street/Lane
Area/Locality/Taluk
City/Town/District
PIN Code
State/U.T.
5. CONTACT DETAILS
Tel. (Off) (with STD)
+
Tel. (Res) (with STD)
+
Mobile *
+ 9 1
(Mobile Number required for SMS alerts)
Email ID
6. OTHER DETAILS
Occupation Details
Private Sector
Public Sector
Government
Professional
Self Employed
Homemaker
Student
Others
Income Range (p.a.)
Upto 1 lac
1-5 lac
5-10 lac
10-25 lac
25 lac+
Educational Qual.
Below SSC
SSC
HSC
Graduate
Masters
Prof.
7. SUBSCRIBER BANK DETAILS
Change Bank details of: Tier I    Tier II
Tier I Account :    Savings    Current
Bank A/c Number
Bank Name
Branch Name
Branch Address
PIN Code
Bank MICR Code
IFS Code
Tier II Account: Same as Tier I    Savings    Current
Bank A/c Number
Bank Name
Branch Name
Branch Address
PIN Code
Bank MICR Code
IFS Code
Ver 1.1 Annexure - S2
8. SUBSCRIBERS NOMINATION DETAILS
Change Nomination details of: Tier I      Tier II
Tier I Account :
Name of the Nominee (Up to 3 nominees - Page 4 & 5 for additional nominees)
First Name
Middle Name
Last Name
Relationship with Nominee
DOB (if Minor)
/
/
Nominee's Guardian Details (in case of minor)
First Name
Middle Name
Last Name
Tier II Account : Same as Tier I
Name of the Nominee
First Name
Middle Name
Last Name
Relationship with Nominee
DOB (if Minor)
/
/
Nominee's Guardian Details
First Name
Middle Name
Last Name
Section B тАУ Request for Reissue of I-PIN/T-PIN
I hereby request you to reissue the following:
T-PIN
I-PIN
Section C тАУ Request for Reissue of PRAN card.
I ,
the applicant, do hereby declare that the information provided above is true to the best of my knowledge & belief.
Date :
/
/
Signature/Thumb
Impression* of Subscriber
To be filled by POP / POP-SP
KYC Compliance : Yes
KYC document accepted for identify proof : __________________________________________________________
KYC document accepted for address proof : __________________________________________________________
Copy of PAN card submitted : Yes    No
POP / POP-SP Seal
Signature of Authorized Signatory
Name : ________________________________________ Place : ______________________
Designation : _________________________________
Date :
/
/
Ver 1.1 Annexure - S2

ADDITIONAL NOMINATION FORM

INSTRUCTIONS FOR FILLING IN THE FORM

The details of nominees to whom the outstanding pension wealth of the Subscriber is payable in case of the demise of the Subscriber before entire proceeds are withdrawn is to be provided hereunder.
Submit Nomination details for: Tier I    Tier II
I, hereby nominate the person(s) mentioned below who is/are member(s) of my family to receive the amount in my PRAN account.
1. Name of the Nominee:
1st Nominee 2nd Nominee 3rd Nominee
First Name
Middle Name
Last Name
First Name
Middle Name
Last Name
First Name
Middle 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 for minor)
1st Nominee
/
/
2nd Nominee
/
/
3rd Nominee
/
/
4. Relationship with Nominee:
1st Nominee 2nd Nominee 3rd Nominee
5. Percentage Share:
1st Nominee
%
2nd Nominee
%
3rd Nominee
%
6. Nominee's Guardian Details (Only for minor):
1st Guardian 2nd Guardian 3rd Guardian
First Name
Middle Name
Last Name
First Name
Middle Name
Last Name
First Name
Middle Name
Last Name
Dated this day of 20 at
Signature/Thumb Impression* of Subscriber
Ver 1.1 Annexure - S2
TO BE FILLED/ATTESTED BY POP-SP/DDO/NL-CC
Certified that the above declaration and nomination details has been signed / thumb impressed before me by Shri/Smt/Ms. after he / she have read the entries / entries have been read over to him / her by me and got confirmed by him / her.
Rubber Stamp of the POP-SP/DDO/NL-CC
Signature of the Authorised Person
POP-SP/DDO/NL-CC Registration Number : ____________________________ Designation of Authorised Person : ________________________
Date
/
/
POP-SP/DDO/NL-CC Office Name : ____________________________
TO BE FILLED/ATTESTED BY POP/POP-SP/PAO/DTO/DTA/PrAO/NL-AO/NL-OO
Rubber Stamp of POP/POP-SP/PAO/DTO/DTA/PrAO/NL-AO/NL-OO
POP/POP-SP/PAO/DTO/DTA/PrAO/NL-AO/NL-OO Registration Number:
_______________________________________
Signature of Authorised Person

рд░рд╛рд╖реНрдЯреНрд░реАрдп рдкреЗрдВрд╢рди рдкреНрд░рдгрд╛рд▓реА (NPS) Form S-2 (Annexure S2) рдХреИрд╕реЗ рднрд░реЗрдВ: рдкреВрд░реНрдг рдирд┐рдпрдо рд╡ рджрд┐рд╢рд╛рдирд┐рд░реНрджреЗрд╢

рд░рд╛рд╖реНрдЯреНрд░реАрдп рдкреЗрдВрд╢рди рдкреНрд░рдгрд╛рд▓реА (National Pension System - NPS) рдХреЗ рддрд╣рдд рдЕрднрд┐рджрд╛рддрд╛ (Subscriber) рдХреЗ рд╡реНрдпрдХреНрддрд┐рдЧрдд рд╡рд┐рд╡рд░рдг, рдкрддреЗ, рд╕рдВрдкрд░реНрдХ рд╕реВрддреНрд░, рдмреИрдВрдХ рдЦрд╛рддреЗ рдЕрдерд╡рд╛ рдирд╛рдорд╛рдВрдХрди (Nomination) рдореЗрдВ рд╕рдВрд╢реЛрдзрди рдпрд╛ рд╕реБрдзрд╛рд░ рдХрд░рдиреЗ рдХреЗ рд▓рд┐рдП Form S-2 (Annexure S2) рдХрд╛ рдЙрдкрдпреЛрдЧ рдХрд┐рдпрд╛ рдЬрд╛рддрд╛ рд╣реИред рдЗрд╕рдХреЗ рдЕрддрд┐рд░рд┐рдХреНрдд рдирдпрд╛ PRAN Card рдпрд╛ рдЦреЛрдпрд╛ рд╣реБрдЖ I-PIN / T-PIN рджреЛрдмрд╛рд░рд╛ рдЬрд╛рд░реА (Reissue) рдХрд░рд╛рдиреЗ рдХреЗ рд▓рд┐рдП рднреА рдЗрд╕реА рдлреЙрд░реНрдо рдХреЛ рднрд░рдирд╛ рдЕрдирд┐рд╡рд╛рд░реНрдп рд╣реЛрддрд╛ рд╣реИред

рдлреЙрд░реНрдо рднрд░рдиреЗ рд╕реЗ рдкреВрд░реНрд╡ рдзреНрдпрд╛рди рджреЗрдиреЗ рдпреЛрдЧреНрдп рдореБрдЦреНрдп рдмрд╛рддреЗрдВ:
  • рдкреВрд░рд╛ рдлреЙрд░реНрдо рдЕрдВрдЧреНрд░реЗрдЬреА рдХреЗ рдмрдбрд╝реЗ рдЕрдХреНрд╖рд░реЛрдВ (CAPITAL LETTERS) рдФрд░ рдХреЗрд╡рд▓ рдХрд╛рд▓реА рд╕реНрдпрд╛рд╣реА (Black Ink) рд╕реЗ рд╣реА рднрд░реЗрдВред
  • рдЬрд┐рд╕ рд╡рд┐рд╡рд░рдг рдореЗрдВ рдмрджрд▓рд╛рд╡ рдХрд░рдирд╛ рд╣реИ, рдлреЙрд░реНрдо рдХреЗ рд╢реАрд░реНрд╖ рдкрд░ рджрд┐рдП рдЧрдП рд╕рдВрдмрдВрдзрд┐рдд рд╡рд┐рдХрд▓реНрдк (A, B, рдпрд╛ C) рдкрд░ рд╕рд╣реА (тЬУ) рдХрд╛ рдирд┐рд╢рд╛рди рдЕрд╡рд╢реНрдп рд▓рдЧрд╛рдПрдВред
  • рдкреНрд░рддреНрдпреЗрдХ рд╕рдВрд╢реЛрдзрди (рдЙрджрд╛. рдирд╛рдо, рдЬрдиреНрдорддрд┐рдерд┐, рдкрддрд╛ рдпрд╛ рдмреИрдВрдХ рдЦрд╛рддрд╛) рдХреЗ рд╕рдорд░реНрдерди рдореЗрдВ рд╕рдВрдмрдВрдзрд┐рдд рд╡реИрдз рджрд╕реНрддрд╛рд╡реЗрдЬ (Self-Attested Proof) рд╕рдВрд▓рдЧреНрди рдХрд░рдирд╛ рдЕрдирд┐рд╡рд╛рд░реНрдп рд╣реИред

рднрд╛рдЧ-рд╡рд╛рд░ рдлреЙрд░реНрдо рднрд░рдиреЗ рдХреЗ рд╡рд┐рд╕реНрддреГрдд рдирд┐рд░реНрджреЗрд╢ (Section-by-Section Instructions)

1. рдлреЙрд░реНрдо рдХрд╛ рдореБрдЦреНрдп рдЕрдиреБрд░реЛрдз рдкреНрд░рдХрд╛рд░ рдПрд╡рдВ PRAN

рдлреЙрд░реНрдо рдХреЗ рд╕рдмрд╕реЗ рдКрдкрд░ рджрд┐рдП рдЧрдП рддреАрди рд╡рд┐рдХрд▓реНрдкреЛрдВ рдореЗрдВ рд╕реЗ рдЕрдкрдиреА рдЖрд╡рд╢реНрдпрдХрддрд╛рдиреБрд╕рд╛рд░ рдЪрдпрди рдХрд░реЗрдВ:

2. Section A - рд╡реНрдпрдХреНрддрд┐рдЧрдд рд╡рд┐рд╡рд░рдг рдореЗрдВ рдмрджрд▓рд╛рд╡ (Personal Details)

рдпрджрд┐ рдЖрдкрдХреЗ рдирд╛рдо, рдкрд┐рддрд╛/рдорд╛рддрд╛ рдХреЗ рдирд╛рдо, рдЬрдиреНрдорддрд┐рдерд┐ рдпрд╛ рд╡реИрд╡рд╛рд╣рд┐рдХ рд╕реНрдерд┐рддрд┐ рдореЗрдВ рдХреЛрдИ рддреНрд░реБрдЯрд┐ рд╣реИ, рддреЛ рдЗрд╕реЗ рдпрд╣рд╛рдБ рднрд░реЗрдВ:

3. рдкрддрд╛ рдПрд╡рдВ рд╕рдВрдкрд░реНрдХ рд╡рд┐рд╡рд░рдг (Address & Contact Details)

4. рдмреИрдВрдХ рдЦрд╛рддрд╛ рд╡рд┐рд╡рд░рдг (Subscriber Bank Details)

NPS рдХреЗ Tier-I рдЕрдерд╡рд╛ Tier-II рдЦрд╛рддреЗ рд╕реЗ рдЬреБрдбрд╝реЗ рдмреИрдВрдХ рдЦрд╛рддреЗ рдХреЛ рдмрджрд▓рдиреЗ рдХреЗ рд▓рд┐рдП:

5. рдирд╛рдорд╛рдВрдХрди рд╡рд┐рд╡рд░рдг (Nomination Details - Page 3 & Page 4)

рдЕрдкрдиреЗ NPS рдЦрд╛рддреЗ рдореЗрдВ рдЕрдзрд┐рдХрддрдо 3 рдирд╛рдорд╛рдВрдХрд┐рдд рд╡реНрдпрдХреНрддрд┐рдпреЛрдВ (Nominees) рдХрд╛ рд╡рд┐рд╡рд░рдг рджрд░реНрдЬ рдХрд┐рдпрд╛ рдЬрд╛ рд╕рдХрддрд╛ рд╣реИ:

рд╕рддреНрдпрд╛рдкрди рдПрд╡рдВ рдиреЛрдбрд▓ рдХрд╛рд░реНрдпрд╛рд▓рдп рдХреА рдФрдкрдЪрд╛рд░рд┐рдХрддрд╛рдПрдВ (Attestation & Verification)

6. рдЕрднрд┐рджрд╛рддрд╛ рдХреА рдШреЛрд╖рдгрд╛ рдПрд╡рдВ рд╣рд╕реНрддрд╛рдХреНрд╖рд░

рдкреЗрдЬ 3 рдФрд░ рдкреЗрдЬ 4 рдкрд░ рдЕрдкрдирд╛ рдирд╛рдо, рд╕реНрдерд╛рди рдПрд╡рдВ рддрд┐рдерд┐ рд▓рд┐рдЦрдХрд░ рдирд┐рд░реНрдзрд╛рд░рд┐рдд рдмреЙрдХреНрд╕ рдореЗрдВ рдЕрдкрдиреЗ рд╣рд╕реНрддрд╛рдХреНрд╖рд░ (Signature) рдпрд╛ рдмрд╛рдПрдБ рд╣рд╛рде рдХреЗ рдЕрдВрдЧреВрдареЗ рдХрд╛ рдирд┐рд╢рд╛рди рд▓рдЧрд╛рдПрдВред

7. рдиреЛрдбрд▓ рдХрд╛рд░реНрдпрд╛рд▓рдп (DDO / PAO / POP) рджреНрд╡рд╛рд░рд╛ рдкреНрд░рдорд╛рдгреАрдХрд░рдг (Page 5)

рдЖрд╡рд╢реНрдпрдХ рд╕рдВрд▓рдЧреНрдирдХреЛрдВ рдХреА рдЪреЗрдХрд▓рд┐рд╕реНрдЯ (Documents Checklist):
  • рд╕реНрд╡-рд╕рддреНрдпрд╛рдкрд┐рдд рдкреНрд░рд╛рди рдХрд╛рд░реНрдб (PRAN Card) рдХреА рдкреНрд░рддрд┐ред
  • рдкрд╣рдЪрд╛рди рдкреНрд░рдорд╛рдг (PoI) - рдЙрджрд╛. рдкреИрди рдХрд╛рд░реНрдб, рд╡реЛрдЯрд░ рдЖрдИрдбреА, рдбреНрд░рд╛рдЗрд╡рд┐рдВрдЧ рд▓рд╛рдЗрд╕реЗрдВрд╕ред
  • рдкрддрд╛ рдкреНрд░рдорд╛рдг (PoA) - рдЙрджрд╛. рдЖрдзрд╛рд░, рдкрд╛рд╕рдкреЛрд░реНрдЯ, рдирд╡реАрдирддрдо рдмрд┐рдЬрд▓реА/рдкрд╛рдиреА рдмрд┐рд▓ред
  • рдмреИрдВрдХ рдЦрд╛рддрд╛ рдкрд░рд┐рд╡рд░реНрддрди рдХреЗ рдорд╛рдорд▓реЗ рдореЗрдВ рдореВрд▓ рд░рджреНрдж рдХрд┐рдпрд╛ рдЧрдпрд╛ рдЪреЗрдХ (Original Cancelled Cheque)ред