Revision of subscriber registration Form S-1

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'
HIMACHAL PRADESH STATE ELECTRICITY BOA'RD LTD.
(A STATE GOVT.UNDERTAKING)
No.HPSEBLlFlJnd/F&AI instructions/2014-2015
. .- 1 qL) 3l/y
Oated:-
I Y- -/
To
All the Chief Engineers, in HPSEBL All the SE,s/Sr.Xen,s/RE,s in HPSEBL Sub -
Revision of subscriber registration Form S-1 .
Sir,
It is informed that the existing NPS subscriber registration form (S-1) has been
.
revised by the NSDL and a new registratio n form has been notified by the PFRDA . As such all
the DDO's are requested to use the New Registration Form CSRF-1" for registration of
subscriber in National Pension System in future.
It is furiller added that the subscribers are required to submit the self-attested
copies of supporting documents which will be verified with the original by the OOO's offices
before· its submission to CRA-Facilitation Centre for processing. The CSRF-1 form is enclosed
herewith . However the CSRF 1 form can be downloaded on NSOL website.
You are therefore, requested to send form CSRF-1 duly filled in by the
employees appointed on or after 15.05.2003 for registration with NSDL for allotment of PRAN ,
so that the same could be forwarded to the concerned agency for allotment of PRAN.
OA: as above
Yours faithfully,
Copy for information and similar necessary action to the following please:­
1. The Executive Director (Pers), HPSEBL, Shimla-4.
2. The Managing Directors, HPPCLlHPPTCLlBVPCL, Shimla/ Jogindernagar.
3. The Director (Pers) SJVNL, HIMFED Building, Shimla-9.
4. The Addl. Secretary, HPSEBL, Shimla-4
5. The Under Secretary (Gen), Shimla-4 . 6
Th e Accounts Officer (Admn)! (PG) / NG local. ~ SE (IT)
HPSEB , Shimla. He is requ ested to upload the above Ilistructions on th e
we tJsil e of HP SEB L.
DA: as above
O nts
~A
ieer (Funds),
HPSEB Lr~
Sl1 ml\...---L- -- 7 ~.IJ
..
CSRFI
NATIONAL PENSION SYSTEM (NPS)
SUBSCRIBER REGISTRATION FORM
Affix
rec en t colour
photograph of 3.5 cm X 2. 5 em To,
NalionaJ Pension System Trust.
size
Dear Sir/Madam.
thereby request that an NPS account be opened in my name as per the particutars given below:
• indicates mandatory fie.lds . Please fill the form in English and BLOCK letters with black ink pen. (Refer general guidelines al instructi ons page)
Name of
Middle Name
Last Name
Date of Birth'
Ge nder [Please tick (.J)
1
Father's Name'
(Refer S~ . No. 1 of instruc tions)
PAN
L1I
Passport
I I I I I
1
I ,
Female
0
Others
I
Fla tlRoomlDoor/Block no.
I
Premis e. /BuildingNiliage
I
l
Road/Street/Lane
,;",,1,,-=1
L
I
State/U.T
A
J
1
I
I
L1
I c..J...1-'-~....L-J.....---L'
I
1
I
L
J
I I
I
, Please reler Sr. No. 2 of 1M inslru,l;on,.
I
Landmark
I
I
1
LL,
_l 1 l.-LL l -L
I
l
L
L_' L+-I~~
I
I
L
Voter 10
INI U 1111 b 1e II I
ILL
t
J _1
I
-L L I
JJ-
11
- J __
~-
I I I I I r I I I
Premises/BuildingNiliage
I IUI
1 L
1
PERMANENT A DORESS DETAil S
FlatiRoom/Door/Block no.
llJ
1I 1I I I I
amI' ollh~ 10
J Others I
LLl L L
City/Town/District
0
LU ~-,--,---,-I......:.M.l...1
r I ,It I
Aadhaar
Area/Locality/Taluk
"
0
Male
I
L
I
PIN Code
'Iu
~~ ~ ~
I
I
I I 1 I I I I I I I
Ul-;-I-!--i-I-..;.I-!--!-I-!
II I I i! I I I I I I I I I I I I_I !lL !~l!--!-l ill
Road/Street/Lane Area/Locality/Taluk CityfTown/District State/U.T. Proof of Address (Correspondence/Permanent)
Aadhar card
0
Passport
0
Voter 10 card
0
Driving License
Latest Gas Bill' 0
Electricity Bill' 0
Telephone[Landlinel Bill'
'Not more Ihan 3 months old. Please refer Sr. No.2 of the instructions
0
0
Ration Card
0
Registered Lease
Others (please specify)
L I_
_ __
0
Sale agreement of residence
_
0
...J
_
_ _ _ _ _ _
5,
Landline Phone (with STD Code)
Email
I I
I
I
10 1
I I I I I 1
I I I 1 I I I I
I I I I
1
Do you want to subscribe to SMS Alerts: , Yes
0
1
No
Mobile [+
19
I I I I I I I I I J
I I I I _~1 I _U
11
1 1 1
Mobile number is essential for receiving sms alerts regarding your NPS account
0
e:; OTHERD
~
Occupation Details [ptease tick( ) 1
Private Sector 0
Governmenl Sector
Homemaker
0
Siudent
0
Public Sector
o
NRI
~
Please Tick If Applicable
Politically exposed person
~
Income Range (per annum)
Upto 1 lac
~
Educational Qualifications
Account Type [ please tick( V}
0
Below SSC 0
1
Saving Nc
0
0
Business
0
HSC
5 lac to 10 lac
0
Current Nc
Graduate
Branch Address
Bank MICR Code I I I
Bank Name
Branch Name.
I
I
1
IStalelU,T I
I
Professional
0
0
10 lac to 25 lac
Masters
0
0
Agricullure
0
1'------------..
0
0
25 lac and above
0
Professionals ( CA, CS , CMA, etc. )
0
0
I I
I
I I
I . +-I-+--:---!-~-+I--L_ LLL LI I
I,
I I
L! I
I I , I I
Bank Nc Number
0
Olher (please specify)
Related to Politically exposed Person
1 lac to 5 lac
SSC
0
0
I
IFSC
I
1
!
I
Co~ 1
1 of 3
CSRF 1
Name of the Nominee (You can nominate up to a maximum of 3 nominees and if you desire so please fill in Annexure III (Additional Nomination Form) provided separalely)
Ij~L"l \ U
Nominee Name
Relationship with the Nominee
U ~~ 1~U!..·_I_I_I_J!:la-klt
~ Date of Birth (In case of Minor) I (j
I
I
I I I l~ 1 LLLL
I d I Irr1 I fT' I I '1 I y I y I y I
Nominee's Guardian Details (in case of a minor)
Nominee 's Guardian
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I
LUliU_
~
I would like to subscribe for Tier II Account also
YES
0
NO
0
If yes, please submit details in Annexure I. (Tier Ii account is not available for NPS Litel
Swavalamban subscribers).
I would like my PRAN to be printed in Hindi
YES
0
NO
0
It Yes, please submit details on Annexure Ii
o
(i)
PENSION FUND SELECTION (Tier I) : The names of the all PFs are mentioned in the instructions page and are available to the all sector
subscribers with following conditions:
(i) Government Sector: For Governmenl Subscribers, the lollowing PFs act as delaul! PFs as per Ihe guidelines issued by Ihe Governmenl:
(a) L1C Pension Fund Limited (b) S81 Pension Funds Pvl. Limiled (c) UTI Reliremenl Solutions Lid.
(Ii) NPS Lite/Swavalamban : NPS lite'Swavalamban is a group choice model where subscriber has a chOice of PF and Investment option as available with Aggregntor.
(iii) Ali Citizen Model: Subscrib rs under AI! Citizen model has Ihe oplion 10 choose Ihe available PFs as per Iheir choice in th e lable belolY.
(iv) Corporate Model : Subscribers shall ~1ave the option to choose Ihe ava ilable PFs as per the below table in consu ltation with tne ir r(;!spcclive Employer.
Available to
Gov.."m""t
Secto r
\'1;::
(.() nsenl od
(ii) INVESTMENT OPTION (Available for All Citizen Model and Corporate Model Subscribers)
( Please Tick (..J) in the bo x given below showing your investment option).
Active Choice
For
1.
L.
del~ils
Il
c-l
Auto Choice
011 AulO Choice , please refer 10 the Offer Document. Please nole:
In r.ase VOU do no t i nUl t::~II (j. any inves l melit optio:l , your funds will be in ves t din AU !(l Ct,oice
tn case yo u have opted tor A uto ChOice. DO N O T III up section below r ~l a t ~ n 10 A. sel Alloca tion . If! case you do , the AS6ut Alto ~ l lo n instruc:uons WIll be ignored
3ncl Inve s, 1menl Will be ma de as pe r Auto Choice.
(iii) ASSET ALLOCATION (to be filled up only in case you have selected the 'Active Choice' investment option)
Asset Class
(Cannol
e~eed 50%)
C
G
Total
j­- - -­ -+-'---- -- - - - + -- - ­- \ - - - - --+­ - - ----j
%
Note:- The total allocation across E, C and G asset classes musl be equal to
100%. In case, the allocalion is left blank and/or does not equal 100%, the
application shall be rejected.
Declaration & Authorization by aU subscribers
I have read and understood the terms and conditions of the National Pension System and hereby agree to Ihe same and declare thallhe information and documenls furnished
by me are true and correct, to the best of my knowledge and belief. I undertake 10 inform immediately Ihe Cenlral Record Keeping Agency/National Pension System Trusl,
of any change in the above information furnished by me. t do not hold any pre-exisling account under NPS. I understand Ihat I shall be lully liable for submission of any false
or incorrect information or documents.
I further agree 10 be bound by the terms and oonditions of provision of services by CRA, from time 10 time and any amendmenl Ihereof as approved by PFRDA, whether
complele or partial wilhoul any new declaralion being furnished by me. I shall be bound by Ihe lerms and conditions for Ihe usage of I-pin (10 access CRAlNPSCAN and view
details) & T-pin on the CRAwebsile ~
Additional declaralion by Swavalamban subscriber
I havereadlexplained to me and understood the Swavalamban guidelines and I meet the prescribed eligibility crileria for assislance under Ihe scheme. I also undertake to
adhere to Ihe prescribed contribution limit of minimum Rs. 1000/- and maximum of Rs. 12000/-, failing which the Central Government oontribution credited to my accounl
~y be forfe i~d along wilh such interest rates as may be prescribed.
Declaration under the Prevention of Money Laundering Act, 2002
I hereby declare Ihat the contribution paid by me/on my behalf has been derived from legally declared and assessed sources of income. I understand thai NPS Trusl has Ihe
right to peruse my financial prOfile or share Ihe information, with other government authorities. I further agree that NPS Trust has Ihe righl to close my PRAN in case I am
lound viol ating the provisions of any law relating 10 prevention of money laundering.
Date
I rf I ,I I I I 11 I m I , I y I y 1y I y I
ptace:
SignaturelThumb Impression" of Subscriber in black ink
(" LTI in case of male and RTI in case of female)
ACKNOWLEDGEMENT
Name of the Subscriber :
Contribution Amount Remitted:
~
-'--'--1---,-->-1-<-_.1
~
Date of Receipt of Application and Contribution Amount:
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1
1
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Stamp and Signature of the Employer/PoP/Aggregator:
2 of 3
CSRFI
~
L.&.
.1.,
(Subscribers Emptoyment Details to be IlIIed and attested by the Deplt. (All Details are Mandatory)
Date of Retirement
I y I y I LL
I
I I I I
I I I I I I
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Date of Joining
I
Employee Code/lD
I I
,
Group of Employee (Tick as applicable)
GroupA
I
D
,
I
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D
GroupC
I I I
0
GroupD
, I
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I " I ". 1~ 1 Y.i.'Lh
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D
I I I I I I
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I I I I I I I I I I I
I I I I I I I I I I I
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Department
Pay Scale
,
GroupB
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I I I I I I
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Minislry
I I I 1 I I
DDO Registnalion Number
L I I I I
DTO/PAO/CDDO/DTAIPrAO Registration. Number
l I
Ollice
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I I I
I I I ~_LIlJ
I LJ LLLLI l~
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I I I Basic Pay I I I I~LLj _1
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I I I I I I I I I I L
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II is certified that the delails provided in this subscriber reglstralion form by
employed with us,
including Ihe adrlress and employment details provided above are as per the service record of the employee maintained by us. Also, it is further ce rtilied that he/s he has
read entrieslentries have been read over to himlher by us and got confirmed by him/her.
Signature of the Authorised person
_ _ _ (In the box abo'!.e)_
Rubber Stamp of tho 000
_ _ (In the box ab~e L
Deslgna!io n of the Auth oflsed P rs on
N"me of the 000
DeptUMln lstry
--'
-
L­
Signature of the Authorised person
_il n the box above)
Tubber Stamp o f the DTO/PAO/CDDeS!
DTAIPrAO lin 1I1e !lox ~bove)_
1-_
-
Design a tion of Ih e Authorised P e rson
J Name of D10/PAO/CDDO/DTAIPrAO
j
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Dille
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II
II
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I -­
I I I,
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,-,
..-.t'
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(Subscribecs Employment Delails 10 be filled and attested by Carpanale (All Details are Mandatory))
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Dale of Joining
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Employp 10
I
Di'I!e of Reliremenl
1•
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CorporEte Regd. No Allalled by CRA
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1 1­
CBO No. allolled by CRA
I
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Certified thallhe delails prOVided in this subscriber regis Ira lion form by
employed with us, including
the employmenl delails provided above are as per the service record of Ihe employee maintained by us. Also, il is furlher cerlified thaI he I she has read the enlries I entries
h3ve been mad over 10 him I her by us nd gal confirmed by him I her.
I
Date
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-
-
-
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Slgnaturl': ot the AUlllonred Person ( In
th~
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Place
hox abo ve)
Rll bh(tr Stamp of th Corporal a
(III the box nlJove)
Deslyn ation at th e Authorized Person:
',,:,",pn; I: 7:' '":"'.1 .~~~-~~
.firi:.:l.:.E::~C'G~.~~~~;':::-j~i
Ll I I I I I I I I I I I I I I I I
Receipt No. (17 digits)
0
I I I I ! I I
POP-SP Registnalion Number
I
Document accepted for date 01 Birlh Proof:
I
0
Copy of PAN card submitted
KYC Compliance YES
No D
YES
No D
Existing Bank Customer:
I/we hereby certify/canfinm that Shri/SmllKum .
.......................... ............ ............
... .. ........ ... is an existing customer of the Bank having fully operative Saving
Bank ac.count no .
.... ........ " .. ......... ............... ... at .
. ..... brnnch and KYC norms required for opening Bank AccDunl which match Ihe requirements
for opening NPS account have been fully complied with. We further confinm that the S. B. alc of Sh/SmllKum ............ .. .. . .......... " .. ...... . ... ....... .. ..... ... , ...... ............
is not a 'Basic Savings Bank Deposit Ac=unl' .
Adhaar Based KYC Certificate:
l!we hereby certify thai Aadhaar Number ...
..... ....... ........... ..... ....... .. ... of Sh/SmUKum ........ ..... .. ...... ............... ... ........... ........ ............. ..... ..... .... has been
checked and the name and address menlianed on the anginal Aadhaar card are matching with that menlianed on NPS applicallan form .
To be nll.d by POP-SP
Name:
Designation:
POP-SP Seal
' Signature 01 Authorized Signatory
Date
~~t:il:~ntr'~~:'Jr:r:::::Ta:';
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Place:
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, "::i£'!'.i::!;
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Authorisation by Aggregator'. office (NL -AO)
Certified that Ihe subscriber is registered wilh the aggregator and helshe has opted to join NPS. I hereby declare Ihat the subscriber is eligible to join NPS and Ihe above
declaration has been signed !thumb impressed before me by " ... ................................ .............. aller (s)he has read the entries! entries have been read over to her/hlm by me.
Signature of the Authoflsed person (In the box above)
Name of the Aggregalar
t
--­
--­
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IIIII
NPS Lite Accounl Office (NL-AO) Registration Number
t
Membership No. allotted by Aggregator (if any)
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Place
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Date
t
Rubber Stamp of the Aggregalor (In the box above)
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1"1I I
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! 'lTo be 111MIIY CRA·
Received by
Received at
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Acknowledgement Number (by CRA-FC)
PRANAliaied
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NPS Lite - Collection Centre (NL, CC) Registralion Number
y
y
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I I I II
II I I
1
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CRA-FC Registration Number
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111 I I I I'" I "' I I I V I ~ ! y I y I
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Date
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3 of 3 CSRF 1 INSTRUCTIONS FOR FILLING THE SUBSCRIBER REGISTRATION FORM
General Guidelines
(a) Please fill the form in legible handwriling so as to avoid errors in your application processing. Please do not overwrite. Corrections should be made by cancelling and re-writing
and such corrections should be countersigned by the applicant. Each box, wherever provided, shoutd contain only one character (alphabet / number / punctuation mark) leaving
a blank box aner each word.
(b) Applications incomplete in any respect and/or not accompanied by required documents are liable to be rejected. The application is liable to be rejected if mandatory fields are
len btank or the apptication form is printed back to back
(c) The subscriber Should not sign acroSS the photograph. The photograph should not be stapled or clipped to the form. If there is any mark on th e photograph such that it hinders
the clear visibility of the face of the subscriber, the application shall not be accepted.
(d) Copies of all the documents submilted by the applicant should be self-altested and accompanied by originals for verification by the nodal office .
(e) Name end Address of the appticant mentioned on the form, shoutd match with the documentary proof submitted.
(f) The subscriber's thumb impression should be verified by the DDO/PAO/DTO/designated officer of POP-SP/Aggregator
(g) Government employees (mandatorily covered under NPS) may submit their application for Tier II to any POP-SP of their choice. The list of POP-SPs rendering services under
NPS is available on CRA website hltp:/Iwww.npscra.nsdl.co.in
S.No
Item No.
Item Details
Date of Birth
Instructions
Ptease ensure that the date of birth matches as indicated in Ihe document provided in the support.
i.
1
1
Falher's Name
ii .
IIi.
If falher's name has more Ihan 30 digits, you may fill Annexure II for Ihe same
Father's name is mandatory. However, if applicant does nol wanl to provide father's name, hc::/sh e has an option to provide
mother's name on Annexure II and the mother's name will be printed on PRAN card
If the arplicant "ants molher's neme to be printed in stead of F_alher' s l1 ame on PRAN Card . he/she mus l fill Annexure II
Proof of Identity (Copy of anyone)
S. No
1
Passport issued by Government 01 India.
.
2
R~ lio n
3
BHnk Pass book or certificate wll" Photograph .
Gm d with pholograph
2
2,3 & 4
.
Proof 01 Add ress (Co py of anyone)
1
Passport issued by Government of Indta
2
Ra lion card wi th photograph and rosldenhal address
3
Bank Pass book or certlftea t
residenlial addres s
with pholograph and
----­ ---­
~
CorHncate of loe POP bank for an existing Ban k cu stom~
'4 ­
5
Volers Idenlily card with photograph and residential
address.
5
Voters tdentity card with photograph and residential
address
6
Valid Driving license with photograph
6
Valid Driving license with photograph and residential
address
i-
Idenlity,
Correspondence &
Permanent address
dC I<'lils
S.No
--
r­
~.
Certlfl ca le of the POP bank lor on eXisting Bank CUbtomar.
-­
--~
7
C ortifica te 0 1 identity with photog rFl ph signed by a M ember
of Parlio m III or Memher of Le gislativ e t\ss cmb l~1
7
Lelier from any recO{Jnlzed puollc a,,'horily at the level
01 G;u etled officer like Dlstnci Maglstrole, DiviSIona l
com n'lis!"O lonCH , BOO. T c h~ l i d i'1 Mandai Reyenue OlflCer,
Judicial Magistrate etc ,
8
PAN Card issued by Income tax department
8
Certificale of address with photograph signed by a Member
of Parliament or Member of Legis lative Assembly
9
Aa dhar Card / leller
Au thority of India
9
Aadhar Card / lener Issued by Unique Idenlification
Auth ority of India clearly showing the add ress
10
-
i~ $ ued
by Unique Identification
Job cards issued by NREGA duly s'gned by an of ~cer of
Ih ~
Slate Govnmment
- ­ -­
nlity card lS. uea by CenTnlll Sta le 90voll1ln r,t and lis
10
Job cards issued by NREGA duly sig ned by an officer of
the Stale Governm elll
-­-----­ --­
TM,'
11
III
Departments , statuary! Regu la tory Authorities, Public
Sector Undertakings, Scheduled commercial Banks, Public
Financial Institutions, Colleges affiliated to universities
and Professional Bodies such as ICAI, ICWAI, ICSI, Bar
Council etc.
11
12
Photo Identity Card issued by Defence, Paramilitary and
Police departments.
12
Latest Electricity/water bill in the name of the Subscriber
showing the address (tess than 3 months old)
13
Ex-Service Man Card issued by Ministry of Defence to their
employees.
13
Latest Tetephone bill in the name of the Subscriber showing
the address (tess than 3 months old)
14
14
Photo Credit card.
Latest Property/house Tax receipt (not more than one
year old)
15
Existing valid registered lease agreement of Ihe house on
stamp paper ( in case of rentedll eased accommodation)
Idunl1ty card/document w'th aoares5. I­ ued by
any of tI'l& fallowing: C An tra llS lale G . vernmenl ilnd Its
Departments, Sk, tuaryfRegulatory AuthorTt ies, Public
Sector Undertakings, Scheduled Commercial Banks,
Pubtic Financial Institutions for their employees.
Note:
(I) If the address on the document submitted for identity proof by the prospective cuslomer is 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.
(Ii) If the address indicated on the document submiUed for identity proof differs from the current address mentioned in the account
opening form, a separate proof of address should be obtained. All future communications will be sent to correspondence
address . If correspondence & Permanent address are different, then proof for both have to be submilted.
(iii) In Case of Govemment subscribers, the. KYC documents may be submitted within a period of 30 days after generation of PRAN.
Other Details
(Occupalion Details)
3
6
Potitically Exposed
Person
4
7
5
8
6
12
Subscriber's Bank
Details
AIl NRI subscriber would need to furnish an Indian address for communication and bank delaits within India. Fund transfers by NRls
would be subject to regutatory requirements as prescribed by RBI from lime to time and FEMA requirements.
Politically Exposed Persons' (PEPs) are individuals who are or have been entrusted with prominent public functions in a foreign
country, for example heads of state or of the government. senior politicians, senior government. judiciat or military officials, senior
executives of state-owned corporations , important political party officials.
Fa, Tier I, bank details are optional. For activation of Tier II , bank details are mandatory . Please attach a Cancelled cheque (containing
Subscriber Name, Bank Account Number and IFS Code) or Bank Certificate containing Name, Bank Account Number and IFS code,
for direcl credit or electroniC transfer. In case if the cheque is not preprinted with name, additionally. a copy of the bank passbook or
bank certificate containing Name, Bank Account Number and tFS code should be submitted.
In case of more than one nominee, percantage share value for all the nominees ,,,ust be integer. Decimals/Fractional values shall
Subscriber's Nomination
not be accepted in the nomination(s). Sum of percentage share acroSs all the nominees must be equal to 100. If sum of percentage
Details
is not equal to 100, entire nomination will be rejected.
Declaration by
Subscriber
Signature / Thumb impression should only be withi" the box provided in the form . Thumb impression, if used , should be attested
by the "odal officer with the official seal and stamp. Left Thumb Impression in case of male and Right Thumb Impression in case of
femate.
General Information for Subscribers
a)
b)
cJ
The Subscriber can obtain the status of his/ller application from CRA and their deSignated nodal officer.
Subscribers are advised to retain the acknowledgement slip signed/ stamped by the deSignated nodal officer where they submit the application.
For more information I clarifications, contact eRA:
Website: https:/twww.npscra.nsdl.co.in
Call : 022-2499-4200
e-mail: [email protected]
Address: Central Recordkeeping Agency, NSDL e-Governance Infrastructure Limited, 1st Floor. Times Tower, Kamala Mills Compound, Senapati Bapat Marg,
Lower Paret (W), Mumbai - 400 013.
I