Central Recordkeeping Agency Page 1 of 1

AnnexureN5
CENTRALRECORDKEEPINGAGENCY
FinancialYear
CONTRIBUTIONSUBMISSIONFORM -
[UnderNationalPensionSystem(NPS)WithEffectFrom1stJanuary2004] Contributionforthemonthof
TransactionIDNumber(Givenby
NPSCAN)
1009425800109 -
M M - Y Y Y Y
DTO/DTAReg.No. 4042500
DTO/DTANAME(Department/Office)
DTO, Sanatan Dharm Senior Secondary School, Yamuna Nagar
DTO/DTAAddress
Flat/UnitNo.BlockNo.
Vishnu Nagar
NameofPremise/Building/Village
Jagadhari Workshop
Area/Locality/Talukka
-
District/Town/City
Yamuna Nagar
State/UnionTerritory
Haryana
CountryIndiaPinCode135001
PhoneNumber01732252100
FORUSEINRECEIVINGBANK

TotalContribution Amount(inRs.only) Cash/DebittoA/c/Cheque
EmployeeContribution 15644.00 Creditedon
Government
15644.00
Contribution
Total 31288.00 - -
Totalinwords Thirty One Thousand Two Hundred and Eighty Eight Rupees only D D M M Y Y
DETAILSOFPAYMENT(TobefilledbyDTO/DTA)
CRORES LACS THOUSANDS HUNDREDS TENS UNITS SPACEFORBANKSEAL


PaidinCash/DebittoA/c/ChequeNo. Dated
DrawnOn

(NameoftheBank&Branch)
Date:

(Signatureofpersonmakingpayment)
Rs.
DTOs/DTAsCounterfoil
DTO/DTAReg.No. 4042500 TransactionIDNumber(Given
DTO, Sanatan Dharm Senior byNPSCAN)
OnAccountofPensionFundContributionReceivedfrom(DTO/DTA
Secondary School, Yamuna 1009425800109
Name)
Nagar
Cash/Debitto
A/c/ChequeNo.
ForRs. 31288.00
(Tobefilledupby
SPACEFORBANKSEAL
DTO/DTA)
Rs.(In
Thirty One Thousand Two Hundred and Eighty Eight Rupees only
Words)

DrawnOn
(NameoftheBank&Branch)

-
FinancialYear


MonthofContribution - Rs.
M M - Y Y Y Y

This Transaction ID is ID given by Central Recordkeeping Agency (CRA) after submission of Subscribers' Contribution file.
Electronic remittances in NEFT / RTGS (Type-41 only) matching with the SCF amount have to be made to Axis Bank Ltd., CBB
Mumbai Branch.
The Beneficiary Account Name is: NPS Trust Account. Account Type: Current Account. The Beneficiary Account Number is:4042500
The NPS Trustee Bank IFSC Code is: UTIB0NPS001. (Note: All the '0' in the IFSC code are numeric zeros & not alphabetic O)
Mandatory information to be sent in "Sender to Receiver Information" - (Field-7495 Only): PAOFIN40425001009425800109
For clarifications w.r.t. captioned remittances, please feel free to write to Trustee Bank at npstrust@axisbank.com
mailto:npstrust@axisbank.com or call on Toll Free No : 1800-102-6667

https://npscan-cra.com/CRA/paoSubContrChallan.do?ID=1438443761&getName=File... 4/20/2017