CSRF

NATIONAL PENSION SYSTEM (NPS) – SUBSCRIBER REGISTRATION FORM

Select your Central Recordkeeping NSDL e-Governance Karvy Computershare
Agency (CRA) [ Please tick() ] Infrastructure Ltd. Pvt. Ltd.
Affix
recent colour
Please select your category Central Govt. State Govt.
photograph of
[ Please tick() ] All Citizen Model Corporate Sector NPS Lite (GDS) 3.5 cm × 2.5 cm size /
To, Passport size
National Pension System Trust.
Dear Sir/Madam,
I hereby request that an NPS account be opened in my name as per the particulars given below:
* indicates mandatory fields. Please fill the form in English and BLOCK letters with black ink pen. (Refer general guidelines at instructions page)
KYC Number, Retirement Adviser Code and Spouse Name fields are not applicable for Government & NPS Lite Subscribers
KYC Number (if applicable) Generated from Central KYC Registry

Retirement Adviser Code (If applicable)

1. PERSONAL DETAILS: (Please refer to Sr. No.1 of the instructions)

Name of Applicant in full Shri Smt. Kumari
First Name*
Middle Name
Last Name
Subscriber’s Maiden Name (if any)
Father's Name* F i r s t M i d d l e L a s t
(Refer Sr. No. 1 of instructions)
Mother’s Name* F i r s t M i d d l e L a s t
(Refer Sr. No. 1 of instructions)
Father’s name will be printed on PRAN card. In case, mother’s name to be printed instead of father’s name [ Please tick () ]
Date of Birth* (Date of Birth should be supported by relevant documentary proof)
City of Birth*
Country of Birth*
Gender* [ Please tick () ] Male Female Others
Marital Status* Married Unmarried Others Nationality* In-Indian
Spouse Name* F i r s t M i d d l e L a s t
(Refer Sr. No. 1 of instructions)
Residential Status* Indian

2. PROOF OF IDENTITY (Pol)* (Any one of the documents need to be provided along with the identification number)
Passport Passport Expiry Date
Voter ID Card PAN Card
 
Driving License Driving License Expiry Date
NREGA JOB Card
Others Name of the ID ID Number Please refer Sr. No. 2 of the instructions.

UID (Aadhaar)
I hereby authorize CRA registered with Pension Fund Regulatory and Development Authority (PFRDA) to use my Aadhaar details for National Pension System (NPS)and authenticate my identity through the Aadhaar Authentication system (Aadhaar
based e-KYC services of UIDAI) in accordance with the provisions of the Aadhaar(Targeted Delivery of Financial and other Subsidies, Benefits and Services) Act,2016 and the allied rules and regulations notified thereunder. I understand that the
Aadhaar details (physical and / or digital, as the case maybe) submitted for availing services under NPS will be maintained in NPS till the time the account is notinactive in NPS or the timeframe decided by PFRDA, the regulator of NPS,
whichever is later. I understand that Security and confidentiality of personal identity dataprovided, for the purpose of Aadhaar based authentication is ensured by CRA registered with PFRDA till such time it is acting as CRA for my NPS account.
As per the amendments made under Prevention of Money-Laundering (Maintenance of Records) Second Amendment Rules, 2017 Aadhaar and PAN are mandatory underNPS. If you do not have Aadhaar and / or PAN at present, please ensure that tails
these details are provided within six months of submission of this Subscriber Registration Form.

. PROOF OF ADDRESS (PoA)* Correspondence Address Permanent Address

[ Please tick (), as applicable ] Passport /Driving License/UID (Aadhaar)/Voter ID card/NREGA Job Passport /Driving License/UID (Aadhaar)/Voter ID card/NREGA Job
Card/Ration Card/Others Card/Ration Card/Others
#Not more than 3 months old.
Please refer Sr. No. 2 of the instructions Registered Lease/Sale agreement of residence Registered Lease/Sale agreement of residence
#Latest Gas/Electricity/Telephone[Landline] Bill #Latest Gas/Electricity/Telephone[Landline] Bill

4.1 CORRESPONDENCE ADDRESS DETAILS*

Address Type* Residential/Business Residential Business Registered Office Unspecified
Flat/Room/Door/Block no. Landmark
Premises/Building/Village
Road/Street/Lane PIN Code
Area/Locality/Taluk State/UT M I Z O R A M
City/Town/District
Country I N D I A
4.2 PERMANENT ADDRESS DETAILS* Tick () in the box in case the address is same as above.
Address Type* Residential/Business Residential Business Registered Office Unspecified
Flat/Room/Door/Block no. Landmark
Premises/Building/Village
Road/Street/Lane PIN Code
Area/Locality/Taluk State/UT M I Z O R A M
City/Town/District
Country I N D I A
1 of 5
 CSRF
5. CONTACT DETAILS
Tel. (Off) (with STD code) 0 3 Tel. (Res): 0 3
Mobile (Desirable) + 9 1 (Mobile Number is required for communication and to get SMS alerts)
Email ID

6. OTHER DETAILS ( Please refer to Sr no. 3 of the instructions )

 Occupation Details* [ please tick() ]
Private Sector Public Sector Government Sector Professional
Self Employed Homemaker Student Others (Please Specify)
 Income Range (per annum) Upto 1 lac 1 lac to 5 lac 5 lac to 10 lac 10 lac to 25 lac 25 lac and above
 Educational Qualifications Below SSC SSC HSLC Graduate Masters Professionals ( CA, CS, CMA, etc.)
 Please Tick If Applicable Politically exposed person Related to Politically exposed Person (Please refer instruction no.3)
7. SUBSCRIBER BANK DETAILS ( Please refer to Sr no. 4 of the instructions )
(If Subscriber mentions any of the bank details, all the bank details will be mandatory except MICR Code.)
Account Type [ please tick() ] Savings A/c Current A/c
Bank A/c Number PIN Code 7 9 6
Bank Name Country I N D I A
Branch Name State/U.T.
Branch Address
Bank MICR Code IFS Code

8. SUBSCRIBER NOMINATION DETAILS ( Please refer to Sr no. 5 of the instructions )

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 separately)
First Name Middle Name Last Name

Relationship with the Nominee Date of Birth(In case of Minor)

Nominee’s Guardian Details (In case of a Minor)

9. NPS OPTION DETAILS ( Please tick ( ) as applicable) : I would like to subscriber for Tier II Accounts also YES NO If yes, please submit details in Annexure I.
(If you wish to activate Tier II account subsequently, you may submit separate application (Annexure S10) to the associated Nodal Office or to POP/POP-SP of your choice. The
list of POP/POP-SPs rendering services under NPS and Annexure S10 is available on CRA Website).I would like my PRAN to be printed in Hindi. YES NO
10. PENSION FUND (PF) SELECTION AND INVESTMENT OPTION* ( Please refer to Sr no. 6 of the instructions ) If yes, please submit details on Annexure II.
(i) PENSION FUND SELECTION (Tier I) : Please read below conditions before opting for the choice of Pension Funds:
1. Government Sector: For Government Subscribers, the following PFs act as default PFs as per the guidelines issued by the Government:
(a) LIC Pension Fund Limited (b) SBI Pension Funds Pvt. Limited (c) UTI Retirement Solutions Ltd.
2. All Citizen Model: Subscribers under All Citizen model have the option to choose the available PFs as per their choice in the table below.
3. Corporate Model: Subscribers shall have the option to choose the available PFs as per the below table in consultation with their respective Employer.
4. NPS Lite: NPS Lite is a group choice model where subscriber has a choice of PF and investment option as available with Aggregator.

Name of the Pension Fund (Please select only one) Please Tick( ) Availability of the Pension Funds
LIC Pension Fund Limited Available to
SBI Pension Funds Limited Government Sector
UTI Retirement Solutions Limited Available to
Available to NPS Available to All
ICICI Prudential Pension Fund Management Company Limited Corporate
Lite Citizen Model *
Kotak Mahindra Pension Fund Limited Model *
Reliance Capital Pension Fund Limited
HDFC Pension Management Company Limited
Birla Sunlife Pension Management Limited
* Selection of Pension Fund is mandatory both in Active and Auto Choice.
(ii) INVESTMENT OPTION : (Please Tick ( ) in the box given below showing your investment option). Active Choice Auto Choice
Please note: 1. In case you select Active Choice fill up section (iii) below and if you select Auto Choice fill up section (iv) below.
2. In case you do not indicate any investment option, your funds will be invested in Auto Choice (LC 50).
3. In case you have opted for Auto Choice and fill up section (iii) below relating to Asset Allocation, the Asset Allocation instructions will be ignored
and investment will be made as per Auto Choice (LC 50).
(iii) ASSET ALLOCATION (to be filled up only in case you have selected the ‘Active Choice’ investment option)
E C G A Note: 1. The total allocation across E, C , G and A asset classes must be equal to 100%. In
Asset Class (Cannot (Max up to (Max up to (Cannot Total case, the allocation is left blank and/or does not equal 100%, the application shall be rejected.
exceed 50%) 100%) 100%) exceed 5%) 2. Asset class E-Equity and related instruments; Asset class C-Corporate debt and related
instruments; Asset class G-Goverment Bonds and related instruments; Asset Class
Specify %
A-Alternative Investment Funds including instruments like CMBS, MBS, REITS, AIFs, Invlts etc.

(iv)Auto Choice Option(to be filled up only in case you have selected the ‘Auto Choice’investment option).Incase,you do not indicatea choice of LC,your funds will be invested as per LC50.
Life Cycle (LC)Funds Please Tick () Only One

LC 75 Note: 1. LC 75- It is the Life cycle fund where the Cap to Equity investments is 75% of the total asset

2. LC 50- It is the Life cycle fund where the Cap to Equity investments is 50% of the total asset
LC 50
3. LC 25- It is the Life cycle fund where the Cap to Equity investments is 25% of the total asset
LC 25

2 of 5
 CSRF
11. DECLARATION BY SUBSCRIBER* ( Please refer to Sr no. 7 of the instructions )
Declaration & Authorization by all subscribers
I have read and understood the terms and conditions of the National Pension System and hereby agree to the same along with the PFRDAAct, regulations framed thereunder
and declare that the information and documents furnished by me are true and correct, to the best of my knowledge and belief. I undertake to inform immediately the Central
Record Keeping Agency/National Pension System Trust, of any change in the above information furnished by me. I do not hold any pre-existing account under NPS. I
understand that I shall be fully liable for submission of any false or incorrect information or documents.
I further agree to be bound by the terms and conditions of provision of services by CRA, from time to time and any amendment thereof as approved by PFRDA, whether
complete or partial without any new declaration being furnished by me. I shall be bound by the terms and conditions for the usage of I-PIN (to access CRA website and view
details) & T-PIN.

Declaration under the Prevention of Money Laundering Act, 2002

I hereby declare that the contribution paid by me/on my behalf has been derived from legally declared and assessed sources of income. I understand that NPS Trust has
the right to peruse my financial profile or share the information, with other government authorities. I further agree that NPS Trust has the right to close my PRAN in case I am
found violating the provisions of any law relating to prevention of money laundering.

Date

Place : __________________________________ Signature/Thumb Impression* of Subscriber in Black Ink

( * LTI in case of Male and RTI in case of Females)

12. DECLARATION ON FATCA* (Foreign Account Tax Compliance Act) COMPLIANCE (Please refer to Sr no. 8 of the instructions):

Section I * US Person* Yes No

Section II *
For the purposes of taxation, I am a resident in the following countries and my Tax Identification Number (TIN)/functional equivalent in each country is set out below or I have indicated
that a TIN/functional equivalent is unavailable (kindly fill details of all countries of tax residence if more than one):

Particulars Country (1) Country (2) Country (3)

Country/Countries of Tax residency
Address Line 1
Address in the jurisdiction for Tax Residence City/Town/Village
State
ZIP/Post Code
Tax Identification Number (TIN) / Functional equivalent Number
TIN / Functional equivalent Number Issuing Country
Validity of documentary evidence provided (Wherever applicable) D D M M Y Y Y Y
“I certify that:
a) It shall be my responsibility to educate myself and to comply at all times with all relevant laws relating to reporting under section 285BA of the Act read
with the Rules 114F to 114H of the Income tax Rules, 1962 thereunder and the information provided in the Form is in accordance with the aforesaid
rules,
b) the information provided by me in the Form, its supporting Annexures as well as in the documentary evidence are, to the best of my knowledge and
belief, true, correct and complete and that I have not withheld any material information that may affect the assessment/categorization of the account as
a Reportable account or otherwise.
c) I permit/authorise the NPS Trust to collect, store, communicate and process information relating to the Account and all transactions therein, by the NPS
Trust and any of NPS intermediaries wherever situated including sharing, transfer and disclosure between them and to the authorities in and/or outside
India of any confidential information for compliance with any law or regulation whether domestic or foreign.
d) I undertake the responsibility to declare and disclose within 30 days from the date of change, any changes that may take place in the information
provided in the Form, its supporting Annexures as well as in the documentary evidence provided by me or if any certification becomes incorrect and to
provide fresh self-certification along with documentary evidence,
e) I also agree that in case of my failure to disclose any material fact known to me, now or in future, the NPS Trust may report to any regulator and/or any
authority designated by the Government of India (GOI) /RBI/IRDA/PFRDA for the purpose or take any other action as may be deemed appropriate by
the NPS Trust if the deficiency is not remedied by me within the stipulated period.
f) I hereby accept and acknowledge that the NPS Trust shall have the right and authority to carry out investigations from the information available in public
domain for confirming the information provided by me to the NPS Trust
g) I also agree to furnish such information and/or documents as the NPS Trust may require from time to time on account of any change in law either in
India or abroad in the subject matter herein.
h) I shall indemnify NPS Trust for any loss that may arise to the NPS Trust on account of providing incorrect or incomplete information.

Date

Place :
------------------------------------------------------------

Name of subscriber
Signature/Thumb Impression* of Subscriber in Black Ink
( * LTI in case of Male and RTI in case of Females)

3 of 5
 CSRF
13. DECLARATION BY EMPLOYER (DDO)

Applicable to Government Subscribers Only

(Subscribers Employment Details to be filled and attested by the Department (All Details are Mandatory)
Date of Joining Date of Retirement
Employee Code/ID (If applicable)
PPAN (If applicable
Group of Employee (Tick as applicable) Group A Group B Group C Group D

Office

Department

Ministry

DDO Registration Number S G V Basic Pay

DTO Registration Number 4
Pay Scale

It is certified that the details provided in this subscriber registration form by ________________________________________ employed with us,
including the address and employment details provided above are as per the service record of the employee maintained by us. Also, it is further
certified that he/she has read entries/entries have been read over to him/her by us and got confirmed by him/her.

Signature of the Authorised Person Rubber Stamp of the DDO Signature of the Authorised Person Rubber Stamp of the CCA
(in the box above) (DDO) (in the box above) (in the box above) (CCA Office) (in the box above)
Designation of the Authorised Person Designation of the Authorised Person
Name of the DDO Name of DTA
Deptt/Ministry Date
14. DECLARATION BY EMPLOYER / CORPORATE
Applicable to Corporate Subscribers Only
(Subscribers Employment Details to be filled and attested by Corporate (All Details are Mandatory)
Date of Joining Date of Retirement

Employee Code/ID (If applicable)

Corporate Regd. Number (CHO No.) Allotted by CRA

CBO No. allotted by CRA

Certified that the details provided in this subscriber registration form by ________________________________________ employed with us,
including employment details provided above are as per the service record of the employee maintained by us. Also, it is further certified that he/she
has read the entries/entries have been read over to him/her by us and got confirmed by him/her.

Date Place :

Signature of the Authorised Person (in the box above)

Rubber Stamp of the Corporate (in the box above)
Designation of the Authorised Person

4 of 5
 CSRF
15. TO BE FILLED BY POP-SP (A&T) .

Receipt No. (17 digits)

POP-SP Registration Number 3 1 0 0 2 3 0

Document accepted for Date of Birth Proof :

Copy of PAN Card submitted : YES NO KYC Compliance : YES NO

Documents Received : (Originals Verified) Self Certified Tick (Attested) True Copies Tick

Identity Verification : Done Tick

Existing Bank Customer :

I/we hereby certify/confirm that Shri/Smt/Kum ……………………………………………………………………………………. is an existing customer of
the Bank having fully operative Saving Bank Account No. …………………………………………………………………… at
……………………………………….. Branch and KYC norms required for opening Bank Account which match the requirements for opening NPS
account have been fully complied with. We further confirm that the S.B. a/c of Sh/Smt/Kum ……………………………………………………………. is
not a ‘Basic Savings Bank Deposit Account.’

Aadhaar Based KYC Certificate :

I/we hereby certify that Aadhaar Number …………………………………………………………………. of Sh/Smt/Kum ………………………………… ..
……………………………………………… has beenchecked and the name and address mentioned on the original Aadhaar Card are matching with
that mentioned on NPS application form.

Name :

Designation : ________________________ Place : Aizawl

Date :
POP-SP Seal (A&T) Signature of Authorized Signatory

[To be filled by CRA – Facilitation Centre (CRA-FC)]

Received by :

CRA-FC Registration Number :

Received at Date :

Acknowledgement Number (by CRA-FC)

PRAN Allotted :

………………………………………………………………………………………………………………………………………………………………………………

ACKNOWLEDGEMENT

Name of Subscriber :

Contribution Amount Remitted : Rs

Date of Receipt of Application and Contribution Amount : D D M M Y Y Y Y

Stamp and Signature of the Employer/POP (DDO)

5 of 5
 Annexure III to CSRF
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 (Please refer instruction no: 5). Also, please note that in case of demise of the subscriber after
opting for deferred withdrawal, all the outstanding pension wealth present in the NPS account of the subscriber shall be withdrawn upon receiving the
request and paid to the nominees as mentioned in this form and the same would be treated as full and final discharge of the obligation.

I, ___________________________________________________ hereby nominate the person(s) mentioned below who is/are member(s)/ of my family
to receive the amount in my PRAN account under National Pension System in the event of my death.

1. Name of the Nominee : h h h h h h j l j j mml

st nd rd
1 Nominee 2 Nominee 3 Nominee
First Name First Name First Name

Middle Name Middle Name Middle Name

Last Name Last Name Last Name

I 2. Present Communication Address of the nomineesh h h h j l j

Address of 1st Nominee Adress of 2nd Nominee Adress of 3rd Nominee

L 3. Date of Birth* (Only in case of a Minor) h h h h h h j l j

1st Nominee 2nd Nominee 3rd Nominee

I 4. Relationship with the Nominee h h h h h h j l j j

1st Nominee 2nd Nominee 3rd Nominee

iii5. Percentage Share : h h h h h h j l j j mml

1st Nominee % 2nd Nominee % 3rd Nominee %

iii6. Nominee’s Guradian Details (Only in case of a Minor) : h h h h h h j l

1st Nominee’s Guardian Details 2nd Nominee’s Guardian Details 3rd Nominee’s Guardian Details
First Name First Name First Name

Middle Name Middle Name Middle Name

Last Name Last Name Last Name

Dated this __________ day of ___________________ 20____ at _____________

Signature/Thumb Impression* of the Subscriber

*Note:
Left thumb impression in case of illiterate male Subscriber and Right thumb impression in case of illiterate female subscriber
must be obtained.

1 of 2
 Annexure III to CSRF

TO BE FILLED/ATTESTED BY DDO

Certified that the above declaration and nomination details has been signed / thumb impressed before me by Sh/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 DDO Signature of the DDO (Authorised Person)

DDO REGISTRATION NUMBER S G V 1 Designation of the Authorised Person : ____________________

(Allotted by CRA)
DDO Office Name : ___________________________________

Date :

TO BE FILLED/ATTESTED BY DTA (CCA, A&T) DTA (CCA, A&T) REGISTRATION NUMBER

ALLOTTED BY CRA : 3100230

Rubber Stamp of DTA (CCA, A&T) Signature of the Authorised Person (A&T)

2 of 2
 FORM 60
[See third provision to of Rule 114B]

Form of Declaration to be filled by a person who does no have either permanent account number of
general index Register Number and who makes payment in respect of transaction specified in
clauses (c) to (f) of rule 114B of the income Tax Act. 1962.

1. Full Name and Address of the declarant ........................................................................................

..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................

2. Particulars of transaction

Account Type ..................................................... Number ............................................................

3. Amount of the transaction Rs. ..................................................

4. Are you assessed to tax ? Yes / No

5. If yes,
i) Details of Ward / Circle / Range where the last return of income was filed.
ii) Reasons for not having permanent account number / General Index Register Number

6. Details of document being produced in support of address in column (1)

................................................................................................................................................

Verification

I, ........................................................................................................................... do hereby
declare that what is stated above is true to the best of my knowledge and belief.

Date ........................................

Place .......................................
...............................................
Signature of the declarant

Instructions: Documents which can be produced in support of the address are:

(a) Ration Card
(b) Passport
(c) Driving License
(d) Identity Card issued by any institution
(e) Copy of Electricity bill or Telephone bill showing residential address.
(f) Any document of communication issued by authority of Central Government or local bodies
showing residential address.
(g) Any other documentary evidence in support of his address given in the declaration.

Note: Amendment with effect from 1 November, 1998 as per Income Tax Act, 1962 Rule 114 B:
para (c) A time deposit exceeding Rs. 50,000/- with a banking company : para (f) opening
an account with a Banking Company.
 ANNEX-I

(Details to be furnished by the Government Servant)

Name of the Government Servant : __________________________________________

(in Block Letters)
Designation : __________________________________________

Scale of Pay : __________________________________________

Date of birth : __________________________________________

Date of joining Government Service : __________________________________________

Basic Pay : __________________________________________

Nominee for accumulations under The Pension Account :

Percentage
Age Relationship with the
Sl.No. Name of Nominee(s) of share
(Date of Birth) Government Servant
payable

1. ………………………………….. ......................... ................... ........................................

2. ………………………………….. ………………. …………... …………………………

3. ………………………………….. ………………. …………... …………………………

…………………………………………..

Signature of the Government Servant

 ANNEX-II

FORMAT IN WHICH INFORMATION IS REQUIRED TO BE SENT BY DDO TO CENTRAL

RECORD KEEPING AGENCY/CCA TOWARDS TIER-I OF THE NEW DEFINED
CONTRIBUTORY PENSION SCHEME

Name of DDO/ Code No:…………………………………………………………………………………

Name of Office and Address: …………………………………………………………………………….

DatePermanent Details of nominee(S) for the accumulation

Date of under Pension Account
Sl. Name of Government Desig- Basic Pension
Joini-ng
No. Servant nation Pay of Account No. Relation- %
Birth in 16 digits service Age/ ship with age
Name of Nominee(s)
allotted by DOB Govt. of
PAO/CCA servant share

1......….……………………

…………………………..
2. …………………….……

3……………………….….

Name of DDO/Signature :

Office Seal :
 (Hemi Page hi form submit zingah telh a ngái lo)
I: FORMS & DOCUMENTS
1. DDO Forwarding letter.
2. Attested photo copy of Appointment order & DPC meeting minutes (MPSC lakah meeting minute telh a tul lo).
3. Annex I & II (Sl.No.II&III PPAN Dilna)
4. Annexure S-5
5. CSRF page 1-5
6. Annexure III to CSRF page 1-2
7. Cancelled cheque in original (& Bank pass book 1st page Xerox copy)
8. Attested photo copy of Birth certificate
9. Attested photo copy of Voter’s ID
10. Attested photo copy of Aadhaar Card
11. Attested photo copy of PAN Card or Form 60(PAN Card nei lo tan chauh) (Sl.No.IV-XI PRAN Dilna)
II : INSTRUCTIONS
A
1. Form leh document dang ho te A-4 Size a ni tur a ni a, both size copy siam loh tur.
2. a siamThlalâk (photograph) colour, a size : height-3.5 cm, width-2.5cm. Thlalâk hi sign hnan loh tûr a ni. Chilh phal a ni lo a, bel vek tûr a ni.
Passport photograph chu colour, a background colour var(white) chauh pawm a ni.
3. Form zawng zawng hi pen tui dum (black ink) vek a ziak tûr a ni a, box chhûnga ziak tûr chu rîn si lo-in CAPITAL LETTER veka fill up tûr a ni.
4. DDO zawng zawngte hi Code leh Registration number hrang vek pêk (allotted) an ni a. Registration number chu 10 characters, SGV atanga in tan a
ni. Tin, DTO registration number atân mahni Treasury Office dâwr te hman tûr a ni.
5. Date ziakna tur BOX ah chuan DDMMYYYY format a ziak zel tur. E.g. 08/11/2017, 27/09/2017
B
1. A chung( Sl.No. I) angin application form te rem rawh.
2. Annex I, Annex II leh CSRF a Nomination ah mi pathum thleng a dah theih. Nomination a ziakte chuan Share 100 an in sem ang. A belhkhawm 100
a nih loh chuan reject a ni ang. Nomination a ziak lan a nih chuan share a neih a ngai, share pek a nih dawn loh chuan ziak loh mai tur.
3. Percentage of share hi figure a ziak tur a ni. A thu(e.g. FULL) a ziak chu reject a ni ang.
4. Date of joining atan regular appointment join ni ziak tur. Past service(contract/MR etc) joining date ziak loh tur.
5. Basic pay atan ROP 2010 page 19 en tur.
C Annexure S 5
1. Annexure S5 hi mi pakhat tan copy khat zel a ngai lo. DDO in tum khata a rawn thawn zawng zawng tan pakhat(1 copy) a tawk.
2. DDO Registration Number : SGV atanga in tan a ni.
3. DDO Name & designation : Ziak tur.
4. A hnuaiah Enclosed please find ….. tih a awm a. DDO in dilna a rawn forward zat (e.g. mi pakhat, pahnih, etc) kha a thuin ziak tur. E.g One, Two, Ten.
5. Yours faithfully hnuaiah DDO signature leh Seal.
D CSRF
1. Passport photograph bel rawh.
2. Personal details :
2.i. Shri, Smt.Kumari : Mahni nihna tick tur.
2.ii. Name : First name ah ziak vek ni se. Hnam hming nei tan box pakhat tih awl tur. Middle leh Last dah a ngai lo.
H L A L H M I N G M A W I A
2.iii. Father’s Name : Mandatory
2.iv. Mother’s Name : Mandatory (PRAN Card ah Pa hming a in print thin a. Nu hming zawk print lang duh tan Mother’s Name hnuaia sentence
tawpah TICK tur a awm.
2.v. Date of Birth : Service bu a date of birth ziak dan ang leh supporting document awm ngei a ni tur a ni.
2.vi. City of Birth : Pianna khua
2.vii. Country of Birth : Pianna ram. E.g. India
2.viii.Gender : Tick tur
2.ix. Marital status : Tick tur
2.x. Spouse Name : Kawppui te hming ziak tur. Kawppui(nupui pasal) nei lo tan ziak a ngai lo.
2.xi. Residential status : Indian Tick tur.
3. Proof of Identity :
3.i. Tarlan zinga pakhat tal number ziak tur. Attested Xerox copy pawh telh tur.
3.ii. (UID) Aadhaar : Aadhaar nei Aadhaar number ziak tur.
3.iii. UID hnuaia box ah TICK tur.
4. Proof of Address :
4.i. Tarlan zing atanga document submit tura address lanna TICK tur.
4.1. Correspondence Address Details :
4.1.i. PIN Code, State, City leh Area te ziak tur. PIN Code hnuaiah Country ziah tur. A bak House no.leh thil dang chu mahni address ziak duh dan a ni.
4.2. Permanent Address Details : Correspondence address nena a in an chuan fill up lovin TICK tur. Fill up dan chu Correspondence Address instruction nen
a in ang. Permanent zawk ziaka Correspondence ziak lo dilna chu reject zel a ni. Correspondence Address ziak ngei ngei a ngai.
5. Contact Details : Mobile number leh Email ID ziak vek ni se. Mobile No. hi mandatory ni lo mah se, a hnuah fill up tura hriattir leh an ni ang.
6. Other Details : Government Sector leh 1 lac to 5 lac te TICK ni se.
7. Subscriber Bank Details : MICR tih loh chu fill up vek tur. Savings A/C, No., B/Name, Br.Name, Br.Add., PIN, IFSC, State(IFS code chungchiah), Country(PIN code
hnuaiah.
8. Subscribers Nomination Details : Fill up loh tur. Nomination pakhat chauh dah duh tan pawh Annexure III to CSRF hman tur.
9. NPS Option Details : Fill up a ngai lo.
10. PF & Investment Option : Fill up a ngai lo.
11. Declaration by subscriber : Date, Place leh Subscriber signature. Signature hian box rin a si tur a ni lo.
12. FATCA : ‘No’ TICK tur. A dang fill up a ngai lo. A hnuaia Date, Place, Name of Subscriber fill up a, subscriber signature awm tur.
13. Declaration by Employer : i. Dt.of joining, Dt. of retirement (Pian thla a ni awm hnu hnung ber hman tur, kumah pian kum atanga kum 60 belh tur. E.g.
20.3.1989 a piang chu 31.3.2049 ah a pension ang. Ni 1 a piang erawh chu a hma chiah thla tawp ni angin – 1.9.1990 chu 31.8.2050). Group tick tur.
Office, Department, Ministry, DTO(Treasury) Registration Number, DDO Registration Number, Basic pay, pay scale(Pay scale ah pay band 1, GP ziah
lan a ngai lo. PB-1 5200-20200+2400 GP ti lovin 5200-20200+2400 tia ziak mai tur a ni).
Box pa 4 a awm a, vei lam box pa 2 hi DDO tih tur a ni. Signature box ah seal chhut tel loh tur, Seal box ah sign tel loh tur. A hnuai chiahah Designation,
Name, Dept te fill up tur.
14. Declaration by employer/corporate : Fill up a ngai lo.
---Cont/-……
 15. To be filled by POP-SP : POP-SP Registration Number-ah 3100230 ziak tur. Document accepted for Dt. Birth proof atan D.2.v a i ziak tawh kha hmang ang
che. PAN Card submit tel tan YES tick tur. Existing Bank Customer ah hming, A/c No., Branch name ziak tur. Aadhaar Based KYC ah Aadhaar No. leh
hming ziak tur. Box-a seal/signature tih a ngai lo. To be filled by CRA-a ngai lo. Acknowledgement-ah hming, 1st contribution amount(tur) zat, form sign ni,
leh a hnuaia Stamp and Signature of the Employer/PoP ah DDO signature leh seal.

E Annexure III to CSRF

1. Hming ziak tur.
2. 2.1. Name of the Nominee : First name a ziak vek ni se.
2.2. Present communication Address : Nominee address ziak tur.
2.3. Date of Birth(Kum 18 la tling lo nominee te Dt.of Birth ziak tur).
2.4. Relationship (Wife, Husband, Son, etc).
2.5. Percentage : Nominee a hming lang zawng zawng ten 100 in sem tur.
2.6. Guardian : Kum 18 tling lo nominee tan an guardian hming ziak tur. Govt servant(self) ziak loh tur. A hnuaia Date ziak a, subscriber signature awm tur
a ni.

3. To be filled/Attested by DDO : Rubber stamp ah DDO seal, sign loh tur. A ding lamah DDO signature, seal chhut tel loh tur. DDO Registration Number
(SGV a in tan), DDO Designation, Office hming (CMO, North, etc), date ziak tur. A hnuaia box dang chu fill up a ngai lo.

III. DDO HRIATTUR :

Sawrkar hnathawk thar/office rawn join thar an awmin, PPAN/PRAN allot an ni tawh em tih zawh thin tur a ni.

New employee chuan office dang (under GoMz) ah PPAN a neih tawh chuan PPAN thar dilna siam a ngai tawh lo a, a ngai rin
tir tur.

GoMz hnuaia PPAN nei tawh chuan GoMz hnuaiah hna dang/office dangah insawn pawh ni se, vawikhat a neih tawh chuan a
service chhungin a dang apply tur a ni lo.

New employee (under GoMz ni lo) chu a PPAN hmasa a rin theih loh a, PPAN thar dil tur.

New Employee (under GoMz hnuaia PPAN nei sa leh GoMz hnuai ni lo atanga rawn kal e.g. IAS) te chu PRAN an nei tawh em
tih zawh thin tur a ni.

PRAN nei sa tan a thar dil loh tur, PRAN vawi khat nei tawh tan India ram khawi hmunah pawh NPS hmanna ah chuan PRAN
ngai rin zel tur.

PRAN dilna A&T a submit tawh, a dil anga PPAN a nei tih hriattir tawhin thla hnih chhunga PRAN a nei tih hriattirna(SMS or
A&T atanga hriattirna) a dawn loh chuan a rang lamin dilna thar (Annex I&II tel lo), CSRF page 4 ah PPAN ziak langin submit
that tur a ni.

DTO Registration Number

Aizawl South – 4010974 Aizawl North – 4010985 Lunglei – 4010996
Saiha – 4011055 Champhai – 4011000 Lawngtlai – 4011033
Serchhip – 4011022 Kolasib – 4011011 Mamit – 4011044
Chawngte – 4016703