NPS Withdrawal Form For Government Employees.pdf

1. PRAN:
2. Full Name (As in PRAN Card):
First Name
Middle Name
Last Name
3. Father’s/Spouse name:
First Name
Middle Name
Last Name
4. Address:
Flat/Unit No, Block no.
Name of Premise/Building/Village
Area/Locality/Taluka
District/Town/City
State / Union Territory
Country
Pin Code
5. Mobile No.
6. Date of Birth(As in PRAN Card):
7. Email ID:
8. Date of retirement:

Section B – Subscriber’s Withdrawal Details:

Tier – I Account:

1. The Lump-sum amount to be withdrawn and amount to purchase annuity in case of normal withdrawal(Please refer General Instruction no.4)
Description
Lump-Sum amount (Maximum of 60%)
Amount to purchase life annuity (Minimum of 40%)
Total
% share
2. Type of withdrawal:
One Time Withdrawal
Phased Withdrawal
3. In case of Phased Withdrawal#, please mention the percentage of lump-sum amount to be withdrawn this year (Please refer General Instruction no.5)
Description
Phased Lump-Sum Amount Percentage (Minimum 10%)
% share
Tier – II Account:
The entire accumulated pension wealth would be paid out in single lump sum along with the withdrawal/payment of the Tier-I account.

Section C – Subscriber’s Bank Details:

1. For Electronic transfer or Direct Credit through ECS/NEFT/RTGS, Proof attached for Bank Details:
Cancelled Cheque Bank Certificate
2. Type of Bank Account: Savings A/c
Current A/c
3. Bank A/c Number
4. Bank Name
5. Bank Branch
6. Bank Address
7. Pin Code
8. Bank IFS Code
9. Bank MICR Code (Wherever applicable)

Section D – Subscriber’s Annuity Details:

1. Annuity Service Provider (ASP) Name :
2. ASP ID:
3. ASP Scheme Name :
4. ASP Scheme ID :

Declaration:
I _, NPS Subscriber, my PRAN is ,
do hereby declare that the information provided above is true to the best of my knowledge and belief.
Date : D D M M Y YYY
Note: Left thumb impression in case of illiterate male claimants and Right thumb impression in case of illiterate female claimants must be obtained.
Signature/Left Thumb Impression of the Subscriber

Annexure for Nomination Details:
I, hereby nominate the person(s) mentioned below who is/are member(s)/non-member(s) of my family to receive the amount that may stand to my credit in the National Pension System as indicated below, in the event of my death before that eligible accumulated pension wealth amount has become payable or having become payable or having become payable has not been paid.
1. Name of the Nominee:
First Name
Middle Name
Surname/last name