Application For Allotment Of Permanent Retirement Account Number (Pran) Form
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1
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4Annexure S1
Page 1
Application for Allotment of Permanent Retirement Account Number (PRAN)
(To avoid mistake(s), please follow the accompanying instructions and examples carefully before filling up the form)
To affix recent
Coloured photograph
Acknowledgement No.
(3.5 cm × 2.5 cm)
(To be filled by FC)
Permanent Retirement Account Number :
(To be filled by FC after PRAN generation )
Sir/Madam,
I hereby request that a permanent retirement account number be allotted to me.
I give below necessary particulars :
Signature/Left Thumb Impression
Section A - Subscribers Personal Details
( * Indicates Mandatory Field)
of Subscriber in black ink
1. Full Name (Full expanded name: initials are not permitted)
Please Tick as applicable,
Shri
Smt .
Kumari
First Name *
Middle Name
Last Name
2. Gender * Please Tick as applicable,
Male
Female
3. Date of Birth *
4. PAN
D
D
M M
Y
Y
Y
Y
(Date of Birth to be Certified by DDO)
5. Father’s Full Name:
First Name *
Middle Name
Last Name
6. Present Address:
Flat/Unit No, Block no. *
Name of Premise/Building/Village
Area/Locality/Taluka
District/Town/City *
State / Union Territory *
Country *
Pin Code *
7. Permanent Address: If same as above, Please Tick
else,
Flat/Unit No, Block no. *
Name of Premise/Building/Village
Area/Locality/Taluka
District/Town/City *
State / Union Territory *
Country *
Pin Code *
8. Phone No.
STD Code
Phone No.
9. Mobile No.
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Parent category: Legal