Form Csrf 1 - Subscriber Registration Form - National Pension System (Nps)

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CSRF 1
NATIONAL PENSION SYSTEM (NPS)
SUBSCRIBER REGISTRATION FORM
Affix
Please Select your Category [ Please tick(√) ]
recent colour
photograph
Government Sector
Corporate Sector
To,
of
3.5 cm X 2.5 cm
All Citizen Model
NPS Lite/Swavalamban
National Pension System Trust.
size
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)
1. PERSONAL DETAILS:
Name of Applicant in full
Shri
Smt.
Kumari
First Name*
Middle Name
Last Name
Date of Birth*
d
d
/
m m
/
y
y
y
y
(Date of Birth should be supported by relevant documentary proof)
Gender [ Please tick (√) ]
Male
Female
Others
Father's Name*
F
i
r
s
t
M
i
d
d
l
e
L
a s
t
(Refer Sr. No. 1 of instructions)
2. IDENTITY DETAILS*
(Any one of the documents need to be provided)
PAN
Aadhaar
Voter ID
Others
Name of the ID
I D
N u m b e r
Passport
Please refer Sr. No. 2 of the instructions.
3. CORRESPONDENCE ADDRESS DETAILS*
Flat/Room/Door/Block no.
Landmark
Premises/Building/Village
Road/Street/Lane
Area/Locality/Taluk
City/Town/District
PIN Code
State/U.T.
C
o
u
n
t
r
y
4. PERMANENT ADDRESS DETAILS
Tick (√) in the box in case the address is same as above.
Flat/Room/Door/Block no.
Landmark
Premises/Building/Village
Road/Street/Lane
Area/Locality/Taluk
City/Town/District
PIN Code
State/U.T.
C
o
u
n
t
r
y
Proof of Address (Correspondence/Permanent)
Aadhar card
Passport
Voter ID card
Driving License
Ration Card
Registered Lease
Sale agreement of residence
Latest Gas Bill
#
Electricity Bill
#
Telephone[Landline] Bill
#
Others (please specify)
#
Not more than 3 months old. Please refer Sr. No. 2 of the instructions
5. CONTACT DETAILS
Landline Phone (with STD Code)
Mobile +
9
1
Email ID
Do you want to subscribe to SMS Alerts :
Yes
No
Mobile number is essential for receiving sms alerts regarding your NPS account
6. OTHER DETAILS
( Please refer to Sr no. 3 of the instructions )
Occupation Details [ please tick(√) ]
Private Sector
Government Sector
Public Sector
Business
Professional
Agriculture
Homemaker
Student
NRI
Other (please specify)
Please Tick If Applicable
Politically exposed person
Related to Politically exposed Person
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
HSC
Graduate
Masters
Professionals ( CA, CS, CMA, etc.)
7. SUBSCRIBER BANK DETAILS
( Please refer to Sr no. 4 of the instructions )
Account Type [ please tick(√) ]
Saving A/c
Current A/c
Bank A/c Number
Bank Name
Branch Name
Branch Address
PIN Code
State/U.T.
C
o
u
n
t
r
y
Bank MICR Code
IFSC Code
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