Form Csrf 1 - Subscriber Registration Form - National Pension System (Nps) (Page 3 of 7) in pdf

CSRF 1

12. DECLARATION BY EMPLOYER/POP/AGGREGATOR

Applicable to Government Subscribers only

(Subscribers Employment Details to be filled and attested by the Deptt. (All Details are Mandatory)

Date of Joining

Date of Retirement

Employee Code/ID

Group of Employee (Tick as applicable)

Group A

Group B

Group C

Group D

Office

Department

Ministry

DDO Registration Number

DTO/PAO/CDDO/DTA/PrAO Registration Number

Basic Pay

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 DTO/PAO/CDDO/

(In the box above)

DTA/PrAO (In the box above)

Designation of the Authorised Person

Name of the DDO

Name of DTO/PAO/CDDO/DTA/PrAO

Deptt/Ministry

Date

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 ID

Corporate Regd. No Allotted by CRA

CBO No. allotted by CRA

Certified that the details provided in this subscriber registration form by ________________________________________________________ employed with us, including

the 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 Authorized Person (In the box above)

Rubber Stamp of the Corporate

(In the box above)

Designation of the Authorized Person:

To be filled by POP-SP (Only in case of All Citizen Model or Corporate subscribers)

POP-SP Registration Number

Receipt No. (17 digits)

Document accepted for date of Birth Proof:

Copy of PAN card submitted

YES

KYC Compliance YES

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’.

Adhaar Based KYC Certificate:

I/we hereby certify that Aadhaar Number ...………......…....................................of Sh/Smt/Kum………………….......................................................................…..has been

checked and the name and address mentioned on the original Aadhaar card are matching with that mentioned on NPS application form.

To be filled by POP-SP

Name:

Designation:

Place:

POP-SP Seal

Signature of Authorized Signatory

Date

Declaration by the Aggregator (Only in case of NPS Lite/Swavalamban Subscribers)

Authorisation by Aggregator’s office (NL - AO)

Certified that the subscriber is registered with the aggregator and he/she has opted to join NPS. I hereby declare that the subscriber is eligible to join NPS and the above

declaration has been signed /thumb impressed before me by ...................................................after (s)he has read the entries/ entries have been read over to her/him by me.

Signature of the Authorised person (In the box above)

Rubber Stamp of the Aggregator (In the box above)

Name of the Aggregator

NPS Lite Account Office (NL-AO) Registration Number

NPS Lite - Collection Centre (NL - CC) Registration Number

Membership No. allotted by Aggregator (if any)

Place

Date

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

Received by

CRA-FC Registration Number

Received at