Form Csrf 1 - Subscriber Registration Form - National Pension System (Nps) Page 6
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7Annexure III to CSRF 1
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proceeds are withdrawn is to be provided hereunder (Please refer instruction no: 5).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for deferred withdrawal, all the outstanding pension wealth present in the NPS account of the subscriber shall be withdrawn upon receiving the request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:
1st Nominee
2nd Nominee
3rd Nominee
First Name
First Name
First Name
Middle Name
Middle Name
Middle Name
Last Name
Last Name
Last Name
2. Present Communication address of the nominees:
Address of 1st Nominee
Address of 2nd Nominee
Address of 3rd Nominee
3. Date of Birth* (Only in case of a minor):
d d
/
m m
/
y y y y
d d
/
m m
/
y y y y
d d
/
m m
/
y y y y
1st Nominee
2nd Nominee
3rd Nominee
4. Relationship with the Nominee:
1st Nominee
2nd Nominee
3rd Nominee
5. Percentage Share:
1st Nominee
%
2nd Nominee
%
3rd Nominee
%
6. Nominee’s Guardian Details (Only in case of a minor):
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.
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