Form-401-An - Annexure For Nomination Details
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2Form 401-AN
Page 1
Annexure for Nomination Details
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before entire proceeds are withdrawn (Please refer general instruction no: 6) is to be provided hereunder. Also, please note that in case
of demise of the subscriber after opting for phased withdrawal, all the outstanding pension wealth out of the phased lump sum
withdrawal in the account of the subscriber will be 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)/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*:
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:
st
nd
rd
Address of 1
Nominee
Address of 2
Nominee
Address of 3
Nominee
3. Date of Birth* (Only in case of a minor):
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
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