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    Atal Pension Yojana Subscriber Form

    Uploaded by

    Suraj Kundu
    (1) The document is an Atal Pension Yojana (APY) subscriber registration form for a pension program administered by Pension Fund Regulatory and Development Authority. (2) It requests opening an APY account with details like name, date of birth, address, bank details, pension amount selected, and contribution amount. (3) The applicant authorizes automatic debit of contributions from their account until age 60 and agrees to terms and conditions of the pension scheme.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Atal Pension Yojana Subscriber Form

    Uploaded by

    Suraj Kundu
    363 views1 page
    (1) The document is an Atal Pension Yojana (APY) subscriber registration form for a pension program administered by Pension Fund Regulatory and Development Authority. (2) It requests opening an APY account with details like name, date of birth, address, bank details, pension amount selected, and contribution amount. (3) The applicant authorizes automatic debit of contributions from their account until age 60 and agrees to terms and conditions of the pension scheme.

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    GH

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    (1) The document is an Atal Pension Yojana (APY) subscriber registration form for a pension program administered by Pension Fund Regulatory and Development Authority. (2) It requests opening an APY account with details like name, date of birth, address, bank details, pension amount selected, and contribution amount. (3) The applicant authorizes automatic debit of contributions from their account until age 60 and agrees to terms and conditions of the pension scheme.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    363 views1 page

    Atal Pension Yojana Subscriber Form

    Uploaded by

    Suraj Kundu
    (1) The document is an Atal Pension Yojana (APY) subscriber registration form for a pension program administered by Pension Fund Regulatory and Development Authority. (2) It requests opening an APY account with details like name, date of birth, address, bank details, pension amount selected, and contribution amount. (3) The applicant authorizes automatic debit of contributions from their account until age 60 and agrees to terms and conditions of the pension scheme.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    ATAL PENSION YOJANA (APY) - SUBSCRIBER REGISTRATION FORM

    (Administered by Pension Fund Regulatory and Development Authority)

    To,
    The Branch Manager, _______________________________________________________ Bank______________________________Branch

    Dear Sir/Madam,
    I hereby request that an APY account be opened in my name under National Pension System (NPS) as per the particulars given below:
    * Indicates mandatory fields. Please fill the form in English and BLOCK letters
    1. BANK DETAILS:
    Bank A/c Number*
    Bank Name* Bank Branch*
    2. PERSONAL DETAILS:
    Name of Applicant Shri Smt. Kumari
    Full Name
    Date of Birth* d d / m m / y y y y Age Mobile No
    Email ID Aadhaar
    Married Yes No If married , spouse name is mandatory. Spouse will be the default nominee under APY.
    Name of Spouse Aadhaar
    Nominee's Name* Aadhaar
    Nominee's Relationship with the subscriber
    Additional Details in case nominee is a Minor
    Date of Birth* d d / m m / y y y y
    Guardian's Name*
    Whether beneficiary of other statutory social security schemes Yes No
    Whether Income Tax Payer Yes No
    3. PENSION DETAILS
    Frequency of Contribution (Please tick(√)) * Monthly Quarterly Half Yearly
    Pension Amount (Please tick(√)) * 1000 2000 3000 4000 5000
    I hereby a uthori ze the ba nk to debi t my a bove menti oned ba nk a ccount ti l l the a ge of 60
    Contribution Amount for ma ki ng pa yment under APY a s a ppl i ca bl e ba s ed on my a ge a nd the Pens i on Amount
    (in Rs.) s el ected by me. If the tra ns a cti on i s del a yed or not effected a t a l l for i ns uffi ci ent
    (To be filled by the Bank) ba nl a nce, I woul d not hol d the ba nk res pons i bl e. I a l s o underta ke to depos i t the
    a ddi ti ona l a mount together wi th pena l ty thereon.
    Declaration & Authorization by all subscribers
    I meet the pres cri bed el i gi bi l i ty cri teri a for a s s i s ta nce under APY a nd I ha ve rea d a nd unders tood the terms a nd condi ti ons of the Scheme. I hereby a gree
    to the s a me a nd decl a re tha t the i nforma ti on furni s hed by me i s true a nd correct, to the bes t of my knowl edge a nd bel i ef. I underta ke to i mmedi a tel y
    i nform the ba nk of a ny cha nge i n the a bove i nforma ti on furni s hed by me. Further, I do not hold any pre-existing account under APY. I unders ta nd tha t I s ha l l be
    ful l y l i a bl e for s ubmi s s i on of a ny fa l s e or i ncorrect i nforma ti on or documents . I ha ve rea d/been expl a i ned a nd ha ve unders tood the APY gui del i nes . I
    further a gree to be bound by the terms a nd condi ti ons of provi s i on of s ervi ces under the s cheme a s a pproved by PFRDA/Govt. of Indi a .
    Date d d m m y y y y Signature/Thumb Impression* of
    Place Subscriber (* LTI i n ca s e of ma l e a nd RTI
    i n ca s e of fema l e)

    ACKNOWLEDGEMENT - SUBSCRIBER REGISTRATION FOR ATAL PENSION YOJANA (APY)


    (To be filled by the Bank)
    Name of the Subscriber:
    PRAN Number
    Guaranteed Pension Amount
    Periodicity of Contribution
    Contribution Amount under APY
    (in Rs.)
    Name of the Bank
    Bank Branch:
    Receiving Officer's Name:
    Date of Receipt of Application: Stamp and Signature of the Bank

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