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    Atal Pension Yojana (Apy) - Subscriber Registration Form: 1. Bank Details

    Uploaded by

    Prashant Barsing
    The document is a subscriber registration form for the Atal Pension Yojana (APY) pension scheme administered by PFRDA. It contains details of Barsing Prasant Pandharinath registering for the scheme. He is providing his bank account information, personal details like name, DOB, address, spouse and nominee information. He is selecting a monthly pension of Rs. 1000 under the scheme and authorizing a monthly debit of Rs. 151 from his bank account to contribute towards the pension. The form is acknowledged by the bank providing his PRAN number, guaranteed pension amount and contribution details.

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

    Atal Pension Yojana (Apy) - Subscriber Registration Form: 1. Bank Details

    Uploaded by

    Prashant Barsing
    49 views1 page
    The document is a subscriber registration form for the Atal Pension Yojana (APY) pension scheme administered by PFRDA. It contains details of Barsing Prasant Pandharinath registering for the scheme. He is providing his bank account information, personal details like name, DOB, address, spouse and nominee information. He is selecting a monthly pension of Rs. 1000 under the scheme and authorizing a monthly debit of Rs. 151 from his bank account to contribute towards the pension. The form is acknowledged by the bank providing his PRAN number, guaranteed pension amount and contribution details.

    Original Description:

    sbi pENSION yOJNA

    Original Title

    SBI PENSION YOJNA1589638940334APY_MdseYWqC

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    The document is a subscriber registration form for the Atal Pension Yojana (APY) pension scheme administered by PFRDA. It contains details of Barsing Prasant Pandharinath registering for the scheme. He is providing his bank account information, personal details like name, DOB, address, spouse and nominee information. He is selecting a monthly pension of Rs. 1000 under the scheme and authorizing a monthly debit of Rs. 151 from his bank account to contribute towards the pension. The form is acknowledged by the bank providing his PRAN number, guaranteed pension amount and contribution details.

    Copyright:

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

    Atal Pension Yojana (Apy) - Subscriber Registration Form: 1. Bank Details

    Uploaded by

    Prashant Barsing
    The document is a subscriber registration form for the Atal Pension Yojana (APY) pension scheme administered by PFRDA. It contains details of Barsing Prasant Pandharinath registering for the scheme. He is providing his bank account information, personal details like name, DOB, address, spouse and nominee information. He is selecting a monthly pension of Rs. 1000 under the scheme and authorizing a monthly debit of Rs. 151 from his bank account to contribute towards the pension. The form is acknowledged by the bank providing his PRAN number, guaranteed pension amount and contribution details.

    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 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* 00000020013287183
    Bank Name* STATE BANK OF INDIA Bank Branch* SECTOR-12 KHARGHAR

    2. PERSONAL DETAILS:
    Title SHRI First Name* BARSING
    Middle Name PRASANT Last Name PANDHARINATH
    Date of Birth* 19/07/1986 Age 33
    Mobile Number* 9794258005 AADHAAR
    Email ID PRASHANTBARSING2006@GMAIL.COM Married YES
    Name of Spouse* TEJASHREE PRASHANT BARSING Spouse AADHAAR
    Nominee's Name* TEJASHREE PRASHANT BARSING Nominee AADHAAR
    Additional Details in case nominee is a Minor
    Relationship with the subscriber* WIFE
    Nominee's Date of Birth* 18/11/1986
    Guardian's Name
    Whether beneficiary of other social security schemes NO
    Whether Income Tax Payer YES

    3. PENSION DETAILS:
    Pension Amount* 1000 2000 3000 4000 5000

    I hereby authorize the bank to debit my above mentioned bank


    Contribution Amount account till the age of 60 for making payment under APY as
    ( Monthly ) + applicable based on my age and the Pension Amount selected by
    151.00
    (in Rs.) me. If the transaction is delayed or not effected at all for insufficient
    (To be filled by the Bank) balance, I would not hold the bank responsible. I also under take to
    deposit the additional amount together with penalty thereon.

    Declaration & Authorization by all subscribers

    I am not member of any statutory Social Security Scheme. I meet the prescribed eligibility criteria for assistance under APY and I have
    read and understood the terms and conditions of the Scheme. I hereby agree to the same and declare that the information furnished by
    me is true and correct, to the best of my knowledge and belief. I undertake to inform immediately inform the bank, of any change in the
    above information furnished by me. Further, I do not hold any pre-existing account under NPS. I understand that I shall be fully liable for
    submission of any false or incorrect information or documents. I have read/been explained and have understood the APY guidelines. I
    further agree to be bound by the terms and conditions of provision of services under the scheme as approved by PFRDA/Govt. of India.

    Date 16/05/2020 Signature/Thumb Impression* of


    Subscriber
    Place NAVI MUMBAI (* LTI in case of male and RTI in
    case of female)

    ACKNOWLEDGEMENT - SUBSCRIBER REGISTRATION FOR ATAL PENSION YOJANA (APY)


    (To be filled by the Bank)

    Name of the Subscriber: BARSING PRASANT PANDHARINATH


    PRAN Number: 500423613010
    Guaranteed Pension Amount: 1000.00
    Periodicity of Contribution: MONTHLY
    Monthly Contribution Amount under APY (in Rs.) : 151.00
    Name of the Bank: STATE BANK OF INDIA
    Bank Branch: SECTOR-12 KHARGHAR
    Receiving Officer's Name:
    Date of Receipt of Application: 16/05/2020 Stamp and Signature of the Bank
    **This is a computer generated form and does not require signature of the Branch Manager

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