Ver 1.0 Mar.

2025 FORM B2
Form B2
[See Regulation 4,19 and 20]
Claim and Payout Form: Unified Pension Scheme (UPS) Subscriber who Superannuated /Retired on or before 31/03/2025
Before filling the form, please read the INSTRUCTIONS carefully given at the end of the form
Joint photograph of
Protean eGov Technologies Limited (formerly NSDL e- Governance Infrastructure Ltd.) Subscriber & Spouse

3.5 cm × 2.5 cm size /

passport size
PART - A (to be filled by the subscriber) (Do not sign across /
stapple / clip)
1. Detail of Subscribers:
Name
Employee Code / ID
PRAN Date of Birth d d m m y y y y
Date of Superannuation / Retirement under FR 56(j) d d m m y y y y Date of Joining Service d d m m y y y y
Gender Male Female Transgender
PAO (office name)
DDO (office name)
PAN
Ministry / Department (from where retired)
2. KYC Details:
Document Validity
Document Type Identification Number
(one of the documents) (in case of Passport and Driving License)
Aadhaar* / Driving License /
Passport / Voter ID / CKYC /
Letter issued by NPR
3. Current Address:
Flat / House No. / Bldg. Name
Street / Locality
Village & Post Office / Block
City / District State

Country Pin Code

4. Contact Details:
Telephone No. (If any) Mobile No.

E-Mail ID
5. Details of Legally Wedded Spouse as on Date of Superannuation:
Name
DOB d d m m y y y y PAN*

Gender Male Female Transgender Mobile No.

E-Mail Id
Aadhaar No.* Provide last Four Digits
6. Details of Bank Account:
Type of Bank A/C Joint with legally wedded Spouse Single (only in the absence of legally wedded Spouse)
(As on date of superannuation)

Bank A/C No.

Bank Name IFSC

Note: Please ensure that the Government Servant is the Primary Account holder in the Joint Account.
Declaration:
I ___________________________________________ Son / Daughter of Mr. / Mrs. ______________________________ a subscriber of National Pension
System with PRAN_________________________________ and have fully read and understood the provisions of Unified Pension Scheme (UPS) as notified
by GoI vide notification F. No. FX-1/3/2024-PR, dated 24/01/2025 and PFRDA (Operationalisation of Unified Pension Scheme under National Pension
System) Regulations, 2025 as amended from time to time. I hereby declare that I am eligible to avail benefits under UPS in terms of the aforesaid notification
and Regulations. I certify that the information given above is true and correct.

I authorize the CRA, NPS Trust or any other entity connected with UPS to collect and share data/ details of my necessary personal information for the purpose
of the said scheme regulated under the PFRDA Act, 2013 and the relevant regulations notified thereunder.

Place: ________________________ Name: ____________________________________________________________

Date: d d m m y y y y

Signature / Thumb Impression* of Applicant

(*LTI in case of males and RTI in case of females to be provided. Toe impression in case no hands)

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Ver 1.0 Mar. 2025 FORM B2

PART - B (Details as recorded in the CRA System)

1. Details of Partial Withdrawal:

No. of Units Default Pattern Value of Partial Withdrawals

Date of Partial Amount
S. N. Withdrawn as per NAV on the Date of (no. of units withdrawn * NAV) as per default pattern, as
Withdrawal Withdrawn
Default Pattern Superannuation on date of superannuation
1

Total

2. Details of Voluntary Contribution:

Date of Voluntary Amount of Voluntary No. of Units NAV on the Date of Value of Voluntary Contribution
S. N.
Contribution Contribution Allotted Superannuation (no. of units * NAV) as on date of superannuation
1

Total

3. Details for Calculation of UPS benefits payable to Subscriber:

I. Individual Corpus (IC): Value of Corpus as on Date of Superannuation/Retirement.

II. Benchmark Corpus (BC): Value of IC as per Default Pattern of Investment + Value
of Partial Withdrawals amount at the time of Superannuation as per Default Pattern -
value of Voluntary Contribution on Date of Superannuation/Retirement.
III. Final Withdrawal (FW in %).

IV. Representative Annuity Rate (as on Date of Superannuation, as published by PFRDA).

V. Representative Annuity Amount = (IC) x (1-FW%) *(Representative Annuity Rate) /

(12*100) where {IC <= BC}.

PART - C (to be filled by the DDO in the CRA System)

1. Employment Details as per service record:

File No:
Employee Code / ID
Date of Commencement of Qualifying Service (Qualifying
d d m m y y y y
Service as defined in Regulation 2(k) read with Regulation 13)
Date of Superannuation/ Retirement under Fundamental Rules 56(j) (which is not treated as penalty under
d d m m y y y y
Central Civil Services (Classification, Control and Appeal) Rules, 1965)
Length of Qualifying Service in Months (Q)
Length of Qualifying Service in Completed Half Years (L)
(fraction to be ignored)
Date of Start of Monthly Payout d d m m y y y y
(in case of superannuation, next day of superannuation or
in case of retirement under FR 56 (j), next day of retirement)

2. Basic pay details for last 12 months before Superannuation/ Retirement under FR 56 (j):
NPA (non-practicing NPA (non-practicing
Total Total
allowance granted to allowance granted to
Basic Pay (Basic pay + Basic Pay (Basic pay +
medical officer in lieu of medical officer in lieu of
NPA) NPA)
private practice) private practice)

Month 1 Month 7

Month 2 Month 8

Month 3 Month 9

Month 4 Month 10

Month 5 Month 11

Month 6 Month 12

Average of 12 Months of (Basic pay +NPA) = P

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Ver 1.0 Mar. 2025 FORM B2
3. Salary Details of last month before Superannuation/ Retirement under FR 56 (j):

Basic Pay (includes non-practicing allowance granted to medical officer Dearness Total
Month / Year
in lieu of private practice) if any) (BP) Allowance (DA) E= (BP+ DA)
Last month emolument (E)
for lump-sum payment
Certified that the details provided by subscriber in Part-A, details of employment and salary i.e., qualifying service, last basic pay, average basic pay,
superannuation/retirement date, legally wedded spouse details on the date of superannuation, which has been verified by HOO and the entry has been made
as per such certification.
Verified and Certified that the details are true and correct.

Signature & Name of DDO :

DDO Name DDO Registration No.

Date: Place:

Form B2 Joint photograph of

Part D Subscriber & spouse
UPS Payout Order (UPO) issued by PAO
3.5 cm × 2.5 cm size /
(System Generated)
passport size

(Do not sign across /

To,
stapple / clip)
National Pension System Trust
Tower B, B-302, Third Floor, World Trade Center Nauroji Nagar, New Delhi-110029
File No: Date of Issue: d d m m y y y y
UPS Payout Order (UPO) No:
1. Details of Subscriber:
Name
Employee Code / ID
PRAN Date of Birth d d m m y y y y
Date of Superannuation / Retirement under FR 56(j) d d m m y y y y Date of Joining Service d d m m y y y y
Gender Male Female Transgender
PAO (office name)
DDO (office name)
PAN
Ministry / Department (from where retired)
2. Details of Legally Wedded Spouse on the Date of Superannuation / Retirement:
Name
DOB d d m m y y y y PAN

Gender Male Female Transgender Mobile No.

E-mail Id
3. Details of Employment & Salary:
Length of Qualifying Service in number of months
Average of last 12 Months Basic Pay
Last Month Salary (Basic Pay + DA)
Length of Qualifying Service in completed Six Months
Date of Start of Monthly Payout d d m m y y y y
Admissible Payout: Assured Payout*(IC/BC) * (1-FW%) where {IC <= BC} (Assured Payout = (½ of P) x (Q/300)) with the
condition that if (P/2) XQ/300 is less than 10,000, it will be taken as 10,000, where P is basic pay and Q is qualifying service in

Sanction of Admissible UPS Benefits Payable to Subscriber

4. UPS Benefits Payable to Subscriber:
Date of start of Top-Up Payout d d m m y y y y
Lumpsum Payment
Interest on Lumpsum Payment
Monthly Top-Up Amount
DR Amount on Admissible Payout

Arrears on monthly Top-Up and applicable DR upto

Date of Commencement of monthly Top Up

Interest on Arrears (if Applicable)

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Ver 1.0 Mar. 2025 FORM B2
Signature & Name of PAO :

PAO Name PAO Registration No.

Date: Place:

Authorising the release of benefits upon receipt of UPS payout Order after due Verification

Authorised Signatory
NPS Trust

Date: Place:

Instructions to fill the form

1. All fields are mandatory, unless marked with Asterisks.
2. Please fill the details of the subscriber as per the service records.
3. Please give details of DDO, PAO, Department/Ministry of the office from where you retired.
4. Any one of the 5 KYC documents may be provided. In case of online filling of the form Aadhar Number or CKYC ID may be provided.
5. The current address shall be as per the KYC document provided. In case there is change in the current address, the concerned KYC documents is to be
updated first.
6. The mobile number and e-mail id of the claimant shall be verified separately by sending an OTP or a link as may be applicable.
7. The field of date of joining in Central Govt regular service shall be captured from the CRA system, however, in case of any change, it shall be editable
by the subscriber and duly verified by DDO.
8. In case, Aadhaar number is being given for legally wedded spouse, only the last four digits of the Aadhaar number may be provided.

List of Documents to be attached with this form

By Claimant:
i. Photocopy of the first page of Pass Book/Bank Statement or cancelled cheque of the Bank Account or any other bank document showing the name and
account details of Account Holder, in which the payout is to be credited.
ii. Copy of PAN Card of claimant.
iii. KYC documents of claimant.
iv. One joint photograph.
v. Specimen signature of claimant.

By DDO:
i. Copy of the document containing employment details verified by HOO.
ii. Copy of the signed Form by subscriber (in case the form submitted by subscriber in physical mode).

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