Request for Activation of National Pension System Tier-II – Tax Saver (NPS-TTS)

For Central Government employees only

To,
National Pension System
Dear Sir/Madam,

I hereby request that I would like to activate NPS – Tier II Tax Saver account in my name as per the particulars given below. I understand that
the contribution made under this scheme shall have a lock in period of three years from the date of credit of amount to the specified account.

Name* KRANTHI KUMAR MOGALIPURI

PRAN* 110032373262

PAN* AUVPM9055A

Name of the Pension Fund (Please select only one) Please Tick ()

LIC Pension Fund Limited √

SBI Pension Funds Private Limited

UTI Retirement Solutions Limited √

Pension Fund*
ICICI Prudential Pension Funds Management Company Limited

Kotak Mahindra Pension Fund Limited √

HDFC Pension Management Company Ltd

Birla Sunlife Pension Management Limited

2 Nomination Same as Tier I account √ If not, please provide details below.

Name of the Nominee

Relationship Date of Birth (In case of Minor)

Nominee’s Guardian Details (in case of a minor)

Date:

Place:

3 Employment Details

Employee ID

Department

PAO / DTO Name

Ministry

4 Declaration by Subscriber

Tier II - Tax Saver Consent

√ Tier II Tax Saver account will be activated. The amount you contribute will be locked for the period of 3 years. You will be having tax benefits on your
investment. A Pension Fund Manager (PFM) will be assigned on account creation against which you can make your contribution

Signature/Thumb Impression* of Subscriber

(* LTI in case of male and RTI in case of females)

Authorization by Office or by Point of Presence

Signature of the Authorized person Rubber Stamp of the Office

(In the box above) (In the box above)

Registration number of DDO/PAO / POP issued by CRA

Form submitted using OTP Authentication (through Email

and Mobile)

14-08-2022 17:10:36
Notes:

1 A copy of PAN to be submitted.

2 You can nominate up to a maximum of 3 nominees and if you desire so please fill in Annexure III (Additional Nomination Form) separately.
 Annexure III to eNPS Form
ADDITIONAL NOMINATION FORM -TIER II

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proceeds are withdrawn is to be provided hereunder (Please refer instruction no: 5).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, KRANTHI KUMAR MOGALIPURI hereby nominate the person (s) mentioned below who is/are
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

JUI

Middle Name Middle Name Middle Name

Last Name Last Name Last Name

BANERJEE

2. Present Communication address of the nominees:

Address of 1st Nominee Address of 2nd Nominee Address of 3rd Nominee

1103, BALAJI SYMPHONY

SUKAPUR

NEW PANVEL

3. Date of Birth* (Only in case of a minor):

1st Nominee 2 6 / 0 2 / 1 9 8 3 2nd Nominee 3rd Nominee

4. Relationship with the Nominee:

1st Nominee 2nd Nominee 3rd Nominee

W I F E

5. Percentage Share:

1st Nominee 1 0 0 % 2nd Nominee % 3rd Nominee %

6. Nominee’s Guardian Details (Only in case of a minor):

1st Nominee 2nd Nominee 3rd Nominee

First Name First Name First Name

Middle Name Middle Name Middle Name

Last Name Last Name Last Name

Signature/ Thumb Impression* of the Subscriber

Date of Registration:

*Note: Left thumb impression in case of illiterate male Subscriber and Right thumb impression in case of illiterate female subscriber must be obtained.