ATAL PENSION YOJANA (APY) -

ACCOUNT CLOSURE FORM

(VOLUNTARY EXIT)
To,
The Branch Manager,
Boyad. Branch
Branch
Dear SirMadam,
hereby request that my account opened under Atal
details are as follows: Pension Yojana may be closed. The
PRAN

Name of PRAN Holder

Savings Bank Account for credit of

Corpus (Pension Wealth)*
Reason for Closure (Please select)
Not ableto pay contributions Require Funds urgently
Others (specify :
" In casea:subscrlber, who has avallad
before the age 60, helshe ahall only be Government
refunded
co-contribution undar APY, choos0s to
the contrlbutlons made by him/her to APY,voluntarily exit APY
achual income earned on hlelhor contrlbutlons (after deducting th0 along with the net
etc. chargess. wheroas, te Govemment co-contribution, and tha account malntonanco, assets manaceonent
Income arned on the Government co
çontributton, shall not be returned to such subscribers.

Date.. 02)\202
Place:Signature/Thumb improselon of Subscriber
. ("LTIin çase of male and RTI Incase offemale)

240.