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Atal Pension Yojana (Apy) - Subscriber Registration Form

This document contains a registration form for the Atal Pension Yojana (APY) pension program administered by PFRDA. The form collects personal details like name, date of birth, bank account, and nominee details. It also asks the applicant to select a guaranteed monthly pension amount of either Rs. 1000, 2000, 3000, 4000, or 5000 and the periodicity of contributions to be made (monthly or quarterly). By signing, the applicant agrees to the terms and conditions of APY and authorizes automatic debits from their bank account for contributions until age 60. Upon acceptance, the bank issues an acknowledgment with details of the PRAN number, selected pension amount, contribution periodicity and amount.

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Borah Pranjal
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334 views1 page

Atal Pension Yojana (Apy) - Subscriber Registration Form

This document contains a registration form for the Atal Pension Yojana (APY) pension program administered by PFRDA. The form collects personal details like name, date of birth, bank account, and nominee details. It also asks the applicant to select a guaranteed monthly pension amount of either Rs. 1000, 2000, 3000, 4000, or 5000 and the periodicity of contributions to be made (monthly or quarterly). By signing, the applicant agrees to the terms and conditions of APY and authorizes automatic debits from their bank account for contributions until age 60. Upon acceptance, the bank issues an acknowledgment with details of the PRAN number, selected pension amount, contribution periodicity and amount.

Uploaded by

Borah Pranjal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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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*
Bank Name* Bank Branch*
2. PERSONAL DETAILS:
Name of Applicant in full 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
Periodicity of contribution (Please tick(√)) * Monthly Quarterly Half Yearly
Pension Amount (Please tick(√)) * 1000 2000 3000 4000 5000
Contribution Amount I hereby authorize the bank to debit my above mentioned bank account till the age of 60 for making payment
(Monthly/Quarterly ) under APY as applicable based on my age and the Pension Amount selected by me. If the transaction is
(in Rs.) delayed or not effected at all for insufficient banlance, I would not hold the bank responsible. I also
undertake to deposit the additional amount together with overdue interest thereon.
(To be filled by the Bank)
Declaration & Authorization by all subscribers
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 immediately inform the bank of any change in the above information furnished by
me. 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 d d m m y y y y Signature/Thumb Impression* of
Place Subscriber (* 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:
PRAN Number
Guaranteed Pension Amount
Periodicity of Contribution (Tick one) Mo n t h l y Q u a r t e r l y
Monthly Contribution/ Quarterly 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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