Form For Withdrawal by Claimant Due To Death of Subscriber
Form For Withdrawal by Claimant Due To Death of Subscriber
I hereby apply for the payment of the accumulated pension wealth in NPS
Tier-I account of as per the relevant provisions of the PFRDA (Exits and withdrawals
under NPS) Regulations, 2015 as amended.
Tier II:- The entire accumulated pension wealth in Tier II account would be paid along with lumpsum withdrawal of
Tier I account.
I herewith give below the necessary details: Signature / Thumb Impression*
*In case of female right thumb Impression and in case of male left thumb Impression may be taken. of the Claimant / Guardian
2. PRAN*
3. Name of the Subscriber* First Middle Last
4. Subscriber Gender* Male Female
5. Maiden Name (In case of female married Subscriber) First Middle Last
6. Father's Name* First Middle Last
7. Marital Status of the Subscriber* Married Unmarried/Others
Spouse Name of the Subscriber (only if subscriber was married & First Middle Last
8.
Spouse is alive)
9. Spouse Gender (only if subscriber was married & Spouse is alive) Male Female
10. Date of Death of the Subscriber* DD / MM / YYYY
11. Date of Birth of the Subscriber (As in PRAN Card)* DD / MM / YYYY
12. Name of the Claimant* First Middle Last
13. Aadhar/VID
14. PAN of claimant*
15. CKYC Number
16. Are you a Politically Exposed Person (PEP)* Yes No
17. Are you related to a Politically Exposed Person (PEP)* Yes No
Do you have any history of conviction under any criminal proceedings
in India or abroad?* Yes No
18.
If Yes, please provide details
Address :
Section D - Claimant’s Annuity Details - (Please refer instruction No. 11 & 12) (Not to be filled in case of complete withdrawal)
Select Annuity Service Provider (please tick one of the below options as per your choice)
Bajaj Allianz Life Insurance Co. Ltd. Canara HSBC Oriental Bank of Commerce Life Insurance Co. Ltd.
HDFC Life Insurance Co. Ltd. ICICI Prudential Life Insurance Co Ltd.
IndiaFirst Life Insurance Co. Ltd. Kotak Mahindra Life Insurance Co. Ltd.
Life Insurance Corporation of India Max Life Insurance Co. Ltd.
SBI Life Insurance Co. Ltd. Star Union Dai-ichi Life Insurance Co. Ltd.
Tata AIA Life Insurance Co. Ltd.
Select Annuity Scheme (please tick one of the below options as per your choice)
Annuity for Life
Annuity for Life with return of purchase price on death
Annuity payable for life with 100% annuity payable to spouse on death of annuitant
Annuity payable for life with 100% annuity payable to spouse on death of annuitant with return on purchase of annuity
NPS-Family Income option (Default annuity)(Mandatory For Government Sector Subscriber)
Other (Please Specify)
Select Annuity Frequency: Please tick one of the below options as per your choice. (For Government Subscriber, annuity frequency is monthly only)
Monthly Quarterly Half Yearly Annual
*In case of female right thumb Impression and in case of male left thumb Impression may be taken
Section E - Subscriber’s Family Member Details* (To be filled in case claimant has selected NPS-Family Income option)
Family Member Details for providing annuity as chosen by the subscriber.
Note: In case of children being more than 3, please specify in an additional sheet.
$
Mandatory in case Claimant opts for NPS-Family Income option.
Declaration by the Claimant
I hereby declare and state that all the personal details provided by me in the form as above are true and correct to the best of my knowledge. I also agree
that NPS Trust / CRA shall not be held responsible/liable for any losses or delays that may arise due to provision of incorrect details including details
pertaining to bank account by me. Further, I authorize the National Pension System Trust(NPST)/ CRA to share informations pertaining to my withdrawal
application with the Annuity Service Providers for facilitating the purchase of annuity in applicable cases as is required under NPS.
Place:
Date: DD / MM / YYYY
Declaration when Proposal form is filled by person other than proposer/proposer signs in a vernacular language/proposer is illiterate
(Not to be filled in case of complete withdrawal)
I hereby state that I have read out and explained the contents of this proposal form and all other relevant I/We state that the product details, contents of
documents to the proposer in language, that he/she/they undertook that this form and relevant documents have been
he/she/they have understood the same and agree to abide by the terms and conditions of the resulting fully explained to me/us and that I/We have fully
policy and have affixed his/her/their signature/thumb impression on the proposal form in my presence. understood them. I/We certify that the replies in
the proposal form have been recorded as per
Signature of the person the information provided by me/us.
making the declaration
Date D D / M M / Y Y Y Y
Date D D / M M / Y Y Y Y
[As per Regulation 3(c) of PFRDA (Exits and Withdrawals) under Regulations, 2015]
(To be filled in case of complete withdrawal)
Request cum under taking form for withdrawal of total pension wealth due to death of Subscriber and/or where the total pension wealth is equal to
or less than Rs. 2,00, 000/- in case of government sector Subscriber
Date :
*Signature/Thumb Impression of the Claimant
Place : (Signature of Guardian in case the Claimant is a minor)
*In case of female right thumb Impression and in case of male left thumb Impression may be taken.
Date D D / M M / Y Y Y Y
Rubber Stamp of the DDO/POP-SP/NLCC Signature of the DDO/POP-SP/NLCC Registration No. of DDO/POP-SP /NLCC
Date D D / M M / Y Y Y Y
*In case of female right thumb Impression and in case of male left thumb Impression may be taken.
Ver 1.1
7. Withdrawal preference: j Photo Identity card issued by Latest Electricity/Water bill in the
Defence, Paramilitary and Police name of the subscriber / Claimant
i.
The entire accumulated NPS wealth in the individual pension Departments. and showing the address (Less
account of the deceased subscriber shall be paid as lump sum to the than 6 months old).
nominee(s)/legal heir(s). k Ex-Service Man Card issued Latest Telephone bill in the name
by Ministry of Defence to their of the subscriber/ Claimant and
ii. Claimant is not required to fill Section D, Section E and Declaration employees. showing the address (less than 6
by Proposer if Claimant opts for Complete Withdrawal or Claimant months old).
opts for Lump Sum Withdrawal only.
l Photo credit Card. Latest property/house Tax
iii. In case nominee is a minor, the form shall be filled up by the guardian. Receipt (not more than one year
old).
iv. The nominee or family member of the deceased subscriber have the
option to purchase any of the annuities available with the empanelled m – Existing Valid registered lease
agreement of the house on stamp
Annuity Service Providers (ASPs).
paper (in case agreement of the
v. If the nomination is not registered by the deceased subscriber before house on stamp paper (in case of
rented/leased accommodation).
his/her death, the accumulated pension wealth shall be paid to the
family members on the basis of the legal heir certificate issued by n Identity card issued by The identity card/document with
the Revenue Authorities of the State concerned or the Succession Central / State government address, issued by any of the
and its Departments, Statuary following:
Certificate issued by a court of competent jurisdiction.
Regulatory Authorities, Public
8. The nominee(s)/legal heir(s) need to provide his/her complete bank details Sector Undertakings, Scheduled Central/State Government
Commercial Banks, Public and its Departments, Statuary/
like name of the bank, branch, complete address of branch, account type Financial Institutions, Colleges Regulatory Authorities, Public
and IFSC otherwise the form may get rejected by CRA. Please make affiliated to Universities and Sector Undertakings, Schedules
sure there is no cutting or overwriting in this section. The lump sum payment Professional Bodies such as ICAI, Commercial Banks, Public
shall be directly credited to the bank account of the nominee(s)/legal ICWAI, ICSI, Bar Council etc. Financial Institution for their
Employees.
heir(s)thorough electronic mode of payment.
Ver 1.1
10.
The Nodal Office after verifying the completeness of the Withdrawal time and purchase price is returned to the nominee after the death
Form and supporting documents in all respects after signature/thumb of the spouse If the spouse predeceases the annuitant, payment
impression of nominee/ legal heir and declaration and attestation of the of annuity will cease after the death of the annuitant and purchase
authorised person at Nodal Office shall send at below mentioned address price is paid to the nominee.
for processing of the withdrawal claim for record keeping within 90 days Note:
from the date of approval: Please note the exit from NPS and purchase of annuity from empanelled
ASP are two separate processes. It is mandatory for subscribers
NPS Claims Processing Cell
to purchase annuity scheme from Annuity Service Providers (ASP)
Central Record Keeping Agency, empanelled by PFRDA. Post receipt of the form by ASP and completely
NSDL e-Governance Infrastructure Ltd, satisfying themselves of completeness of the form and KYC requirements,
1st Floor, Times Tower, annuity shall be issued to subscriber (applicable to government sector
Kamala Mills Compound, subscriber).
Senapati Bapat Marg, Lower Parel,
The more details on the availability of particular annuity scheme with an
Mumbai - 400013.
ASP and annuity quotes etc. are available on the CRA’s website as per
11. Annuity Service Providers link below:
There are 11 Annuity Service Providers empanelled by PFRDA for www.npscra.nsdl.co.in/annuity-service-providers.php
providing the annuity services to NPS subscribers as per the list provided ASP Scheme Details and Annuity Selection Matrix may change. Please
below (Name of the ASPs are given in an alphabetical order). visit CRA website before filling Annuity Details. The list of empanelment
Name of the ASPs, minimum age and minimum corpus required for of ASPs may undergo changes depending upon new empanelment of
annuity purchase ASPs by PFRDA from time to time.
The following are the variants that are available in India and with most of 13. The balance of the accumulated amount shall be paid as lump sum to the
the ASPs. Subscriber needs to select any of the below mentioned option nominee(s) or legal heirs, as the case may be, of such subscriber.
on the withdrawal form: 14. If the accumulated pension wealth in the permanent retirement account
1.
Annuity for life - On death of the annuitant, payment of annuity of the subscriber at the time of his death is equal to or less than two lakh
rupees, the nominee/legal heirs, has the option to withdraw the entire
ceases.
accumulated pension wealth by submitting request come undertaking
2.
Annuity for life with return of purchase price on death - On death
form without purchase of annuity. Upon exercise of this option the right of
of the annuitant, payment of annuity ceases and the purchase price is
the family members to receive any pension or other amounts under the
returned to the nominee
National Pension System shall extinguish.
3.
Annuity payable for life with 100% annuity payable to spouse on
15. The nominee/claimant claiming the lump sum amount needs to provide
death of annuitant - On death of the annuitant, annuity is paid to the
his/her complete bank details like name of the bank, branch, complete
spouse during his/her life time. If the spouse predeceases the annuitant, address of branch, account type and IFSC otherwise the form may
payment of annuity will cease after the death of the annuitant. get rejected by CRA. Please make sure there is no cutting attempt on
4. Annuity payable for life with 100% annuity payable to spouse and overwriting in this section. The lump sum payment shall be directly
on death of annuitant with return on purchase of annuity - On credited to the bank account of the nominee/claimant through electronic
death of the annuitant, annuity is paid to the spouse during his/her life mode of payment.