Annexure CS-S2 (To avoid mistake(s), please read the accompanying instructions carefully before filling up the form)

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Request For Change/Correction in Subscriber Master details And/Or Reissue of I-Pin/T-Pin/PRAN Card

PRAN is mandatory. Fill only the field(s)which is/are to be modified with the reviseddetails.
I hereby request for the following details for the change. (Please tick ) Change or Correction in name Changes or Correction in Nomination details Reissue of I PIN and/or T PIN Permanent Retirement Account Number *: I hereby submit the following details of change. (Please tick the box on left margin of appropriate row where change/correction is required and provide the details in the corresponding rows.) Changes or Correction in other Personal details Reissue of PRAN Card

Section A:

Change in Personal Details (Please refer to Sr. No.1 to 5of the instructions for supporting document)

Change or Correction in Name (* Indicates Mandatory Field)

1. Full Name (Full expanded name: Initials are not permitted) Please Tick as applicable First Name * Middle Name Last Name Shri Smt. Kumari

If the correction in the name to be made in Hindi, Yes 2. Gender : Male D D M M Y Female Y Y Y

(Please provide the details in the annexure on Page No. 7)

3. Date of Birth

(Please refer to Sr. No.3 of the instructions for supporting document)

4. PAN 5. Category (Please tick () any one): Government 6. Fathers Full Name: First Name * Middle Name Last Name Private Sector

(PAN should be supported by copy of PAN card) Self Employed NRI / Others

In case of changes in details pertaining to the point 1 or 3 or 6, CRA shall reprint the PRAN card and shall send the same to the subscriber. This will be charged by CRA. 7. Present Address* (NRIs may please refer to Sr. No. 5 of the instructions): Flat/Unit No, Block no. Name of Premise/Building/Village Area/Locality/Taluka District/Town/City State / UnionTerritory Country Pin Code

Annexure CS-S2 8. Permanent Address*:If same as above, Please Tick Flat/Unit No, Block no. Name of Premise/Building/Village Area/Locality/Taluka District/Town/City State / UnionTerritory Country else,

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Pin Code

9. Phone No. STD Code 10. Mobile No. 11. Email ID Phone No.

12. Do you want to subscribe to SMS Alerts (To be made available later, on a chargeable basis): 13. Subscribers Bank Details:(please refer to Sr. No. 6 of instruction) You want to change Bank details of: Tier I Tier II

Yes

No

(In case you want to change bank details in both Tier I & Tier II Account, tick both check box)

Tier I Account:
Bank A/c Number Bank Name Bank Branch Bank Address

Savings A/c

Current A/c

Pin Code Bank MICR Code IFS code (Wherever applicable)

Tier II Account: If same as above for Tier I Yes

Savings A/c Bank A/c Number Bank Name Bank Branch Bank Address Current A/c

OR,

Pin Code Bank MICR Code IFS code (Wherever applicable)

Annexure CS-S2

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Section B - Subscribers Nomination Details (Please refer to Sr. No.7 and 8 of the instructions)
You want to change Nomination details of: Tier I Tier II

(In case you want to change nomination details in both Tier I & Tier II Account, tick both check box)

Tier I Account:
1. Name of the Nominee: 1st Nominee First Name* 2nd Nominee First Name * First Name* 3rd Nominee

Middle Name

Middle Name

Middle Name

Last Name

Last Name

Last Name

2. Date of Birth (In case of a minor): 1st Nominee 3. Relationship with the Nominee: 1st Nominee*

2nd Nominee

3rd Nominee

2nd Nominee*

3rd Nominee *

4. Percentage Share: 1st Nominee*

% 2nd Nominee *

3rd Nominee*

5. Nominees Guardian Details (in case of a minor): 1st Nominees Guardian Details 2nd Nominees Guardian Details First Name First Name

3rd Nominees Guardian Details First Name

Middle Name

Middle Name

Middle Name

Last Name

Last Name

Last Name

Tier II Account:
1. Name of the Nominee: 1st Nominee First Name*

If same as above for Tier I Yes

2nd Nominee First Name *

else,
3rd Nominee First Name*

Middle Name

Middle Name

Middle Name

Last Name

Last Name

Last Name

2. Date of Birth (In case of a minor): 1st Nominee 3. Relationship with the Nominee: 1st Nominee*

2nd Nominee

3rd Nominee

2nd Nominee*

3rd Nominee *

4. Percentage Share: 1st Nominee*

% 2nd Nominee *

3rd Nominee*

Annexure CS-S2 5. Nominees Guardian Details (in case of a minor): 1st Nominees Guardian Details First Name 2nd Nominees Guardian Details First Name 3rd Nominees Guardian Details First Name

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Middle Name

Middle Name

Middle Name

Last Name

Last Name

Last Name

Certified that the above declaration has been signed before me by _______________________________________________________ after he / she has read the entries / entries have been read over to him / her by me and got confirmed by him / her. Also certified that the date of birth and employment details is as per employee records available with the Corporate.

Rubber Stamp of the Corporate Signature of the Authorised Person Designation of the Authorised Person : _________________________________ Name of the Corporate ______________________ Date : D D M M Y Y Y Y

Section D Request for Reissue of I-PIN/T-PIN

I hereby request you to reissue the following T-PIN I-PIN

Section ERequest for Reissue of PRAN card.

Reissue of T-Pin, I-Pin and reissue of PRAN card will be chargeable by the CRA.

I _________________________________________________________________ , the applicant, do hereby Declare that the information provided above is true to the best of my knowledge & belief. Date : D D M M Y Y Y Y Signature/Thumb Impression* of the Subscriber

Annexure CS-S2

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To be filled by POP-SP
Copy of PAN card submitted : Yes No

Signature of Authorized Signatory Name : ___________________________________ Dsignation : ________________________________ Place : __________________ Date :
D D M M Y Y

POP-SP Seal

[To be filled by CRA/CRA-FC ]

Received by: ________________________________ Received at:_____________________________________ Acknowledgement Number (To be provided by CRA-FC) CRA-FC Registration Number: _______________________ Date:______________

Annexure CS-S2 INSTRUCTIONS FOR FILLING THE FORM

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a. This form is to be used for the purpose of change/correction in subscriber personal details, nominee details, reissue of I-Pin /T-Pin or reissue of PRAN card. b. The form is to be submitted at the POP-SP for carrying out the necessary changes. c. Form to be filled legibly in BLOCK LETTERS and in BLACK INK only. Please fill the form in legible handwriting so as to avoid errors in your application processing. Please do not overwrite. Corrections should be made by cancelling and re-writing and such corrections should be countersigned by the applicant. d. Please tick the box on the left margin of appropriate row where change/correction is required and provide the details in the corresponding row. Please strike off the remaining blank rows for which no change is requested. Each box, wherever provided, should contain only one character (alphabet/number/punctuation mark) leaving a blank box after each word. e. Details Marked with (*) are the mandatory fields. f. Mention 12 digits PRAN correctly. g. All dates Should be in DDMMYYYY Format h. Application incomplete in any respect and/or not accompanied by required documents is liable to be rejected. The application is liable to be rejected if mandatory fields are left blank. i. Reissue of T-Pin, I-Pin and reissue of PRAN card will be chargeable by the CRA. j. Subscribers are advised to retain the acknowledgement slip signed/ stamped by the POP-SP where they submit the application Subscribers Personal Details Sr. No. 1. Item No. Item Details Guidelines for Filling the Form

Section A Subscribers Personal Details In case of change in name please provide the requisite proof such as marriage certificate or Gazette copy of name change. 2. 2. Gender Please provide a copy of Gazette Notification supporting the change Please ensure that this matches with the Date of Birth as indicated in the document 3. 3. Date of Birth provided in support. Fund transfers by NRIs would be subject to regulatory requirements as prescribed by 4 5. Category RBI from time to time and FEMA requirements. An NRI subscriber would need to furnish an Indian address as present address for Present Address& communication and bank details within India. 5. 7& 8. Permanent Address All future communications will be sent to present address. List of documents accepted as proof of address is given below. The subscribers shall provide a cancelled cheque, the details of which should match 6. 13 Bank Details the bank details provided. Section B - Subscribers Nomination Details 1) Subscriber can nominate a maximum of three nominees. 2) Subscriber cannot fill the same nominee details more than once for same tier. 3) Percentage share value for all the nominees must be integer. Decimals/Fractional 7 1 to 4. Nomination Details values shall not be accepted in the nomination(s). 4) Sum of percentage share across all the nominees must be equal to 100. If sum of percentage is not equal to 100, entire nomination will be rejected. Nominees Guardian 8. 5. If a nominee is a minor, then nominees guardian details shall be mandatory. Details Illustrative list of documents acceptable as proof of identity and address No. Proof of Identity (Copy of any one) No. Proof of Address (Copy of any one) 1 School Leaving Certificate 1 Electricity bill^ 2 Matriculation Certificate 2 Telephone bill^ 3 Degree of Recognized Educational Institution 3 Depository Account Statement^ 4 Depository Account Statement 4 Credit Card Statement^ 5 Bank Account Statement / Passbook 5 Bank Account Statement / Passbook^ 6 Credit Card 6 Employer Certificate^ 7 Water Bill 7 Rent Receipt^ 8 Ration Card 8 Ration Card 9 Property Tax Assessment Order 9 Property Tax Assessment Order 10 Passport 10 Passport 11 Voters Identity Card 11 Voters Identity Card 12 Driving License 12 Driving License 13 PAN Card Certificate of address signed by a Member of Parliament or Certificate of identity signed by a Member of Parliament or 13 Member of Legislative Assembly or Municipal Councilor or 14 Member of Legislative Assembly or Municipal Councilor or a a Gazetted Officer. Gazetted Officer. Note: 1) Proof of Address mentioned in Sr. No. 1 to 7 (^) should not be more than six months old on the date of application. 2) You are required to bring original documents & two self-attested photocopies (Originals will be returned over-thecounter after verification) 1. Full Name GENERAL INFORMATION FOR SUBSCRIBERS a) b) c) For any further clarification please refer to the PFRDA website www.pfrda.org.in or call on our toll free no. 1800110708 The Subscriber can obtain the status of his/her application from the CRA website or through the respective employer. For more information Visit us at http://www.npscra.nsdl.co.in Call us at 022-24994200 e-mail us at [email protected] Write to: Central Recordkeeping Agency, National Securities Depository Limited, 4th Floor, A Wing, Trade World, Kamala Mill s Compound, Senapati Bapat Marg, Lower Parel (W), Mumbai - 400 013.