Ver 1.

NATIONAL PENSION SYSTEM (NPS)

Exit from National Pension System Due to Superannuation/Incapacitation

Claim ID Acknowledgement No
recent colour
To, photograph of
NPS Trust. 3.5 cm × 2.5 cm size /
Passport size
Sir/Madam,

I hereby apply for the payment

of the accumulated pension wealth in my NPS Tier-I account 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 Subscriber

Sr.No Particular Remarks

Section A - Subscriber’s Personal Details
1. Govt. Sector
Subscriber Sector* 2. All India citizens/corporate
3. NPS Lite / GDS
Organisation Name* (PAO/DTO/CHO/NLAO Name)
1.
2. PRAN*
3. Full Name* First Middle Last
4. Subscriber Gender* Male Female
5. Father's Name* First Middle Last
6. Marital Status* Married Unmarried/Others
7. Maiden Name (In case of female married subscriber) First Middle Last
8. Spouse’s Name* (only if subscriber is married & spouse is alive) First Middle Last
9. Spouse Gender* (only if subscriber is married & spouse is alive) Male Female
Date of Retirement / attaining 60 / 65 years of age / Discharge
10. DD / MM / YYYY
(In case of Incapacitation)*
11. Date of Birth (As in PRAN Card)* DD / MM / YYYY
12. Aadhar/VID
13. PAN*
14. CKYC Number
15. Are you a Politically Exposed Person (PEP)* Yes No
16. 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
17.
If Yes, please provide details
Mobile number* : +91
18. Contact details Alternate phone number :
E-mail ID* :
Subscriber’s full address with pin code*
19.
(Please refer instruction No. 9 for documents to be submitted)

Section B - Subscriber’s Bank Details - (Please refer instruction No. 7)

20. Bank Account Number*# :
21. Bank Name*
Bank Branch Name and Address : The monthly pension and lump
22.
all the details carefully.*
IFSC Code (attach a cancelled cheque leaf or copy of bank
23.
*
Fields marked with * are mandatory. # Should be same where last salary credited in case of Government sector/Corporate sector subscribers

Section C - Subscriber’s Withdrawal Details - (Please refer instruction No. 8)

On attaining superannuation or attaining 60 / 65 years of age or superannuation due to Incapcitation
a) Would you like to withdraw full amount (if less than or equal to 2 Lakh/1 Lakh (NPS Lite)) Yes No
or
b) Would you like to have normal Withdrawal (Lump sum & Annuity Withdrawal )# Yes No
or
#
c) Would you like to opt for Withdrawal of Deferred Corpus : Yes No
Lump Sum Withdrawal Annuity Withdrawal
or
d) Would you like to opt for Phase withdrawal : Yes No
Enter Withdrawal amount Withdraw total holdings
#
Please provide the Percentage of corpus that you wish to opt for lump sum withdrawals and purchase of annuity
% of corpus opted for lump sum withdrawal Percentage of corpus opted for purchase of Total (100%)
(Max 60%) annuity (Min 40%)
Ver 1.4
Section D - Subscriber’s Annuity Details -
of Deferred Lump Sum Corpus & phase 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.
Tata AIA Life Insurance Co. Ltd. Star Union Dai-ichi Life Insurance Co. Ltd.

Date : DD / MM / YYYY * Signature/Thumb Impression of the Subscriber

*In case of female right thumb Impression and in case of male left thumb Impression may be taken

Section E - Subscriber’s Nomination Details*

Nomination Details: Applicable to those eligible sums as per regulations. Name :
Nominee must be immediate family member of subscriber (Spouse, Relationship : Percentage Share:
Children etc) in general except for exceptions as provided in Regulations.
Date of Birth of Nominee (Only in case of minor) : DD / MM / YYYY
Guardian Name (Only in case of minor)
Guardian DOB (Only in case of minor)
Address & Contact Details :

Guardian Signature (Only in case of minor)

Name :
Relationship : Percentage Share:
Date of Birth of Nominee (Only in case of minor) : DD / MM / YYYY
Guardian Name (Only in case of minor)
Guardian DOB (Only in case of minor)
Address & Contact Details :

Guardian Signature (Only in case of minor)

Name :
Relationship : Percentage Share:
Date of Birth of Nominee (Only in case of minor) : DD / MM / YYYY
Guardian Name (Only in case of minor)
Guardian DOB (Only in case of minor)
Address & Contact Details :

Guardian Signature (Only in case of minor)

Section F - Subscriber’s Family Member Details*

Family Member Details for providing annuity as chosen by the subscriber.
Sr.No Details Full Name Aadhar/VID PAN$ Date of Birth$
1. Spouse$ DD / MM / YYYY
2. Dependent Mother (if living) DD / MM / YYYY
3. Dependent Father (if living) DD / MM / YYYY
4. Child 1 (if living) DD / MM / YYYY
5. Child 2 (if living) DD / MM / YYYY
6. Child 3 (if living) DD / MM / YYYY
Note: In case of children being more than 3, please specify in an additional sheet.
Fields marked with* are mandatory.
$
Mandatory in case subscriber opts for Joint Life Policy & NPS-Family Income option.
Ver 1.4
Declaration by the Subscriber
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.

Date : DD / MM / YYYY * Signature/Thumb Impression of the Subscriber

*In case of female right thumb Impression and in case of male left thumb Impression may be taken.

Declaration by the Proposer:

I hereby declare that the foregoing statements and informations have been given by me after fully understanding the questions and the annuity options and
the same are true, accurate and complete in every manner and respects and that I have not withheld or omitted to give any material information. I understand
and agree that the statements in this proposal constitute warranties. I do hereby agree and declare that these statements and this declaration shall be the
basis of the contract of assurance between me and Annuity Service Provider (Company) and that if there be any misstatement or suppression of material
information or if any untrue statement is contained therein or in case of fraud by me, which comes to the knowledge of the company at any future point of time,
the said contract shall be treated as per provisions of Section 45 of the Insurance Act 1938 or any other applicable provisions as amended from time to time.
I also understand and agree that the company shall additionally levy or recover all the applicable taxes like service tax, surcharges, cess etc. from the
premiums which are necessitated by various enactments of central and/or state legislatures from time to time.
I understand that the contract will be governed by the provisions of the Insurance Act 1938, and other applicable laws in India and that the contract will not

conditions contained in the contract. I also agree that the amount held in proposal/policy deposit shall not earn any interest.
I further state that the product features and terms and conditions of the policy have been thoroughly explained to me and having understood, I consent to
the same.

I also acknowledge and agree that the funds will not be returned to me in case I choose to cancel the policy under free look period. These funds will be
payable by company directly to any other annuity scheme chosen by me which is authorized and approved under the prevalent regulations and applicable
rules. Further, no interest will be payable to me on the funds held during this transition period.
I hereby authorize company to send information and servicing related communication regarding this proposal or resulting policy through Email/SMS/Phone
Call.

Signature / Left thumb Impression of the

Signature of the witness Proposer

photograph

Name and Address of witness:

Place:

Date: DD / MM / YYYY

I hereby state that I have read out and explained the contents of this proposal form and all other I/We state that the product details, contents of
relevant documents to the proposer in language, he/she/they have this form and relevant documents have been
understood the same and agree to abide by the terms and conditions of the resulting policy and have fully explained to me/us and that I/We have fully
understood them. I/We certify that the replies in
the proposal form have been recorded as per
the information provided by me/us.

Signature of the person

making the declaration

Name & Address

Signature / Left thumb Impression of the

Proposer

Place Date: DD / MM / YYYY

Ver 1.4

TO BE FILLED/ATTESTED BY DDO/PAO/POP-SP

maintained by us.The complete information provided in this form including declaration and nomination details have been provided by the Subscriber
Sh/Smt/Ms. after he / she having read the entries / entries have been

2. That all the contributions with respect to the Subscriber’s NPS contribution and employer contribution have been transferred in to the PRAN of the

of disability (in case of Non Govt. Subscriber) [applicable in case of Withdrawal due to incapacitation only]

Rubber Stamp of the DDO/POP-SP/NLCC

Signature of the Authorised Person

DDO/POP-SP/NLCC Registration Number

Designation of theAuthorised Person :

Date D D / M M / Y Y Y Y

Rubber Stamp of the DTO/PAO/POP/Aggregator

Signature of the Authorised Person

DTO/PAO/POP/ Aggregator Registration Number

Designation of the Authorised Person :

Date D D / M M / Y Y Y Y

[As per Regulation 3(a)/4(a)/5(a) of PFRDA (Exits and Withdrawals) under the Regulations, 2015]

Request cum under taking form for withdrawal of total pension wealth at superannuation and where the total pension wealth is equal to or less
than Rs. 2,00,000/- for NPS subscriber and Rs. 1,00,000/- in case of NPS lite Subscriber respectively

I, S/D/W/o , aged about years,

residing at

1. That I am a Subscriber of National Pension System, holding PRAN

(Rs. 1,00,000/- for NPS Lite), I understand that I am eligible to opt for withdrawal of the total pension wealth under NPS rules/guidelines,

I also certify that all the details provided in the form above are true and correct to the best of my knowledge

Date : DD / MM / YYYY * Signature/Thumb Impression of the Subscriber

*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

Rubber Stamp of the Signature of the Registration No. of

DTO/PAO/POP/Aggregator DTO/PAO/POP/Aggregator DTO/PAO/POP/ Aggregator
Ver 1.4

INSTRUCTIONS FOR FILLING FORM

Superannuation or attaining 60 / 65 years of age

General Instructions: Government Sector subscribers)
ix. During deferment period, the account maintenance charges and
will not be allowed if NPS subscribers registered on or after July 1, 2014 including the charges payable to Central Record Keeping Agency,
are NOT FATCA compliant. Hence, subscribers are requested to provide Pension Fund, Trustee Bank and any other intermediary shall
continue to apply and shall be charged by deducting units from the
account
x. In case of Phased Withdrawal, Subscriber needs to purchase Annuity
2. As per amendments made under Prevention of Money-Laundering
(Maintenance of Records) Second Amendment Rules, 2017, Withdrawal xi. For more details of Annuity options, please refer to Instructions No. 12
not seeded into PRAN. Subscribers are requested to seed their Aadhaar 9. List of documents acceptable as Proof Identity and Address for exit under
and PAN into NPS account before initiating withdrawal request NPS (for all variants):-
(Aadhaar not mandatory till Hon’ble supreme court order) Sl. Proof of Identity (Copy of Proof of Address (Copy of
No. any one of the given below any one of the given below
and takes a print out of online form and submits it to the nodal documents) documents)
a Passport issued by Government Passport issued by Government
However, he/she has the option to submit the physical form to his nodal
of India. of India.
mode only. Physical forms submitted to CRA will not be processed. b Ration Card with Photograph. Ration card with photograph and
3b. Subscriber (other than government sector & Corporate) has an option to residential address.
initiate a self-authorization using Aadhaar. This facility will be available c
only if the NPS pension wealth is below threshold limit as prescribed with Photograph with photograph and residential
in PFRDA (Exits and Withdrawals under National Pension System) address.
Regulation 2015 or circular issued by the authority. d Voters Identity card with Voters Identity card with
photograph and residential photograph and residential
overwriting. address. address.
5. Fields marked with (*) are mandatory. e Valid Driving license with Valid Driving license with
6. Correct postal address, including the pin code should be provided. photograph. photograph and residential
7. Documents to be enclosed with withdrawal application form: address.
f PAN Card issued by income tax Letter from any recognized public
i. Copy of the Address proof
of the address provided on the withdrawal form. The address on the department. authority at the level of Gazetted
withdrawal form should match with address present on the address
proof. Divisional Commissioner, BDO,
ii. Copy of the Identity proof Tehsildar, Mandal Revenue
iii. Copy of PRAN card (Not required in case of Government Sector
Subscriber)If Copy of PRAN Card is not available, print out of g
photograph signed by a Member photograph signed by a Member
submission of the PRAN card. of Parliament or Member of of Parliament or member of
iv. Cancelled cheque (containing Subscriber Name, Bank Account Legislative Assembly. Legislative Assembly.
h Aadhar Card/letter issued by Aadhar Card/letter issued by
Containing Name, Bank Account Number and IFSC code, for direct
credit or electronic transfer. India. of India. Clearly showing the
8. Withdrawal preference: address.
i. Select the Withdrawal preference as Normal withdrawal or Complete i Job Cards issued by NREGA duly Job Cards issued by NREGA duly
Withdrawal (if accumulated NPS wealth is less than or equal to Rs. 2
lacs/Rs. 1 lacs (For NPS Lite Subscribers)). Government.
ii. If subscriber selects the Normal withdrawal option, he/she needs to
of the State Government.
sum and amount to purchase life annuity provided under Section C j Photo Identity card issued by Latest Electricity/Water bill in the
the Form. Defence, Paramilitary and Police name of the subscriber / Claimant
iii. If subscriber selects deferred withdrawal option, he/she can defer the Departments. and showing the address (Less
lump sum withdrawal amount up to 70 years of age while annuity than 6 months old).
purchase can be deferred up to 3 years from the date of attainment k Ex-Service Man Card issued Latest Telephone bill in the name
of superannuation. In case of deferment as well, the subscriber
by Ministry of Defence to their of the subscriber/ Claimant and
as Lump-sum and amount to purchase life annuity provided under employees. showing the address (less than 6
Section C of the Form. months old).
iv. In case of percentage of withdrawal is not provided by the subscriber, l Photo credit Card. Latest property/house Tax
a default 60% of the accumulated pension wealth shall be paid as Receipt (not more than one year
lump sum to the subscriber and rest 40% of the amount shall be old).
utilised for annuity purchase. m – Existing Valid registered lease
v. The subscriber needs to provide the Annuity details under Section agreement of the house on stamp
D-Annuity Details, in case of Normal withdrawal or Deferred paper (in case agreement of the
withdrawal. The selection of Annuity scheme and Annuity Service house on stamp paper (in case of
Provider is mandatory. rented/leased accommodation).
vi. The subscriber availing the complete withdrawal option (where the n Identity card issued by The identity card/document with
accumulated amount at superannuation is less than Rs. 2 lacs/ Central /State government address, issued by any of the
Rs.1 lacs (For NPS Lite Subscribers)) shall leave the Annuity Details
and its Departments, Statuary following:
up Request Cum Undertaking Form provided along with the Form. Regulatory Authorities, Public
Sector Undertakings, Scheduled Central/State Government
vii. In case of death of subscriber during deferment period of annuity
Commercial Banks, Public and its Departments, Statuary/
purchase, the deferred amount shall be paid as per PFRDA (Exits
and Withdrawal under National Pension System) Regulation, 2015 Financial Institutions, Colleges Regulatory Authorities, Public
Sector Undertakings, Schedules
viii. In case of death of subscriber during deferment period of annuity
purchase, the annuity shall be purchased by the spouse as Professional Bodies such as Commercial Banks, Public
ICAI, ICWAI, ICSI, Bar Council Financial Institution for their
under National Pension System) Regulation, 2015 (applicable for etc. Employees.
Ver 1.4
10. The subscriber needs to provide his/her complete bank details like name The following are the variants that are available in India and with most of the
of the bank, branch, complete address of branch, account type and ASPs. Subscriber needs to select any of the below mentioned option on the
IFSC otherwise the form may get rejected by CRA. Please make sure page 1 of the withdrawal form:
there is no cutting attempt on this section. The lump sum payment 1. Annuity for life - On death of the annuitant, payment of annuity ceases
shall be directly credited to the bank account of the subscriber through
electronic mode of payment. 2. Annuity for life with return of purchase price on death - On death of
the annuitant, payment of annuity ceases and the purchase price is returned
If there is any change in Bank Details and Address details, subscribers to the nominee.
are requested to update the same in CRA records prior to initiation of
online withdrawal request. At the time of initiation of online withdrawal 3. Annuity payable for life with 100% annuity payable to spouse on
request, updation of Bank Details and Address Details is not allowed. death of annuitant - On death of the annuitant, annuity is paid to the spouse
during his/her life time. If the spouse predeceases the annuitant, payment of
annuity will cease after the death of the annuitant.
Form and supporting documents in all respects after signature/thumb
impression of subscriber and declaration and attestation of the authorized 4. Annuity payable for life with 100% annuity payable to spouse on
death of annuitant with return on purchase of annuity - On death of the
keeping within 90 days from the date of approval: annuitant, annuity is paid to the spouse during his/her life time and purchase
price is returned to the nominee after the death of the spouse. If the spouse
NPS Claims Processing Cell, predeceases the annuitant, payment of annuity will cease after the death of
Central Record Keeping Agency, the annuitant and purchase price is paid to the nominee.
NSDL e-Governance Infrastructure Ltd, Note:
1st Floor, Times Tower,
Kamala Mills Compound, Senapati Bapat Marg, Please note the exit from NPS and purchase of annuity from empanelled
Lower Parel, Mumbai - 400013. ASP are two separate processes. It is mandatory for subscribers to purchase
annuity scheme from Annuity Service Providers (ASP) empanelled by
12. Annuity Service Providers PFRDA. Post receipt of the form by ASP and completely satisfying themselves
of completeness of the form and KYC requirements, annuity shall be issued
There are 11 Annuity Service Providers empanelled by PFRDA for providing to subscriber.
the annuity services to NPS subscribers as per the list provided below
(Name of the ASPs are given in an alphabetical order). The more details on availability of particular annuity scheme with an ASP
and annuity quotes etc. are available on the CRA’s website as per link below:
Name of the ASPs, minimum age and minimum corpus required for annuity
www.npscra.nsdl.co.in/annuity-service-providers.php
purchase
ASP Scheme Details and Annuity Selection Matrix may change. Please
Minimum Minimum
Annuity Service Provider Name
Age Corpus (Rs.) ASPs may undergo changes depending upon new empanelment of ASPs by
Bajaj Allianz Life Insurance Co. Ltd. PFRDA from time to time.
37 25,000
13. Default Annuity Scheme (Applicable in case of Government Sector
Canara HSBC Oriental Bank of Subscribers only)
45 2,25,000
Commerce Life Insurance Co. Ltd. The subscriber upon exit from NPS shall have to purchase annuity with a
HDFC Life Insurance Co. Ltd. 20 Any Amount minimum of 40% of the accumulated pension wealth which shall provide for
annuity for life of the subscriber and his or her spouse (if any) with provision
ICICI Prudential Life Insurance Co Ltd 30 Any Amount
for return of purchase price of the annuity and upon the demise of such
IndiaFirst Life Insurance Co. Ltd. 40 10,000 subscriber, the annuity be re-issued to the family members in the order
Kotak Mahindra Life Insurance Co. Ltd. 45 2,24,000 such annuity by utilizing the purchase price required to be returned under the
Life Insurance Corporation of India 30 50,000
covered) :
Max Life Insurance Co. Ltd. 50 2,50,000 (a) living dependent mother of the deceased subscriber;
SBI Life Insurance Co. Ltd. 18 50,000 (b) living dependent father of the deceased subscriber.
Star Union Dai-ichi Life Insurance Co. Ltd 45 1,00,000
price shall be returned to the surviving children of the subscriber and in the
Tata AIA Life Insurance Co. Ltd. 45 2,24,200 absence of children, the legal heirs of the subscriber, as may be applicable
However, the subscriber who does not wish to opt default option mentioned
above and wishes to choose the annuity contract of his choice from the
available annuity types or contracts with the annuity service providers may
choose an option as mentioned under instruction no.12 above.