Annexure S1

Page 1

Application for Allotment of Permanent Retirement Account Number (PRAN)

(To avoid mistake(s), please follow the accompanying instructions and examples carefully before filling up the form)

To affix recent

Acknowledgement No.

Coloured photograph

(3.5 cm 2.5 cm)

(To be filled by FC)

Permanent Retirement Account Number :

(To be filled by FC after PRAN generation )

Sir/Madam,

I hereby request that a permanent retirement account number be allotted to me.

I give below necessary particulars :

Section A - Subscribers Personal Details

( * Indicates Mandatory Field)

Signature/Left Thumb Impression

of Subscriber in black ink

1. Full Name (Full expanded name: initials are not permitted)

Please Tick as applicable,

Shri

Smt .

Kumari

First Name *

Middle Name

Last Name

2. Gender * Please Tick

Male

Female

3. Date of Birth *

4. PAN

DM
MY
YY

Y (Date of Birth to be Certified by DDO)

5. Fathers Full Name:

First Name *

Middle Name

Last Name

6. Present Address:

Flat/Unit No, Block no. *

Name of Premise/Building/Village

Area/Locality/Taluka

District/Town/City *

State / Union Territory *

Country *

Pin Code *

7. Permanent Address:
If same as above, Please Tick

else,

Flat/Unit No, Block no. *

Name of Premise/Building/Village

Area/Locality/Taluka

District/Town/City *

State / Union Territory *

Country *

Pin Code *

8. Phone No.

STD Code

Phone No.

9. Mobile No.

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10. Email ID

11. Subscribers Bank Details : (Please refer instruction no. 4)

Savings A/c

Current A/c

Bank A/c Number*

Bank Name*

Bank Branch*

Bank Address*

Pin Code*

Bank IFS Code

(If IFS code is not available, then provide MICR)

Bank MICR Code

Declaration by subscriber for Bank details: At present, I do not have a Bank account. However, I confirm to provide the requisite Bank
account details within six months or on opening of Bank account whichever is earlier to the associated nodal office for updating the same in CRA system.

(Please tick () in case, Bank details are not available)

12. Value Added Services:

No

ii) Email Alert:

No

I _____________________________________________________________ , the applicant, do hereby declare that

Date :
Signature/Left Thumb
D

D M M Y

Y Y Y
Impression of Subscriber

Section B - Subscribers Employment Details to be filled and attested by DDO (All Details are Mandatory)

1. Date of Joining

2. Date of Retirement

DDM M YYYY

DDM MY YYY

3.
PPAN

(Please refer to instructions No.5.)

4.
Group of the Employee (Please Tick)
Group A

Group B

Group C

Group D

Office

Department

Ministry

8. DDO Registration Number

9. PAO/CDDO Registration Number

(Please refer to

10. Basic Salary

instructions No.6.)

11. Pay Scale

Certified that the above declaration has been signed / thumb impressed 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 Department.

Signature of the Authorised Person

Rubber Stamp of the DDO

Designation of the Authorised Person : _________________________________

Name of the DDO ______________________

Date :

D D M M Y Y Y Y
Department / Ministry _______________________

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Section C - Subscribers Nomination Details (* Indicates Mandatory Field for nominee)

1. Name of the Nominee *:

1st Nominee

2nd Nominee

3rd Nominee

First Name *

First Name *

First Name *

Middle Name

Middle Name

Middle Name

Last Name

Last Name

Last Name

2. Date of Birth (In case of

2nd Nominee

3rd Nominee

3. Relationship with the Nominee*:

1st 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

First Name *

First Name *

First Name *

Middle Name

Middle Name

Middle Name

Last Name

Last Name

Last Name

6. Conditions rendering nomination invalid:

1st Nominee

2nd Nominee

3rd Nominee

Section D - Subscriber Scheme Details

1st Scheme

2nd Scheme

3rd Scheme

Pension Fund Managers Name/Code

Pension Fund Managers Name/Code

Pension Fund Managers Name/Code

Scheme ID No./Name

Scheme ID No./Name

Scheme ID No./Name

Percentage Share

Percentage Share

Percentage Share

Section E - Declaration

I understand that there would be PFRDA approved Terms and Conditions for Subscribers on the CRA website governing I-Pin (to
access CRA / NPSCAN and view details) & T-pin. I agree to be bound by the said terms and conditions and understand that CRA may,
as approved by PFRDA, amend any of the services completely or partially without any new Declaration/Undertaking being signed.

I _________________________________________________________________ , the applicant, do hereby declare that what is stated above is true to the best of my
information & belief.

Date :

D M M Y Y

Signature/Left Thumb

Impression of Subscriber

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Y Y

Annexure S1

Page 4

INSTRUCTIONS FOR FILLING PRAN FORM

Form to be filled legibly in BLOCK LETTERS and in BLACK INK only.

Details Marked with (*) are the mandatory fields.

'Individual' Subscriber should affix a recent colour photograph (size 3.5 cm x 2.5 cm) in the space provided on the form. The photograph should not be stapled
or clipped to the form. (The clarity of image on PRAN card will depend on the quality and clarity of photograph affixed on the form.)

Signature /Left thumb impression should only be within the box provided in the form. The signature should not be on the photograph. If there is any mark on
the photograph such that it hinders the clear visibility of the face of the Subscriber, the application will not be accepted.

Thumb impression, if used, should be attested by a Magistrate or a Notary Public or a Gazetted Officer under official seal and stamp.

Sr.
Item No
Item Details
Guidelines for Filling the Form

No.

Section A - Subscribers Personal Details

1
3.
Date of Birth
All Dates Should be in DDMMYYYY Format

2
6.
Present Address
All future communications will be sent to present address.

3
8, 9, 10
Phone No., Mobile No,
It is advisable to mention either Telephone number or Mobile number or Email

& Email ID
id so that Subscriber can be contacted in future for any discrepancy.

For subscribers, the Bank details are mandatory. In case, Bank details are not

4
11
Subscribers Bank
available at the time of filling the form, subscriber has to accept the declaration for

Details
providing the Bank details within six months or on opening of Bank account

whichever is earlier.

Section B - Subscribers Employment Details

It is mandatory to fill the Subscribers Employment details in the application. The employment details should be filled by the respective DDO of the Subscriber
and should be verified by the Authorised Signatory.
DDO should ratify Overwriting / Striking off of any of the employment details.
5
3.
PPAN
Kindly provide the PPAN (Permanent Pension Account Number), if it has been

allotted to the subscriber by the concerned PAO.

PAO/CDDO Reg. No. and DDO Reg. No. are the unique Registration number

PAO/CDDO Reg. No.

6
8&9

CDDOs will register as both PAOs and DDOs.

& DDO Reg. No.

NCDDOs will register only as DDOs and obtain the PAO Reg. No. from their

respective PAOs.

Section C - Subscribers Nomination Details

Subscriber can nominate maximum of three nominees.

Subscriber can not fill the same nominee details more than once.

7
4.
Percentage Share
Percentage share value for all the nominees must be integer. Fractional value will not

be accepted.

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.

8
5.
Nominees Guardian
If a nominee is a minor, then nominees guardian details will be mandatory.

Details

Section D - Subscriber scheme details

If the Subscriber is unable to mention the Scheme details i.e. PFM Name, Scheme Name & Percentage Allocation he can contact the nearest Facilitation Centre
(FC) for information or the Subscriber can also search for the scheme details on [Link]

Subscriber can select maximum three schemes. Details of the schemes are available on

[Link]

9
Scheme
Subscriber can not fill the same scheme details more than once.

If a scheme name is filled in the form for scheme setup there must be a PFM name and percentage contribution

filled for that scheme.

If the Scheme details are not filled, default scheme as approved by PFRDA will be applicable

Scheme Contribution Value will be in terms of percentage. It cannot be in terms of amount.

10
Percentage Share
Percentage contribution value for all the schemes must be integer. Fractional value will not be accepted.

If the sum of contributions (in percentage) across all the schemes is not equal to 100, the balance will be allotted

to the default scheme approved by PFRDA.

GENERAL INFORMATION FOR PRAN SUBSCRIBERS

Subscribers can obtain the application form for PRAN in the format prescribed by PFRDA (Pension Fund Regulatory & Development Authority) from DDO or
can freely download from the CRA website ([Link] ).

The request for a reprint of PRAN card with the same PRAN details or/and changes or correction in PRAN data can be made by filling up 'Request
for change/correction in subscriber master details and/or re-issue of I-Pin/T-Pin/PRAN card or/and Request For change in signature and/or change
in photograph. The form is available from the sources mentioned in (a) above.

The Subscriber can obtain the status of his/her application from the CRA website or through the respective PAO/CDDO.
For more information

Visit us at [Link]

Call us at 022-24994200
e-mail us at [Link]@[Link]

Write to: Central Recordkeeping Agency, NSDL e-Governance Infrastructure Limited, 1 st Floor, Times Tower, Kamala Mills Compound, Senapati Bapat Marg,
Lower Parel (W), Mumbai - 400 013.

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