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Get Atal Pension Yojana Form

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 Place m y Signature/Thumb Impression of Subscriber LTI in case of male and RTI in case of female PROVISIONAL ACKNOWLEDGEMENT - SUBSCRIBER REGISTRATION FOR ATAL PENSION YOJANA APY SUBJECT TO REALISATION OF FUNDS Name of the Subscriber Bank account number Guaranteed Pension Amount Periodicity of Contribution Monthly Contribution Amount under APY Name of the Bank Receiving Officer s Name Date of Receipt of Application PERSONS BORN BEFORE 1ST JUNE 1975 ARE NOT ELIGIBLE Stamp and Signature of the Bank. ATAL PENSION YOJANA APY - SUBSCRIBER REGISTRATION FORM Administered by Pension Fund Regulatory and Development Authority To The Branch Manager BankBranch 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 / m m / y y y y Age Mobile No Aadhaar Email ID Married Yes No If married spouse name is mandatory Name of Spouse Nominee s Name Nominee s Relationship with the subscriber Additional Details in case nominee is a Minor Guardian s Name Whether beneficiary of other statutory social security schemes Whether Income Tax Payer 3. PENSION DETAILS Pension Amount Please tick Contribution Amount I hereby authorize the bank to debit my above mentioned bank account till the age of 60 for making payment Monthly under APY as applicable based on my age and the Pension Amount selected by me. If the transaction is delayed or not effected at all for insufficient banlance I would not hold the bank responsible. I also undertake in Rs. to deposit the additional amount together with penalty 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. Further I do not hold any pre-existing account under NPS* I understand that I shall be fully liable for submission of any false or incorrect information or documents. ATAL PENSION YOJANA APY - SUBSCRIBER REGISTRATION FORM Administered by Pension Fund Regulatory and Development Authority To The Branch Manager BankBranch 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..

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