Form-ISS (Ver 1.

4) Page 1

National Pension System (NPS) - Request for Subscriber Shifting

NSDL e-Governance Infrastructure Limited
(Please fill all the details in CAPITAL LETTERS & in BLACK INK only. All fields / sections marked in * are mandatory.)

Section A - General Information*(Mandatory for all sector Subscribers. Please tick the respective block which is applicable.)

I) Subscriber's Name *: POOJA KESHAV AHER

II) PRAN (Permanent Retirement Account Number) *: 110136698326

III) Existing PRAN association (Refer Instruction No. I)

a) Sector: * Central Government State Government All Citizens of India (UOS) Corporate Sector √

b) DDO / CBO / POP-SP Reg. No: * 6544871 DDO / CBO / POP-SP Name: * Accenture Solutions Private Limited

IV) Target PRAN association (Refer Instruction No. II)

a) Sector: * Central Government State Government All Citizens of India (UOS) √ Corporate Sector

b) DDO / CBO / POP-SP Reg. No: * 6276896 DDO / CBO / POP-SP Name: * ICICI BANK LTD Adalat Road Aurangabad

V) PAN

VI) Nomination Details*(Mandatory - You can nominate up to a maximum of 3 nominees and if you desire so please fill Additional
Nomination Form provided on Page 5&6. Please refer to Instruction No. VI.)

Nominee's Name: :

Relationship with the Nominee: Date of Birth (In Case of Minor):

Nominee’s Guardian Details (in case of a minor):

Section B - Additional information for Subscribers shifting to Government Sector

I. Employment Details (All Details are Mandatory):

[Subscriber's Employment Details to be filled and attested by DDO. Please refer to Instruction No. VII, VIII & IX]

a) Date of Joining: (dd/mm/yyyy) b) Date of Retirement: (dd/mm/yyyy)

c) Group of the Employee : A B C D

d) Office:

e) Department:

f) Ministry:
Form submitted using OTP Authentication (through Email
g) Basic Salary: and Mobile)

h) Pay Scale: 2023.01.27.12.20.11

II. Scheme Preference Details:Please submit Subscriber Scheme Preference details on Page 4.

Certified that the above declaration has been signed / thumb impressed before me by
_______________________________________________________________________________________________________________________________
POOJA KESHAV AHER
_______________ 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
employment details are as per employee records available with the Department

Signature of the Authorised Rubber Stamp of the DDO

Designation of the Authorised Name of the DDO

Date Department / Ministry

Form-ISS (Ver 1.4) Page 2

Section C - Additional information for Subscribers shifting to All Citizens of India (UOS) & Corporate Sector

I. Subscriber Scheme Preference*:

Do you wish to continue with the existing Pension Fund and Investment Option: Yes No (If ‘No, please submit details on Page

• If Subscriber is shifting to Corporate sector, applicable only if the target Corporate has given the option of selecting scheme

II. KYC details* (Applicable only if Subscriber is shifting from Government Sector. Refer Instruction No. X)

a) KYC document accepted for Identify

b) KYC document accepted for Address

c) Document accepted for Date of birth proof :

d) Existing Customer:

I/we hereby certify/confirm that POOJA KESHAV AHER

Shri/Smt/Kum................................................................................................................................................................................................................ is an existing
KYC verified customer.The above applicant is having an operative Bank/Demat/Folio/............................. account (specify nature of the account) having account
number/client ID ............................... maintained at .................................. branch/office. The KYC documents available with us for this customer/client matches

I/we hereby certify/confirm that

Shri/Smt/Kum................................................................................................................................................................................................................is not a ‘Basic

III. Employment Details*(Applicable if Subscriber is shifting to Corporate Sector. To be verified by the Corporate Office of the Subscriber.)

a) Date of Joining*: b) Date of Retirement*:

DDMMYYYY DDMMYYYY

c) Employee ID*: d) CHO Reg No*:

Certified that the above declaration has been signed / thumb impressed before me by
POOJA KESHAV AHER
_______________________________________________________________________________________________________________________________
_______________ 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
employment details are as per employee records available with the Corporate.

Signature of the Authorised

Designation of the Authorised

Rubber Stamp of the Corporate

Declaration (Applies to Subscribers across all sectors):

I agree to be bound by the terms and conditions for the target sector (in which my PRAN will belong after processing of this Intersector Shifting request) and
understand that CRA may, as approved by PFRDA, amend any of the services completely or partially without any new Declaration / Undertaking being signed.
Further, I agree to pay all the necessary charges, as applicable, of the target sector.

Date Signature/Left Thumb impression of Subscriber*

For Office use only (To be filled up by the officer accepting the form)

Received by: Nodal Office Registration Number:

Received at: Date: Time Stamp

Details verified by: Date: Time Stamp

Receipt Number issued by the receiving office (only for POP-SP)

Form-ISS (Ver 1.4) Page 3
INSTRUCTIONS FOR FILLING THE FORM
I. Details of the DDO / CBO / POP-SP with which the PRAN is currently associated.
II. Details of the DDO / CBO / POP-SP with which the PRAN will be associated after shifting.
III. Please quote the correct PRAN and attach a copy of the PRAN card.
IV. This form is to be used by the Subscriber only.
V. Sector for 'Existing PRAN association' and 'Target PRAN association can be the same only if a Subscriber is shifting from one State Government to another
State.
VI. In case of more than one nominee, percentage share value for all the nominees must be integer. Decimals/Fractional values shall not be accepted in the
nomination(s). 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.
VII. Employment details are to be captured in CRA system by the target PAO/DTO/DTA along with other details, if the Subscriber is shifting from UOS to
Central / State Government sector.
VIII. Nodal Office have to modify the employment details of the Subscriber after the shifting of the PRAN, in case of Subscriber Shifting from Central
Government to State Government or vice versa or across two State Governments, i.e, both existing and new PRAN association are Government Sectors.
IX. On execution of Subscriber Shifting request, Nodal Office shall ensure that the Subscriber is FATCA compliant in the CRA system (Applicable if subscriber
is registered on/after July 1, 2014).
X. Illustrative list of documents acceptable as proof of identity and address.

S.No Proof of Identity (Copy of any one) S.No Proof of Address (Copy of any one)
1 Passport issued by Government of India. 1 Passport issued by Government of India.
2 Ration card with photograph. 2 Ration card with photograph and residential address
3 Bank Pass book or certificate with Photograph. 3 Bank Pass book or certificate with photograph and residential
4 Certificate of the POP for an existing customer. 4 Certificate of the POP for an existing customer.
5 Voters Identity card with photograph and residential address. 5 Voters Identity card with photograph and residential address
6 Valid Driving license with photograph 6 Valid Driving license with photograph and residential address
Letter from any recognized public authority at the level of
Certificate of identity with photograph signed by a Member of
7 7 Gazetted officer like District Magistrate, Divisional commissioner,
Parliament or Member of Legislative Assembly
BDO, Tehsildar, Mandal Revenue Officer, Judicial Magistrate etc.
Certificate of address with photograph signed by a Member of
8 PAN Card issued by Income tax department 8
Parliament or Member of Legislative Assembly
Aadhar Card / letter issued by Unique Identification Aadhar Card / letter issued by Unique Identification Authority of
9 9
Authority of India India clearly showing the address
Job cards issued by NREGA duly signed by an officer of the State Job cards issued by NREGA duly signed by an officer of the State
10 10
Government Government
The identity card/document with address or letter of allotment of
Identity card issued by Central/State government and its accommodation issued by any of the following: Central/State
Departments, Statutory/ Regulatory Authorities, Public Sector Government and its Departments, Statutory/Regulatory
11 Undertakings, Scheduled commercial Banks, Public Financial 11 Authorities, Public Sector Undertakings, Scheduled Commercial
Institutions, Colleges affiliated to universities and Professional Banks, Financial Institutions and listed companies for their
Bodies such as ICAI, ICWAI, ICSI, Bar Council etc. employees. Pension or Family Pension Payment Orders issued
by Govt. Departments or PSU containing address.
Photo. Identity Card issued by Defence, Paramilitary and Police Latest Electricity/water/piped gas bill in the name of the
12 12
department's Subscriber / Claimant and showing the address (less than 2
Latest Telephone bill (landline & postpaid mobile) in the name
13 Ex-Service Man Card issued by Ministry of Defence to their 13 of the Subscriber / Claimant and showing the address (less
employees. than 2 months old)
14 Photo Credit card. 14 Latest Property/house Tax receipt (not more than one year old)
Existing valid registered lease agreement of the house on
15
stamp paper ( in case of rented/leased accommodation)
Note:
You are required to bring original documents & two self-attested photocopies for verification.
Form-ISS (Ver 1.4) Page 4

SUBSCRIBER SCHEME PREFERENCE:

(i). PENSION FUND SELECTION – (TIER I): Please read below conditions before opting for the choice of Pension Funds:

1. Government Sector: The following Pension Funds (PFs) will act jointly as default PFs, if choice is not exercised by the government employee/subscriber (a) LIC
Pension Fund Limited (b) SBI Pension Funds Pvt. Limited (c) UTI Retirement Solutions Ltd. In case of Central Autonomous Bodies (CAB)/ State Government
(SG)/State Autonomous Bodies (SAB) employees, selection made under this section needs to be ignored, if choice to employees is not notified by the respective
State Govt/Ministry. 2. All Citizens of India Sector: Subscribers have the option to choose the available PFs as per their choice in the table below. 3. Corporate
Sector: Subscribers shall have the option to choose the available PFs as per the below table in consultation with their respective Employer.

Name of the Pension Fund (Please select only one) Please Tick () only one Default Choice of Pension Funds

LIC Pension Fund Limited

Available in Government sector, if
SBI Pension Funds Private Limited employee/subscriber does not exercise
choice of PF
UTI Retirement Solutions Limited

ICICI Prudential Pension Funds Management Company Limited

Kotak Mahindra Pension Fund Limited

HDFC Pension Management Company Limited

Aditya Birla Sun Life Pension Management Limited

* Selection of 01 Pension Fund is mandatory for All Citizens subscriber

(ii). INVESTMENT OPTION [Please Tick () in the box given below showing your investment option].

Active Choice Auto Choice

Please note:

1. In case you select Active Choice fill up section (iii) below and if you select Auto Choice fill up section (iv) below.
2. In case you do not indicate any investment option, your funds will be invested in Auto Choice (LC 50).
3. In case you have opted for Auto Choice and fill up section (iii) below relating to Asset Allocation, the Asset Allocation instructions will be ignored and
investment will be made as per Auto Choice (LC 50).

(iii) ACTIVE CHOICE-ASSET ALLOCATION (To be filled up only in case you have selected ‘Active Choice’ the investment option)

Asset Class E C G A Total Note:1. Asset class E-Equity and related instruments; Asset class C-
(Cannot (Max up to (Max up to (Cannot Corporate debt and related instruments; Asset class G-Government Bonds
exceed 75%) 100%) 100%) exceed 5%) and related instruments; Asset Class A-Alternative Investment Funds
Specify % 100 % including instruments like CMBS, MBS, REITS, AIFs, Invlts. Etc.
Choices in Not In case of Government employee/subscriber the Active choice of Asset Allocation is
Not available Available
Govt sector available restricted to Asset Class 'G' only

Please note:

1. The maximum permitted Equity Investment is 75% of the total asset allocation.
2. The total allocation across E, C, G and A asset classes must be equal to 100%. In case, the allocation is left blank and/or does not equal 100%, the
application
shall be rejected.
(iv) AUTO CHOICE OPTION (to be filled up only in case you have selected the ‘Auto Choice’ investment option. In case, you do not indicate a choice of LC, your
funds will be invested as per LC 50.)

Life Cycle (LC) Please Tick () Choices in Govt

Funds Only One sector Note:
1. LC 75- It is the Life cycle fund where the Cap to Equity investments is 75% of the total asset
LC75 Not available 2. LC 50- It is the Life cycle fund where the Cap to Equity investments is 50% of the total asset
3. LC 25- It is the Life cycle fund where the Cap to Equity investments is 25% of the total asset
LC50 4. Govt. employee can exercise Auto Choice of Asset Allocation for LC 25 & LC 50 only
Available
LC25

Date: Place:

Name of Subscriber: POOJA KESHAV AHER Signature/Thumb Impression* of Subscriber in black ink (* LTI in
case of male and RTI in case of females)
Form-ISS (Ver 1.4) Page 5

ADDITIONAL NOMINATION FORM

The details of nominees to whom the outstanding pension wealth of the Subscriber is payable in case of the demise of the Subscriber before entire proceeds are
withdrawn is to be provided hereunder (Please refer instruction no: VI). Also, please note that in case of demise of the Subscriber after opting for deferred
withdrawal, all the outstanding pension wealth present in the NPS account of the Subscriber shall be withdrawn upon receiving the request and paid to the
nominees as mentioned in this form and the same would be treated as full and final discharge of the obligation.

I, POOJA KESHAV AHER hereby hereby nominate the person(s) mentioned below who
is/are member(s)/ of my family to receive the amount in my PRAN account under National Pension System in the event of my death.

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. Present Communication address of the Nominees*:

Address of 1st Nominee Address of 2nd Nominee Address of 3rd Nominee

3. Date of Birth* (Only in case of a minor):

1st Nominee 2nd Nominee 3rd Nominee

4. Relationship with the Nominee:

1st Nominee 2nd Nominee 3rd Nominee

5. Percentage Share:

1st Nominee % 2nd Nominee % 3rd Nominee %

6. Nominee’s Guardian Details (Only in case of a minor):

1st Nominee's Guardian Details 2nd Nominee's Guardian Details 3rd Nominee's Guardian Details

First Name First Name First Name

Middle Name Middle Name Middle Name

Last Name Last Name Last Name

Signature/ Thumb Impression* of the Subscriber

Dated this at
Form-ISS (Ver 1.4) Page 6

TO BE FILLED/ATTESTED BY POP-SP/DDO

Certified that the above declaration and nomination details has been signed / thumb impressed before me by
Sh/Smt/Ms.___________________________________________________________________________after he / she has read the
entries / entries have been read over to him / her by me and got confirmed by him / her.

Rubber stamp of the POP-SP/DDO Signature of the Authorised Person

POP-SP/DDO Registration Number 6276896 Designation of the Authorised Person :

(Allotted by CRA) ICICI BANK LTD Adalat

POP-SP/DDO Office Name

Date:

TO BE FILLED/ATTESTED BY POP/POP POP/POP-SP/PAO/DTO/DTA/PrAO Registration Number

SP/PAO/DTO/DTA/PrAO (Allotted by CRA):

Rubber Stamp of the POP/POP-SP/PAO/DTO/DTA/PrAO

Signature of the Authorised Person