Form-ISS (Ver 1.

4) Page 1

National Pension System (NPS) - Request for Subscriber Shifting

Protean eGov TechnologiesNSDL
Limited (formerly Infrastructure
e-Governance NSDL e-Governance
LimitedInfrastructure 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 *: _____________________________________________________________________________________________
(First Name) (Middle Name) (Last Name)

II) PRAN (Permanent Retirement Account Number) *:

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: *___________________________ DDO / CBO / POP-SP Name: *____________________________________________

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: *_______________________ DDO / CBO / POP-SP Name: *______________________________________

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: : _____________________________________________________________________________________________

(First Name) (Middle Name) (Last Name)

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

D D M M Y Y Y Y

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

(First Name) (Middle Name) (Last Name)

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:

g) Basic Salary:

h) Pay Scale:

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 _______________________________________________________
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 Person _________________________________________ Rubber Stamp of the DDO

Designation of the Authorised Person ____________________________ 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 4)

 If Subscriber is shifting to Corporate sector, applicable only if the target Corporate has given the option of selecting scheme preference to
the associated employees.

 If Subscriber is shifting from Government Sector, please submit Subscriber Scheme Preference details on Page 4.

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

a) KYC document accepted for Identify Proof:_______________________________________

b) KYC document accepted for Address Proof : _____________________________________

c) Document accepted for Date of birth proof : _____________________________________

d) Existing Customer:

I/we hereby certify/confirm that 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
the requirement for opening NPS account and are in compliance with PMLA Rules.

I/We further confirm that the Savings Bank a/c of Sh/Smt/Kum ................................................................................................ is not a ‘Basic Savings Bank
Deposit Account (applicable in case of Bank PoP).

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*:

D D M M Y Y Y Y D D M M Y Y Y Y

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

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 employment details are as per
employee records available with the Corporate.

.
Signature of the Authorised Person __________________________________

Designation of the Authorised Person __________________________________ 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
Bank Pass book or certificate with photograph and residential
3 Bank Pass book or certificate with Photograph. 3
address
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 Gazetted
Certificate of identity with photograph signed by a Member officer like District Magistrate, Divisional commissioner, BDO,
7 7
of Parliament or Member of Legislative Assembly 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 India
9 9
Authority of India clearly showing the address

Job cards issued by NREGA duly signed by an officer of Job cards issued by NREGA duly signed by an officer of the State
10 10
the State 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
Government and its Departments, Statutory/Regulatory Authorities,
Sector Undertakings, Scheduled commercial Banks, Public
11 11 Public Sector Undertakings, Scheduled Commercial Banks, Financial
Financial Institutions, Colleges affiliated to universities and
Institutions and listed companies for their employees. Pension or
Professional Bodies such as ICAI, ICWAI, ICSI, Bar
Family Pension Payment Orders issued by Govt. Departments or PSU
Council etc.
containing address.
Photo. Identity Card issued by Defence, Paramilitary and Latest Electricity/water/piped gas bill in the name of the Subscriber /
12 12
Police department’s Claimant and showing the address (less than 2 months old)
Ex-Service Man Card issued by Ministry of Defence to Latest Telephone bill (landline & postpaid mobile) in the name of the
13 13
their employees. Subscriber / Claimant and showing the address (less 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 stamp paper
15
( 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) Default Choice of Pension Funds
Please Tick (√) only one

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
(Cannot (Max up (Max up (Cannot C-Corporate debt and related instruments; Asset class G-
exceed 75%) to 100%) to 100%) exceed 5%) Government Bonds and related instruments; Asset Class A-
Alternative Investment Funds including instruments like CMBS,
Specify % 100% MBS, REITS, AIFs, Invlts. Etc.
Choices in Not In case of Government employee/subscriber the Active choice of Asset
Not available Available
Govt sector available Allocation is restricted to Asset Class 'G' only
Please note:
1. Upto 50 years of age, the maximum permitted Equity Investment is 75% of the total asset allocation.
2. From 51 years and above, maximum permitted Equity Investment will be as per the equity allocation matrix provided in Annexure A. The tapering off of
equity allocation will be carried out as per the matrix on date of birth.
3. 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.)

Please Tick Choices in

Life Cycle (LC) Note:
(√) Only Govt sector
Funds 1. LC 75- It is the Life cycle fund where the Cap to Equity investments is 75% of the total asset
One
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
Available 4. Govt. employee can exercise Auto Choice of Asset Allocation for LC 25 & LC 50 only
LC25

Date: Place:
Signature/Thumb Impression* of Subscriber in black ink
Name of Subscriber: ____________________________________________ (* 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,____________________________________________________________________________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. In DD/MM/YYYY):

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 ________day of ___________ 20 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___________________ Designation of the Authorised Person :____________________

(Allotted by CRA)
POP-SP/DDO Office Name _____________________

Date:_____________

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

PrAO (Allotted by CRA): _____________________________

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

______________________________________________________
Signature of the Authorised Person
Annexure A to ISS Ver 1.4 Page 7

Equity Allocation Matrix for Active Choice

Age (years) Max. Equity Allocation

Upto 50 75%
51 72.50%
52 70%
53 67.50%
54 65%
55 62.50%
56 60%
57 57.50%
58 55%
59 52.50%
60 & above 50%

Please note:
1. Upto 50 years of age, the maximum permitted Equity Investment is 75% of the total asset allocation.
2. From 51 years and above, maximum permitted Equity Investment will be as per the equity allocation matrix provided
above. The tapering off of equity allocation will be carried out as per the matrix on date of birth.