Form 501 Nps – Fill Out and Use This PDF

SWAVALAMBAN

National Pension System (NPS)

Withdrawal Form for Claim of Accumulated Pension Wealth by Subscriber on attaining 60 years of age

(To be filled by Subscriber - Please fill all the details in CAPITAL LETTERS & in BLACK INK only)

Sir/Madam,

I hereby submit a request for withdrawal under NPS for both Tier-I / Tier-II (please tick as applicable) fund accumulations in my Permanent Retirement Account and give below the necessary details:

Section A – Subscriber’s Personal Details:

1. PRAN *:

2.Full Name (As in PRAN Card) *: First Name*

Middle Name Last Name

3.Father’s/Spouse name*:

First Name*

Middle Name

Last Name

4. Address*:

Flat/Unit No, Block no.*

Name of Premise/Building/Village

Area/Locality/Taluka

District/Town/City*

State / Union Territory*

Country*

Section B – Subscriber’s Withdrawal Details:

Tier – I Account:

1.The Lump-sum amount to be withdrawn and amount to purchase annuity in case of normal withdrawal*(Please refer

General Instruction no.4&5)

Note: A separate form needs to be filled in for purchase of Annuity and for arranging the monthly pension/annuity. The subscriber is required to follow the procedure laid down by Annuity Service Provider (ASP)

3.In case of Phased Withdrawal#, please mention the percentage of lump-sum amount to be withdrawn this year (Please refer General Instruction no.6)

% share

Note: In phased withdrawal of lump-sum amount, subscriber can opt to withdraw lump-sum amount for accumulated pension wealth in a phased manner over the period from 60 years (or any other retirement age as prescribed by employer) to 70 years. Subscriber has to withdraw minimum of 10% of the remaining pension wealth every year; at the age of 70 years, subscriber would compulsory withdraw any amount lying to their credit. Also, note that in phased withdrawal of lump-sum amount, subscriber is subject to the NAV movement and may lose or gain in the future depending on the underlying fund’s performance.

For subscriber opting for phased withdrawal, the Central Recordkeeping Agency (CRA) maintenance charges would be deducted from the corpus/units lying in the account of the subscriber

Tier – II Account:

The entire accumulated pension wealth would be paid out in single lump sum along with the withdrawal/payment of the Tier-I account.

Section C – Subscriber’s Bank Details:

1. For Electronic transfer or Direct Credit through ECS/NEFT/RTGS, Proof attached for Bank Details*:

(Please note that Mode of remittance of funds would be through ECS/NEFT/RTGS/Electronic Transfer only and bank charges, if any, for direct credit would be deducted from pension wealth)

3.Bank A/c Number*

4.Bank Name*

5.Bank Branch*

6.Bank Address*

9. Bank MICR Code (Wherever applicable)

Section D – Subscriber’s Annuity Details:

1. Annuity Service Provider (ASP) Name *:

2. ASP ID*:

3. ASP Scheme Name *:

4. ASP Scheme ID *:

*Note: Left thumb impression in case of illiterate male claimants and Right thumb impression in case of illiterate female claimants must be obtained.

Annexure for Nomination Details

INSTRUCTIONS FOR FILLING IN THE 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 (Please refer general instruction no: 7) is to be provided hereunder. Also, please note that in case of demise of the subscriber after opting for phased withdrawal, all the outstanding pension wealth out of the phased lump sum withdrawal in the account of the subscriber will be paid to the nominee(s) as mentioned in this form and the same would be treated as full and final discharge of the obligation. In case, if you wish to appoint multiple nominees, please fill in the form 401-AN.

I, ____________________________________ hereby nominate the person(s) mentioned below who is/are member(s)/non-

member(s) of my family to receive the amount that may stand to my credit in the National Pension System as indicated below, in the event of my death before that eligible accumulated pension wealth amount has become payable or having become payable or having become payable has not been paid.

1. Name of the Nominee:

2. Nominee’s current communication Address

Flat/Unit No, Block no*_____________________________________________________________________

Name of Premise/Building/Village ____________________________________________________________

Area/Locality/Taluka___________________________ ____________________________________________

District/Town/City*________________________________________________________________________

State / Union Territory*_____________________________________________________________________

Country*____________ Pin Code*____________ Email ID:_________________________________________ Mobile No.:_____________

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

4.Relationship of the nominee with the Subscriber*:

(e.g. If nominee is son, subscriber should fill the relationship as ‘Son’)

5.Nominee’s Guardian Details*(only in case of a minor):

*Note: Left thumb impression in case of illiterate male Subscriber and Right thumb impression in case of illiterate female subscriber must be obtained.

TO BE FILLED/ATTESTED BY NL-CC/POP/POP-SP

Certified that the above declaration and nomination details has been signed / thumb impressed before me by Sh/Smt/Ms. _________

________________________________________after he / she have read the entries / entries have been read over to him / her by me

and got confirmed by him / her.

(DDMMYYYY)

TO BE FILLED/ATTESTED BY NL-AO/POP/POP-SP

NL-AO/POP/POP-SP Registration Number (Allotted by CRA):

___________________________________________________________

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CLAIM FOR THE WITHDRAWAL OF ACCUMULATED PENSION WEALTH OF THE

SUBSCRIBER UNDER NATIONAL PENSION SYSTEM

Advanced Stamped Receipt

I _________________________________covered under the National Pension System with Permanent Retirement Account

Number (PRAN) _____________________has received a sum of Rs./-

(Rupees_____________________________________________________________only) from National Pension System /

National Pension System Trust by deposit in my Saving Bank / Current Account towards the settlement of my National

Pension System (NPS) account.

Affix 1 Rupee

Revenue Stamp and sign across

Signature or Left/ Right hand thumb impression of the NPS Subscriber*

(*Note: Left thumb impression in case of illiterate male claimants and Right thumb impression in case of illiterate female claimants must be obtained.)

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ACKNOWLEDGMENT RECEIPT

Acknowledgment slip to the NPS Subscriber on receipt of completed application form for Withdrawal on attaining 60 years of age

(To be filled by NL-AO/POP/POP-SP)

Received from PRAN :

Acknowledgement Number : (Generated by CRA)