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Form 303

Page 1

National Pension System (NPS)

Withdrawal Form for Claim of Accumulated Pension Wealth by Claimant(s) due to death of the subscriber

(Please fill all the details in CAPITAL LETTERS & in BLACK INK only.)

Date :

Acknowledgement Number :

(DD/MM/YYYY)

(Generated by CRA)

POP Registration No.:___________________

POP-SP Registration No.:___________________

Receipt Number issued by receiving office:

Entered By: ___________________ Date: ________________ Verified By: ___________________ Date: __________________

Sir/Madam,

I/We being a nominee(s)/legal heir(s)/guardian of minor nominee(s) or minor heir(s) of the deceased subscriber apply for the payment of the accumulated pension wealth of the deceased subscriber under the NPS and give below the necessary details:

Section A – Subscriber’s Details:

1. PRAN *:

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

Middle Name

Last Name

3.Father’s name/Spouse’ Name *: First Name*

Middle Name

Last Name

4. Date of Birth of the deceased subscriber *(As in PRAN Card):

(DDMMYYYY)

Section B – Nominee’s Details:

1.Name of the Nominee* (Please refer instruction no.1-3 under section “This application should be filled by”):

1st Nominee

2nd Nominee

3rd Nominee

First Name*

Middle Name

Last Name

2. Nominee’s Address*:
1st Nominee	2nd Nominee	3rd Nominee
Flat/Unit No, Block no*_________________________	Flat/Unit No, Block no*_________________________	Flat/Unit No, Block no*________________________
____________________________________________	____________________________________________	___________________________________________
Name of Premise/Building/Village ________________	Name of Premise/Building/Village ________________	Name of Premise/Building/Village _______________
____________________________________________	____________________________________________	___________________________________________
Area/Locality/Taluka___________________________	Area/Locality/Taluka___________________________	Area/Locality/Taluka_________________________
____________________________________________	____________________________________________	___________________________________________
District/Town/City*____________________________	District/Town/City*____________________________	District/Town/City*___________________________
____________________________________________	____________________________________________	___________________________________________
State / Union Territory*_________________________	State / Union Territory*_________________________	State / Union Territory*________________________
____________________________________________	____________________________________________	___________________________________________
Country______________ Pin Code______________	Country______________ Pin Code____________	Country_____________ Pin Code_____________

Form 303

Page 2

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

1st Nominee

2nd Nominee

3rd Nominee

4. Relationship with the Subscriber*:

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*

Middle Name

Last Name

7. Nominee/Guardian Email id*(If nominee is minor, email id of guardian to be provided):

1st Nominee :

2nd Nominee:

3rd Nominee:

Section C – Nominee’s Bank Details (Please refer General Instruction no.6):

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

	Cancelled Cheque	Bank Certificate
2.	Type of Bank Account*:
2.	Type of Bank Account*:	Savings A/c	Current A/c

3.Bank A/c Number*

4.Bank Name*

5.Bank Branch*

6.Bank Address*

7. Pin Code *

8. Bank IFS Code*

9. Bank MICR Code (Wherever applicable)

II.Bank Details of the 2nd Nominee:

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

Cancelled Cheque

Bank Certificate

Type of Bank Account*:

Savings A/c

Current A/c

Bank A/c Number*

4. Bank Name*

Bank Branch*

Bank Address*

7. Pin Code *

8. Bank IFS Code*

9. Bank MICR Code (Wherever applicable)

Form 303

Page 3

III.Bank Details of the 3rd Nominee:

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

Cancelled Cheque

2.Type of Bank Account*:

3.Bank A/c Number*

Bank Certificate

Savings A/c

Current A/c

4.Bank Name*

5.Bank Branch*

6.Bank Address*

7. Pin Code *

8. Bank IFS Code*

9. Bank MICR Code (Wherever applicable)

I/We (as mentioned below), the nominee(s)/legal heir(s)/guardian of minor nominee(s) or minor heir(s) of NPS Subscriber Shri/Smt._______________

________________________________do hereby declare that the information provided above is true to the best of my/our knowledge and belief.

1st Nominee or of guardian of 1st Nominee

2nd Nominee or of guardian of 2nd Nominee

3rd Nominee or of guardian of 3rd Nominee

Signature/Left Thumb

Impression*

Name of 1st Nominee or of guardian of 1st

Name of 2nd Nominee or of guardian of 2nd

Name of 3rd Nominee or of guardian of 3rd

Nominee ______________________________

______________________________________

Date :

D D M M Y Y Y Y

Self attested

Self attested photograph of

photograph of the

the nominee/guardian

nominee/guardian

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

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

TO BE FILLED/ATTESTED BY POP/POP-SP

Certified that the above declaration and details has been signed / thumb impressed before me by ________________________________

____________________________after the nominee(s)/legal heir(s)/guardian of minor nominee(s) or minor heir(s) 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/POP-SP

Signature of the Authorised Person

POP/POP-SP Registration Number _______________________	Designation of the Authorised Person : ________________________________
(Allotted by CRA)

Date :

D D M M Y Y Y Y

POP/POP-SP Office Name : _________________________________________

Form 303

Page 4

CLAIM FOR THE WITHDRAWAL OF ACCUMULATED PENSION WEALTH BY CLAIMANTS – DUE TO THE DEATH OF THE SUBSCRIBER

This application should be filled by:-

1.If a valid nomination subsists by the Nominee (s), if the nominee (s) is/are minor (s) guardian of the minor(s)

2.If no nomination subsists: By the family members (family includes posthumous child if any) except major sons and married daughters whose husbands are live, of the deceased family member duly supported by a list of surviving family members furnished by Executive Magistrate indicating complete particulars such as name, relationship with the deceased member (in case of parents whether dependent or not) age, marital status. Also, if any family member is minor by the guardian of the minor.

3.If both 1 & 2 above are not applicable by legal heir (s) duly supported by a ‘legal heir certificate’ from the appropriate sate authority (Revenue dept).

Documents to be enclosed with the application:-

1.Death certificate in original of the deceased subscriber.

2.Copy of PRAN card. In case PRAN card is not available, a duly notarized affidavit as to the reasons of non-submission of the PRAN card is needs to be submitted.

3.Certified copy of family member’s certificate issued by Executive Magistrate for cases where no nomination was registered with us.

4.Legal heir certificate when the claim is being made by.

5.Cancelled cheque (containing nominee Name, Bank Account Number and IFS Code) or Bank Certificate containing Name, Bank Account Number and IFSC code, if opted for direct or electronic transfer.

6.A pre-signed receipt acknowledging the receipt of the proceeds by nominee/nominees/legal heir (as applicable)

7.Identification and address proof of the nominee or nominees, in case of multiple nominees. The documents that can be provided as identification and address proof are as mentioned below:

a)Ration Card with photograph and residential address

b)Bank Passbook with photograph and residential address

c)Credit Card with photograph, any other address proof like latest telephone bill, electricity bill in the name of the nominee.

d)Passport

e)Aadhar Card issued by UIAD

f)Voter’s Photo Identity Card with residential address

g)Driving license with photograph and residential address

h)PAN card and any other address proof like latest telephone bill, electricity bill in the name of the nominee.

i)Certificate of identity with photograph signed by a Member of Parliament or Member of Legislative Assembly or Municipal Councilor or a Gazetted Officer and any other address proof like latest telephone bill, electricity bill in the name of the nominee

In case if the address is not present on any of the above documents or differs with address provided in this form, proof in respect of current residential address like latest telephone bill, electricity bill in the name of the nominee should be submitted.

INSTRUCTIONS FOR FILLING UP THE FORM

1.All the columns in the form should be filled with black ink pen without any overwriting

2.Fields marked with (*) are mandatory.

3.The day on which CRA receives the confirmation of funds transferred to Subscriber’s nominee(s) accounts; the PRAN will be deactivated in the CRA System.

4.Correct postal address, including the pin code should be provided

5.The literate claimant should sign the application form. In case of the claimant being illiterate, Left hand thumb impression by illiterate male claimant and Right hand thumb impression by illiterate female should be affixed in the claim form.

6.If the Nominee/ legal heir is minor, Bank account number should be in the name of nominee/ legal heir. Bank account’s guardian should be same as mentioned in the withdrawal form.

For the purpose of this document Pension Wealth means: The total amount of contributions made by the subscriber in the scheme plus the investment income derived from the investment of the contributions made by the subscriber from the date of joining of National Pension System till the date of execution of withdrawal request in the CRA System.

Form 303

Page 5

CLAIM FOR THE WITHDRAWAL OF ACCUMULATED PENSION WEALTH BY CLAIMANTS –

DUE TO THE DEATH OF THE SUBSCRIBER UNDER National PENSION SYSTEM

Advanced Stamped Receipt

1st Nominee/ Guardian of 1st Nominee (if nominee is minor)
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	National	Pension	System	account	of	late
Shri/Smt……………………………………………………………...with PRAN Number ………………………………
					Affix 1 Rupee
					Revenue Stamp
					and sign across

			Signature or Left/ Right hand thumb impression of the Nominee/Guardian*

----------------------------------------------------------------------------------------------------------------------------- ---------------------------------------

2nd Nominee/ Guardian of 2nd Nominee (if nominee is minor)

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 National Pension System account of late Shri/Smt…………………………………………………………….with

PRAN Number ………………………………

Affix 1 Rupee

Revenue Stamp

and sign across

Signature or Left/ Right hand thumb impression of the Nominee/Guardian*

----------------------------------------------------------------------------------------------------------------------------- ---------------------------------------

3rd Nominee/ Guardian of 3rd Nominee (if nominee is minor)

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 National Pension System account of late Shri/Smt…………………………………………………………….with

PRAN Number ………………………………

Affix 1 Rupee

Revenue Stamp

and sign across

Signature or Left/ Right hand thumb impression of the Nominee/Guardian*

-------------------------------------------------------------------------------------- ------------------------------------------------------------------------------

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

Form 303

Page 6

ACKNOWLEDGMENT RECEIPT

Acknowledgment slip to the 1st Claimant on receipt of completed application form for Withdrawal due to death of the subscriber

(To be filled by POP/POP-SP)

Received from PRAN :

POP-SP Registration Number : _____________________

POP Registration Number:

___________________________

Received at: _________________________ Date : ____________________________

Time: __________________

Acknowledgement Number :

(Generated by CRA)

.........................................................................................................................................................................................................

ACKNOWLEDGMENT RECEIPT

Acknowledgment slip to the 2nd Claimant on receipt of completed application form for Withdrawal due to death of the subscriber

(To be filled by POP/POP-SP)

Received from PRAN :

POP-SP Registration Number : _____________________

POP Registration Number:

___________________________

Received at: _________________________ Date : ____________________________

Time: __________________

Acknowledgement Number :

(Generated by CRA)

ACKNOWLEDGMENT RECEIPT

Acknowledgment slip to the 3rd Claimant on receipt of completed application form for Withdrawal due to death of the subscriber

(To be filled by POP/POP-SP)

Received from PRAN :

POP-SP Registration Number : _____________________

POP Registration Number:

___________________________

Received at: _________________________ Date : ____________________________

Time: __________________

Acknowledgement Number :

(Generated by CRA)

Question	Answer
Form Name	Nps From 303 Form
Form Length	6 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min 30 sec
Other names	nps form fillable pdf, nps online, nps form online, nps pdf form

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