Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697802884683.pdf (India)
Ver 1.4 Claim ID To, NPS Trust.

Sir/Madam, I NATIONAL PENSION SYSTEM (NPS) Exit from National Pension System Due to Superannuation/Incapacitation Acknowledgement No recent colour photograph of 3.5 cm × 2.5 cm size / Passport size hereby apply for the payment of the accumulated pension wealth in my NPS Tier-I account as per the relevant provisions of the PFRDA (Exits and withdrawals under NPS) Regulations, 2015 as amended.
Tier II:- The entire accumulated pension wealth in Tier II account would be paid along with lumpsum withdrawal of Tier I account.

I herewith give below the necessary details: *In case of female right thumb Impression and in case of male left thumb Impression may be taken.

Sr.No Section A - Subscriber’s Personal Details Particular Signature / Thumb Impression* of the Subscriber Remarks Subscriber Sector* Organisation Name* (PAO/DTO/CHO/NLAO Name) 1.

Govt.

Sector 2.

All India citizens/corporate 3.
NPS Lite / GDS PRAN* Full Name* Subscriber Gender* Father's Name* Marital Status* Maiden Name (In case of female married subscriber) Spouse’s Name* (only if subscriber is married & spouse is alive) Spouse Gender* (only if subscriber is married & spouse is alive) Date of Retirement / attaining 60 / 65 years of age / Discharge (In case of Incapacitation)* Date of Birth (As in PRAN Card)* Aadhar/VID PAN* CKYC Number Are you a Politically Exposed Person (PEP)* Are you related to a Politically Exposed Person (PEP)* Do you have any history of conviction under any criminal proceedings in India or abroad?
* If Yes, please provide details Contact details Subscriber’s full address with pin code* (Please refer instruction No.

9 for documents to be submitted) Male First First Middle Female Middle Married Unmarried/Others First First Male DD / MM / YYYY DD / MM / YYYY Middle Middle Female Last Last Last Last Yes Yes Yes No No No Mobile number* : +91 Alternate phone number : E-mail ID* : 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.


Section B - Subscriber’s Bank Details - (Please refer instruction No.

7) 20.

21.

22.

23.

Bank Account Number*# : Bank Name* Bank Branch Name and Address : The monthly pension and lump all the details carefully.

* IFSC Code (attach a cancelled cheque leaf or copy of bank * Fields marked with * are mandatory.
# Should be same where last salary credited in case of Government sector/Corporate sector subscribers Section C - Subscriber’s Withdrawal Details - (Please refer instruction No.
8) On attaining superannuation or attaining 60 / 65 years of age or superannuation due to Incapcitation a) Would you like to withdraw full amount (if less than or equal to 2 Lakh/1 Lakh (NPS Lite)) Yes No or b) Would you like to have normal Withdrawal (Lump sum & Annuity Withdrawal )# c) Would you like to opt for Withdrawal of Deferred Corpus#: Lump Sum Withdrawal Annuity Withdrawal or or Yes No Yes No d) Would you like to opt for Phase withdrawal : Yes Enter Withdrawal amount No Withdraw total holdings # Please provide the Percentage of corpus that you wish to opt for lump sum withdrawals and purchase of annuity % of corpus opted for lump sum withdrawal (Max 60%) Percentage of corpus opted for purchase of annuity (Min 40%) Total (100%) Ver 1.4 Section D - Subscriber’s Annuity Details - of Deferred Lump Sum Corpus & phase withdrawal) Select Annuity Service Provider (please tick one of the below options as per your choice) Bajaj Allianz Life Insurance Co. Ltd. HDFC Life Insurance Co. Ltd. IndiaFirst Life Insurance Co. Ltd. Life Insurance Corporation of India SBI Life Insurance Co. Ltd. Tata AIA Life Insurance Co. Ltd. Canara HSBC Oriental Bank of Commerce Life Insurance Co. Ltd. ICICI Prudential Life Insurance Co. Ltd. Kotak Mahindra Life Insurance Co. Ltd. Max Life Insurance Co. Ltd. Star Union Dai-ichi Life Insurance Co. Ltd.
Date : DD / MM / YYYY * Signature/Thumb Impression of the Subscriber *In case of female right thumb Impression and in case of male left thumb Impression may be taken Section E - Subscriber’s Nomination Details* Nomination Details: Applicable to those eligible sums as per regulations.

Nominee must be immediate family member of subscriber (Spouse, Children etc) in general except for exceptions as provided in Regulations.
Name : Relationship : Percentage Share: Date of Birth of Nominee (Only in case of minor) : DD / MM / YYYY Guardian Name (Only in case of minor) Guardian DOB (Only in case of minor) Address & Contact Details : Guardian Signature (Only in case of minor) Name : Relationship : Percentage Share: Date of Birth of Nominee (Only in case of minor) : DD / MM / YYYY Guardian Name (Only in case of minor) Guardian DOB (Only in case of minor) Address & Contact Details : Guardian Signature (Only in case of minor) Name : Relationship : Percentage Share: Date of Birth of Nominee (Only in case of minor) : DD / MM / YYYY Guardian Name (Only in case of minor) Guardian DOB (Only in case of minor) Address & Contact Details : Guardian Signature (Only in case of minor) Section F - Subscriber’s Family Member Details* Family Member Details for providing annuity as chosen by the subscriber.
Sr.No Details Full Name Aadhar/VID PAN$ Date of Birth $ 1.

2.

3.

4.

5.

6.

Spouse$ Dependent Mother (if living) Dependent Father (if living) Child 1 (if living) Child 2 (if living) Child 3 (if living) Note: In case of children being more than 3, please specify in an additional sheet.

Fields marked with* are mandatory.

$Mandatory in case subscriber opts for Joint Life Policy & NPS-Family Income option.
DD / MM / YYYY DD / MM / YYYY DD / MM / YYYY DD / MM / YYYY DD / MM / YYYY DD / MM / YYYY Ver 1.4 Declaration by the Subscriber I hereby declare and state that all the personal details provided by me in the form as above are true and correct to the best of my knowledge.

I also agree that NPS Trust / CRA shall not be held responsible/liable for any losses or delays that may arise due to provision of incorrect details including details pertaining to bank account by me.
Further, I authorize the National Pension System Trust (NPST)/ CRA to share informations pertaining to my withdrawal application with the Annuity Service Providers for facilitating the purchase of annuity in applicable cases as is required under NPS.

Date : DD / MM / YYYY * Signature/Thumb Impression of the Subscriber *In case of female right thumb Impression and in case of male left thumb Impression may be taken.
Declaration by the Proposer: I hereby declare that the foregoing statements and informations have been given by me after fully understanding the questions and the annuity options and the same are true, accurate and complete in every manner and respects and that I have not withheld or omitted to give any material information.

I understand and agree that the statements in this proposal constitute warranties.
I do hereby agree and declare that these statements and this declaration shall be the basis of the contract of assurance between me and Annuity Service Provider (Company) and that if there be any misstatement or suppression of material information or if any untrue statement is contained therein or in case of fraud by me, which comes to the knowledge of the company at any future point of time, the said contract shall be treated as per provisions of Section 45 of the Insurance Act 1938 or any other applicable provisions as amended from time to time.
I also understand and agree that the company shall additionally levy or recover all the applicable taxes like service tax, surcharges, cess etc.

from the premiums which are necessitated by various enactments of central and/or state legislatures from time to time.

I understand that the contract will be governed by the provisions of the Insurance Act 1938, and other applicable laws in India and that the contract will not conditions contained in the contract.
I also agree that the amount held in proposal/policy deposit shall not earn any interest.

I further state that the product features and terms and conditions of the policy have been thoroughly explained to me and having understood, I consent to the same.

I also acknowledge and agree that the funds will not be returned to me in case I choose to cancel the policy under free look period.
These funds will be payable by company directly to any other annuity scheme chosen by me which is authorized and approved under the prevalent regulations and applicable rules.

Further, no interest will be payable to me on the funds held during this transition period.

I hereby authorize company to send information and servicing related communication regarding this proposal or resulting policy through Email/SMS/Phone Call.
Signature of the witness Signature / Left thumb Impression of the Proposer photograph Name and Address of witness: Place: Date: DD / MM / YYYY I hereby state that I have read out and explained the contents of this proposal form and all other relevant documents to the proposer in language, he/she/they have understood the same and agree to abide by the terms and conditions of the resulting policy and have I/We state that the product details, contents of this form and relevant documents have been fully explained to me/us and that I/We have fully understood them.
I/We certify that the replies in the proposal form have been recorded as per the information provided by me/us.
Signature of the person making the declaration Name & Address Signature / Left thumb Impression of the Proposer Place Date: DD / MM / YYYY Ver 1.4 TO BE FILLED/ATTESTED BY DDO/PAO/POP-SP maintained by us.The complete information provided in this form including declaration and nomination details have been provided by the Subscriber after he / she having read the entries / entries have been Sh/Smt/Ms.

2.
2.

T hat all the contributions with respect to the Subscriber’s NPS contribution and employer contribution have been transferred in to the PRAN of the of disability (in case of Non Govt.
Subscriber) [applicable in case of Withdrawal due to incapacitation only] Rubber Stamp of the DDO/POP-SP/NLCC Signature of the Authorised Person DDO/POP-SP/NLCC Registration Number Designation of the Authorised Person : Date D D / M M / Y Y Y Y Rubber Stamp of the DTO/PAO/POP/Aggregator Signature of the Authorised Person DTO/PAO/POP/ Aggregator Registration Number Designation of the Authorised Person : Date D D / M M / Y Y Y Y [As per Regulation 3(a)/4(a)/5(a) of PFRDA (Exits and Withdrawals) under the Regulations, 2015] Request cum under taking form for withdrawal of total pension wealth at superannuation and where the total pension wealth is equal to or less than Rs.
2,00,000/- for NPS subscriber and Rs.

1,00,000/- in case of NPS lite Subscriber respectively I, residing at S/D/W/o , aged about years, 1.

That I am a Subscriber of National Pension System, holding PRAN (Rs.
1,00,000/- for NPS Lite), I understand that I am eligible to opt for withdrawal of the total pension wealth under NPS rules/guidelines, I also certify that all the details provided in the form above are true and correct to the best of my knowledge Date : DD / MM / YYYY * Signature/Thumb Impression of the Subscriber *In case of female right thumb Impression and in case of male left thumb Impression may be taken.
Date D D / M M / Y Y Y Y Rubber Stamp of the DDO/POP-SP/ NLCC Signature of the DDO/POP-SP/ NLCC Registration No.

of DDO/POP-SP/ NLCC Rubber Stamp of the DTO/PAO/POP/Aggregator Signature of the DTO/PAO/POP/Aggregator Registration No.
of DTO/PAO/POP/ Aggregator Date D D / M M / Y Y Y Y Ver 1.4 INSTRUCTIONS FOR FILLING FORM Superannuation or attaining 60 / 65 years of age General Instructions: Government Sector subscribers) will not be allowed if NPS subscribers registered on or after July 1, 2014 are NOT FATCA compliant.

Hence, subscribers are requested to provide 2.

A s per amendments made under Prevention of Money-Laundering (Maintenance of Records) Second Amendment Rules, 2017, Withdrawal not seeded into PRAN.
Subscribers are requested to seed their Aadhaar and PAN into NPS account before initiating withdrawal request (Aadhaar not mandatory till Hon’ble supreme court order) and takes a print out of online form and submits it to the nodal However, he/she has the option to submit the physical form to his nodal mode only.

Physical forms submitted to CRA will not be processed.

3b.

Subscriber (other than government sector & Corporate) has an option to initiate a self-authorization using Aadhaar.
This facility will be available only if the NPS pension wealth is below threshold limit as prescribed in PFRDA (Exits and Withdrawals under National Pension System) Regulation 2015 or circular issued by the authority.

overwriting.

5.

Fields marked with (*) are mandatory.

6.

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

7.

Documents to be enclosed with withdrawal application form: i.

Copy of the Address proof of the address provided on the withdrawal form.
The address on the withdrawal form should match with address present on the address proof.

ii.

Copy of the Identity proof iii.

Copy of PRAN card (Not required in case of Government Sector Subscriber)If Copy of PRAN Card is not available, print out of submission of the PRAN card.

iv.

Cancelled cheque (containing Subscriber Name, Bank Account Containing Name, Bank Account Number and IFSC code, for direct credit or electronic transfer.

8.

Withdrawal preference: i.


Se lect the Withdrawal preference as Normal withdrawal or Complete Withdrawal (if accumulated NPS wealth is less than or equal to Rs.

2 lacs/Rs.

1 lacs (For NPS Lite Subscribers)).

ii.

If subscriber selects the Normal withdrawal option, he/she needs to sum and amount to purchase life annuity provided under Section C the Form.

iii.
iii.

I f subscriber selects deferred withdrawal option, he/she can defer the lump sum withdrawal amount up to 70 years of age while annuity purchase can be deferred up to 3 years from the date of attainment of superannuation.

In case of deferment as well, the subscriber as Lump-sum and amount to purchase life annuity provided under Section C of the Form.

iv.
iv.

In case of percentage of withdrawal is not provided by the subscriber, a default 60% of the accumulated pension wealth shall be paid as lump sum to the subscriber and rest 40% of the amount shall be utilised for annuity purchase.

v. T he subscriber needs to provide the Annuity details under Section D-Annuity Details, in case of Normal withdrawal or Deferred withdrawal.

The selection of Annuity scheme and Annuity Service Provider is mandatory.

Sl.

No.

a b c d e f g h i j k ix.


D uring deferment period, the account maintenance charges and including the charges payable to Central Record Keeping Agency, Pension Fund, Trustee Bank and any other intermediary shall continue to apply and shall be charged by deducting units from the account In case of Phased Withdrawal, Subscriber needs to purchase Annuity x. xi.

For more details of Annuity options, please refer to Instructions No.

12 9.
12 9.

L ist of documents acceptable as Proof Identity and Address for exit under NPS (for all variants):- (Copy of Identity Proof of any one of the given below documents) Passport issued by Government of India.

Ration Card with Photograph.

Proof of Address (Copy of any one of the given below documents) Passport issued by Government of India.

Ration card with photograph and residential address.

with Photograph and Identity Voters photograph address.

Valid Driving photograph.


card with residential license with PAN Card issued by income tax department.

and Identity card with residential with photograph and residential address.

Voters photograph address.

Valid Driving license with residential and photograph address.

Letter from any recognized public authority at the level of Gazetted Divisional Commissioner, BDO, Tehsildar, Mandal Revenue photograph signed by a Member of Parliament or Member of Legislative Assembly.
Aadhar Card/letter issued by photograph signed by a Member of Parliament or member of Legislative Assembly.

Aadhar Card/letter issued by India.

Job Cards issued by NREGA duly Government.

of India.

Clearly showing the address.

Job Cards issued by NREGA duly Photo Identity card issued by Defence, Paramilitary and Police Departments.

issued Ex-Service Man Card by Ministry of Defence to their employees.

l Photo credit Card.

m – vi.


T he subscriber availing the complete withdrawal option (where the accumulated amount at superannuation is less than Rs.

2 lacs/ Rs.1 lacs (For NPS Lite Subscribers)) shall leave the Annuity Details n up Request Cum Undertaking Form provided along with the Form.

vii.

In case of death of subscriber during deferment period of annuity purchase, the deferred amount shall be paid as per PFRDA (Exits and Withdrawal under National Pension System) Regulation, 2015 viii.
In case of death of subscriber during deferment period of annuity purchase, the annuity shall be purchased by the spouse as under National Pension System) Regulation, 2015 (applicable for Identity card issued by Central /State government and its Departments, Statuary Regulatory Authorities, Public Sector Undertakings, Scheduled Commercial Banks, Public Financial Institutions, Colleges Professional Bodies such as ICAI, ICWAI, ICSI, Bar Council etc.

of the State Government.


Latest Electricity/Water bill in the name of the subscriber / Claimant and showing the address (Less than 6 months old).

Latest Telephone bill in the name of the subscriber/ Claimant and showing the address (less than 6 months old).

Latest Tax Receipt (not more than one year old).

Existing Valid registered lease agreement of the house on stamp paper (in case agreement of the house on stamp paper (in case of rented/leased accommodation).
The identity card/document with address, issued by any of the following: property/house Central/State Government and its Departments, Statuary/ Regulatory Authorities, Public Sector Undertakings, Schedules Public Commercial Financial their Employees.

Institution Banks, for Ver 1.4 10.

The subscriber needs to provide his/her complete bank details like name of the bank, branch, complete address of branch, account type and IFSC otherwise the form may get rejected by CRA.
Please make sure there is no cutting attempt on this section.

The lump sum payment shall be directly credited to the bank account of the subscriber through electronic mode of payment.

If there is any change in Bank Details and Address details, subscribers are requested to update the same in CRA records prior to initiation of online withdrawal request.

At the time of initiation of online withdrawal request, updation of Bank Details and Address Details is not allowed.
Form and supporting documents in all respects after signature/thumb impression of subscriber and declaration and attestation of the authorized keeping within 90 days from the date of approval: NPS Claims Processing Cell, Central Record Keeping Agency, NSDL e-Governance Infrastructure Ltd, 1st Floor, Times Tower, Kamala Mills Compound, Senapati Bapat Marg, Lower Parel, Mumbai - 400013.

12.
12.

Annuity Service Providers There are 11 Annuity Service Providers empanelled by PFRDA for providing the annuity services to NPS subscribers as per the list provided below (Name of the ASPs are given in an alphabetical order).

Name of the ASPs, minimum age and minimum corpus required for annuity purchase Annuity Service Provider Name Minimum Age Minimum Corpus (Rs.)
Bajaj Allianz Life Insurance Co. Ltd. Canara HSBC Oriental Bank of Commerce Life Insurance Co. Ltd. HDFC Life Insurance Co. Ltd. ICICI Prudential Life Insurance Co Ltd IndiaFirst Life Insurance Co. Ltd. Kotak Mahindra Life Insurance Co. Ltd. Life Insurance Corporation of India Max Life Insurance Co. Ltd. SBI Life Insurance Co. Ltd. Star Union Dai-ichi Life Insurance Co. Ltd Tata AIA Life Insurance Co. Ltd. 37 45 20 30 40 45 30 50 18 45 45 25,000 2,25,000 Any Amount Any Amount 10,000 2,24,000 50,000 2,50,000 50,000 1,00,000 2,24,200 The following are the variants that are available in India and with most of the ASPs.
Subscriber needs to select any of the below mentioned option on the page 1 of the withdrawal form: 1.

Annuity for life - On death of the annuitant, payment of annuity ceases 2.

Annuity for life with return of purchase price on death - On death of the annuitant, payment of annuity ceases and the purchase price is returned to the nominee.

3.
3.

Annuity payable for life with 100% annuity payable to spouse on death of annuitant - On death of the annuitant, annuity is paid to the spouse during his/her life time.

If the spouse predeceases the annuitant, payment of annuity will cease after the death of the annuitant.

4.
4.

Annuity payable for life with 100% annuity payable to spouse on death of annuitant with return on purchase of annuity - On death of the annuitant, annuity is paid to the spouse during his/her life time and purchase price is returned to the nominee after the death of the spouse.

If the spouse predeceases the annuitant, payment of annuity will cease after the death of the annuitant and purchase price is paid to the nominee.
Note: Please note the exit from NPS and purchase of annuity from empanelled ASP are two separate processes.

It is mandatory for subscribers to purchase annuity scheme from Annuity Service Providers (ASP) empanelled by PFRDA.

Post receipt of the form by ASP and completely satisfying themselves of completeness of the form and KYC requirements, annuity shall be issued to subscriber.

The more details on availability of particular annuity scheme with an ASP and annuity quotes etc.
are available on the CRA’s website as per link below: www.npscra.nsdl.co.in/annuity-service-providers.php ASP Scheme Details and Annuity Selection Matrix may change.

Please ASPs may undergo changes depending upon new empanelment of ASPs by PFRDA from time to time.

13.
Default Annuity Scheme (Applicable in case of Government Sector Subscribers only) The subscriber upon exit from NPS shall have to purchase annuity with a minimum of 40% of the accumulated pension wealth which shall provide for annuity for life of the subscriber and his or her spouse (if any) with provision for return of purchase price of the annuity and upon the demise of such subscriber, the annuity be re-issued to the family members in the order such annuity by utilizing the purchase price required to be returned under the covered) : (a) living dependent mother of the deceased subscriber; (b) living dependent father of the deceased subscriber.
price shall be returned to the surviving children of the subscriber and in the absence of children, the legal heirs of the subscriber, as may be applicable However, the subscriber who does not wish to opt default option mentioned above and wishes to choose the annuity contract of his choice from the available annuity types or contracts with the annuity service providers may choose an option as mentioned under instruction no.12 above.