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Get Application For G P Fund Withdrawal

Annexure A1 Form 102-GP Page 1 National Pension System NPS Withdrawal Form for Claim of Accumulated Pension Wealth on exiting before the age of normal superannuation for Government Employees To be filled in by Subscriber - Please fill all the details in CAPITAL LETTERS in BLACK INK only. ASP Scheme Name 4. ASP Scheme ID Declaration I NPS Subscriber my PRAN is do hereby declare that the information provided above is true to the best of my knowledge and belief. D D M M Y YYY Note Left thumb impression in case of illiterate male claimants and Right thumb impression in case of illiterate female claimants must be obtained. Signature/Left Thumb Impression of the Subscriber Page 3 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pension wealth of the subscriber is payable in case of the demise of the subscriber before entire proceeds are withdrawn Please refer general instruction no 6 is to be provided hereunder.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. 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. FOR OFFICE PURPOSE ONLY-NOT TO BE FILLED IN BY THE SUBSCRIBER Date DD/MM/YYYY Self attested photograph of the subscriber Acknowledgement Number Generated by CRA DDO Registration No* PAO/DTO/POP/POP-SP Registration No* Receipt Number issued by receiving office Entered By Date Verified By Date Sir/Madam I hereby submit a request for withdrawal under NPS for both Tier-I and Tier-II 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 4. Address Flat/Unit No Block no. Name of Premise/Building/Village Area/Locality/Taluka District/Town/City State / Union Territory Country Pin Code 6. Date of Birth As in PRAN Card 7. Date of resignation 5. Mobile No* 7. Email ID Page 2 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 Lump-Sum amount Maximum of 20 Description Amount to purchase life annuity Minimum of 80 share Total 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 The entire accumulated pension wealth would be paid out in single lump sum along with the withdrawal/payment of the Tier-I account.

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