NPS-103 - Death Withdrawal Form
NPS-103 - Death Withdrawal Form
NPS-103 - Death Withdrawal Form
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 NPSfor both Tier-I / Tier-II (please tick as
applicable). I / we understand further that the entire accumulated pension wealth in both Tier I and Tier II (as applicable)
would be settled as per the NPS scheme and hereby give below the necessary details:
1. PRAN *:
Middle Name
Last Name
Middle Name
Last Name
Section B – Details of the Claimant (person entitled to receive claim proceeds under the policy):
Area/Locality/Taluka___________________________ ____________________________________________
District/Town/City*________________________________________________________________________
1. For Electronic transfer or Direct Credit through ECS/NEFT/RTGS, Proof attached for Bank Details*:
4. Bank Name*
5. Bank Branch*
6. Bank Address*
I/We (as mentioned below), the nominee(s)/legal heir(s)/guardian of minor nominee(s) or minor heir(s)of NPS
SubscriberShri/Smt./Ms._______________________________________________do hereby declare that the information provided
above is true to the best of my/our knowledge and belief.
Signature/Left Thumb
Impression*
TO BE FILLED/ATTESTED BY DDO/POP-SP
Certified that the above declaration and details has been signed / thumb impressed before me by Sh./Smt/Ms._____________________________
____________________________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.
TO BE FILLED/ATTESTED BY PAO/DTO/POP/POP-SP
PAO/DTO/POP/POP-SP Registration Number (Allotted by CRA):
___________________________________________________________
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I hereby declare that the information given on this death claim application form is true and complete to
the best of my knowledge and belief. I hereby declare and agree that any personal information collected
or held by the National Pension System (NPS) (whether contained in this application or otherwise
obtained) is provided andmay be held, used, and disclosed by the Company to individuals/organisations
associated with the NPS or any selected third party (within or outside of India) for the purposes of
processing this application.
Acknowledgement Number :
(Generated by CRA)
Form 103-GD Page 5
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.