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Revision in Form S1 for Blind and illiterate applicants of NPS

Form S1 revised to facilitate Blind /illiterate applicants of NPS

PENSION FUND REGULATORY AND DEVELOPMENT AUTHORITY

Cir no: PFRDA/ 2013/2/ PDEX / 2

SL-7

SUB: Addendum to Form S1 to be used in case of Blind /illiterate applicants of NPS.

With reference to the subject cited above, PFRDA has issued an addendum to Form S1 to be used for enrolling blind/illiterate applicants under NPS to mitigate the problems faced by them during submission of the Form.

Two separate Annexure A1 & A2 categorically will be used for Government employees and for All Citizen Model & Corporate.

Copies of the annexure are attached herewith for information and use.

Annexure A1

DECLARATION

(Declaration in case if the applicant is illiterate, incapable of writing or blind)

Note:  In case the applicant is illiterate or blind or incapable of writing, the thumb impression of the applicant should be attested by a person of standing whose identity can easily be established but not related to CRA/PFRDA and this declaration should be made by him/her.

I hereby declare that I have fully explained the above questions to the applicant in ……………. (language) and I have truthfully recorded the answers and explained to the applicant and that the applicant has affixed his/her thumb impression to the S1 form after duly understanding the contents thereof.

Signature of the Declarant: (………………  )                    

(   ………………..    )

Thumb

impression*/Signature of

the Applicant

Name of the Declarant: …………………………..

Address of the declarant ………………………………………………………………

……………………………………………………………………………………

……………………………………………………………………………………

1. Signature  of Witness: 

2. Signature of Witness:

Name of Witness:

Name of Witness:

Address of Witness: 

Address of Witness:

Signature of DDO/DTO/PAO: ……………………………

Name of DDO/DTO/PAO: ………………………………..

Stamp:

* Left thumb impression in case of male and right thumb impression in case of female.

Annexure A2

DECLARATION

(Declaration in case if the applicant is illiterate, incapable of writing or blind)

Note: In case the applicant is illiterate or blind or incapable of writing, the thumb impression of the applicant should be attested by a person of standing whose identity can easily be established but not related to CRA/PFRDA and this declaration should be made by him/her.

I hereby declare that I have fully explained the above questions to the applicant in ……………. (language name) and I have truthfully recorded the answers and explained to the applicant and that the applicant has affixed his/her thumb impression to the S1 form after duly understanding the contents thereof.

Signature of the Declarant: ( ………………      )           

(      ………………..    )

Thumb Impression*/Signature of the Applicant

Name of the Declarant: …………………………..

Address of the declarant ………………………………………………………………

……………………………………………………………………………………

……………………………………………………………………………………

3. Signature  of Witness: 

4. Signature of Witness:

Name of Witness:

Name of Witness:

Address of Witness:

Address of Witness:

Name of POP/POP-SP: ……………………………………………

Signature of Authorised Signatory: ………………………………..

Name of the Authorised Signatory: ………………………………..

Stamp:

* Left thumb impression in case of male and right thumb impression in case of female.

Source: PFRDA

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