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GOVERNMENT OF ANDHRA PRADESH Department of Gram Volunteers/Ward Volunteers and Village Secretariats/Ward jecretariats, Vijayawada RC.No.366/F/GSWS/2022 Dated: 17/08/2022 From To Shan Mohan Sagili, LA.S., All the District Collectors in the State Director, GVWV & VSWS Department Sir/Madam, ‘Sub | GVWV & VSWS Department - Drawal of salaries of Village/Ward Functionaries whose services are regularized - National Pension System/ Contributory Pension Scheme ~ Allotment of Permanent Retirement Account Number - certain instructions issued ~ Regarding Ref T. G.0.Ms No.5, GVWV & VSWS Department, Dated 25-06-2022 2. RC.No.305/F/GSWS/2022, GVWV&VSWS Department, Dated 15/07/2022 3. Lr.No.FINO2-160314/6/2022-F-SEC-DTA-2, Treasuries and Accounts Department, Dated 20/07/2022 4. Rc.No.309/F/GSWS/2022, GVWV & VSWS Department, Dated 20-07- 2022 It is to inform that the Village /Ward Secretariats Functionaries whose services have been regularized come under National Pension System (NPS)/ Contributory Pension Scheme (CPS). In order to remit the Employee and Employer contributions every new ‘employee shall get Permanent Retirement Account Number (PRAN) under NPS/CPS. Such deductions in the salary bill and the remittances to the PRAN can be made by a DDO if the DDO has the Registration Number under Central Recordkeeping Agency (NSDL-CRA). Detailed instruction have been given vide ref 3" and 4% cited in this regard. It is noticed that many DDOs are yet to submit Registration forms to the Treasury officers for allotment of Registration Number under Central Recordkeeping Agency (NSDL -CRA Portal) mapped with the Treasury ‘Therefore, the District Collectors are requested to ensure that all the Drawing and Disbursing Officers (DDOs) of Village Secretariats, MPDO’s and Treasury Officers invariably hold a joint workshop on 18-08-2022 and complete the DDO registration with Central Recordkeeping Agency (NSDL-CRA) at the concerned treasury office without fail. Annexure enclosed: DDO Registration Format Subscriber Registration Format Sd/- Sagili Shan Mohan DIRECTOR ADDL‘COMMISSIONER GVWV & VSWS DEPARTMENT Copy to Director of Treasuries and Accounts. All the District Treasury Officers. All the MPDOs in the State. DDO Registration Format S.No. STO Code DOO Code Name ofthe DDO Office PAO/DTO Reg.No Addresst Address2 Address 3 Vilage/ Town/City DISTRICT State PIN Department Phone Email DDO Designation Ministr NATIONAL PENSION SYSTEM (NPS) - SUBSCRIBER REGISTRATION FORM Central Recordkeeping Agency (CRA) - NSDL e-Governance Infrastructure Limited Please select your category [Please tick(¥)] Central Govt Central Autonomous Body All Citizen Model State Govt. ‘State Autonomous Body Corporate Sector Peceport size i Go c NPS Lite (GDS) Naor Penson System Trust ar SeRtacom eby request that an NPS account be opened in my name as per the pateuars given below indicates ander elds Piss lhe for in Engl nd BLOCK eters with black nk pen. ice prow gach wrarcae KYC Number, Retirement Adviser Code and Spouse Name fils are not applicable for Government & NPS Lite Subscribers KY Number ( spotesb=) LL [Genertes fom Conral KY Repity Retirement Adviser Code (i appicabie) 4. PERSONAL DETAILS: Pest refer S: Not ofthe instructions) Name of Applcantinful §— Shi Js.) First Name" LUI | Middle Name fest aalael T Last Name Subserbe’s Maden Name fon A Father's Name* (Paleo. totam) prec Mother's Name" 1 oI I I (Ree Not tats) Fate's name willbe pred on PRAN card. Incase, mthers name oe pint instead of father’s nare [Please tick (7) [) Dae of Br i [] (ate oft shut spared ty evn dssmeta set) z eee Salas [lee] City oF Bith* El ss [sate] es]et] (ES Pe Country of Birth* Gender* [Please tick(v)} Male] Female L]_— Others L) Nationaliy® Indian (J Unmarried C]___ Others C Marital Status" Married C) spoute Name” Leh OC eee esr Residential Sats Indian PROOF OF IDENTITY (Pol) (Ary one ofthe dociments need tobe provided along wih the Passport 7 Voter ID Card Driving License NREGA JOB Card | Tr Others ‘Name of he 1 UID (Aadhaar) (UIDI [Aadhaar] number not required.) "ai RENT a a PRISE TST SRS ROSE SSSR NSCOR PE PAN FOU SY RI WPS VST ES RAP aul | sea lane nar uta St re protege st athe samiann tae Suc’ Roparsan Fam. |. PROOF OF ADDRESS (PoA)* (Pease tk (V), 98 applicable) Correspondence Address Permanent Address | Pup vn ao UD a Yor esNRESA > ears (athaaVetrDcaRNESA Job ago Le tare est Tar [ eg Rp caterer Torta oases eguies ans corel esdonsnlunp Tax Sa ec Toon eo IE 4.1 CORRESPONDENCE ADDRESS DETAILS" Address Type" FlatiRoom/DooeBlock no. Premises/Bullding/Vilage RosdiStreetLane ‘AreafLocality Taluk CityrTown/Distrct StatelUT. ResidentiaBusiess [] Residental [] Business] Reistered Otice[—] Unspeciied [—] PIN Code (7) Tick (7) in the box in case the address is same as above, “42 PERMANENT ADDRESS DETAILS" ‘Address Type" FlavRoom/DoorlBlack no. Premises/Buiding/Vilage RoadiStreetLane ArealLocalty/Taluk CiyrTownDistriet, StateiUT, ResienavBusiness [] Reskenial_[] Business] Repistered Once[] Unspected [—] '&. CONTACT DETAILS Tel (Oth STO code) [> [I] Frat es win sro endef [TT TT TTT Mobic’ (Mandatory) [+18] 4] |] r fy el ns vir nea etme oa ec Email 1D coco [eee Tee (OTHER DETAILS (Please referto Sino. 3of he nsiucons ) > Occupation Detais™ [please tick) = Private Sector] Public Sector C] Government Sector [} Professional [1] - SeitEmployed(] Homemaker C) Student Others (Please Specity) = > Income Range (per annum) Upto 1 lac 1a tote OO Stacto tle 1 10lacto 25lacl] 25 lac and above) > Educational Qualifications Belowssc() ssc] HSC [1] Greduste “| Masters (] Professionals (CA, C8, OMA ete) C] > Please Tick Applicable Politically exposed person [-] __Relatedto Politically exposed Person (] _ (Please refer instruction no.3) ‘SUBSCRIBER BANK DETAILS (Pieate oer o Srno. 4 oft instructions) (All the bank details are mandatory except MICR Cade.) ‘Account Type [please tck(Y)] Savings Ne) Bank Ale Number Bank Name ‘Branch Name Branch Across Bank MICR Code ‘SUBSCRIBERS NOMINATION DETAILS* (leat referto S.No. Sf the instucions) [Name ofthe Nominee (You can nominate upto @ maximum of3 nominees and you desire so please fin Annaxuro Il (Aditonal Nomination Form) provided separate) First Name Wile Name LastName EEEEGEEE Ser] ec efi Fo Pos ot ee Fo tas [ses eT Relationship withthe Nomines [| ata of Birth (Incase of Minot) [2] [711d Nominge's Guardian Details (in case of a minor) FirstName iWidate Name LastName ECO Peet EES a Be] NPS OPTION DETAILS (Please tick (7) a8 appicabe) | would lke to subserbe for Tier Account also YES [_}NO [_) Yes, please submit detals in Annexure. (you who acvat TI account subsequent, youmay submit separate pletion Armenue S10) tothe assoctec Noda fc oro POPIPOP.SP of your caice. The of POP POP.SPs endetng senes unger NPS pnd Annee SOs slate on CRA wedste) would tke my PRAN to be printed in ind! _YES [_]NO 1 IfYes, please submit detalls on Annexure I 410, PENSION FUND (PF) SELECTION AND INVESTMENT OPTION” (Pease refer o tno, 6 ofthe insuctons ) (PENSION FUND SELECTION (er): Please read below conditions before oping forthe chee of Penson Fund: ‘Government Sector: The flowing Pension Funds (PFs) wil at oy as defaut PFS. choco isnot oxeread bythe goverment empoyeeisubscber {@)LIc Person Fund Lined () S81 Pension Funds Pvt. Limite (2) UT Fistremant Scutone Lin ease of Cental Autonomaus Bodes (CAB) State Govorrment| {(8G)State Autonomous Bodies (SAB) employees. election made under he eecton wil be iqnoeed, ence o employees snot tied bythe respective Stale ‘Govt, ‘All CRizen Model: Subscribers under All Ctzen model have the open lo choose the avaliable PFs as perth choice nthe abe below. ‘Corporate Model: Subsbare snl have he optono choose the vate PF as pr the below tbl in consutton wih ther especeve Employer. [NPS Lite: NPS Lit is group choice model where subeerber hae a choice of PF and investment opton as valle wth Aggregator. Defauk Choice f Pension Funds Nae ofthe Pension Fund Pane soar 2) 7 LUC Pension Fund Limited one | Avatable in Government seca, employosisubserber does nol exercise [Sa Pension Funds Prva Limited A reer | UtiRetrementSotsions Lined _ [ICICI Prudential Pension Funds Management Company Limited Kotak Mahindra Pension Fund Lines | HOFC Pension Managemen! Company Lined Bia Suite Penson Management United * Selection of 1 Pension Fund is mandatory fr Al Gin aubeoibor )) INVESTMENT OPTION (Please Tick nthe box gen below showing your investment option. Auto Choe Please not In case you select Active Choice fil up ston) below andi you salet Auto Choice fll up section (iy) below In case you do at inccate any investment option, yout funds wil be invested in Aud Choice (60), In case you have oped for Auta Chace and fil up eecton (i) below relating ta Asset Allocation the Asset Allocation instructions wil be ignored and investment wil be made a8 per Auto Chace (LC 50) (li) ACTIVE CHOICE - ASSET ALLOCATION (tobe filled up only In case you have selected ‘Active Choice’ the investment option) | pee i Seal ean ] | ascetciass | (Cannot | taxupto | Maxupto| (Cannot | Tota | Asset class E-Eauity and related insiuments; Asset cass Corporate cebt and related | exaee7=%)| 10%) | 00%) | exoeds%) | |store; Asset cans C-Govemen Bonds ond relied instuneris, Asst Class =f | rater nesinent Funds poudg stunts ke CNES, MS, RES, AF, eee | Terooie | aun | At, | ReedGoermntenienbae te have ote sean een At ot sae | seatoie Cla c eny Presse nae: Upto 50 years of age, the maium permits Equy vestments 76% of thefts! asst location. From 51 years and above, maximum permited Equity Investment wil be as pr the equity alcation matrix rovded In Annexure A. The tapering off of ety ‘llocation ull be caries out a per the maxon date of BO. ‘he tial allocaon across E,C, Gand Aatet classes must be equa 100% In case, the allocation I ft lank andlor does ot equal 100% the appiation shall be rejected. {iv) AUTO CHOICE OPTION (to be filled up only in case you have selected the ‘Auto Choice’ investment option). In ease, you do not indicate a choice of LC, your funds willbe invested as per LC 50. eo T Pease Tax(71] chosen Gon Funds (OnlyOne | __sector__| Not: 1. LC 75: tie the Lif yee fund where the Cap to Equity investments i 75% ofthe ota asset \Eastere ey 2.6 50: tte Life cyte nd where the Cap o Equly investments is 50% of te ttl asset SABRES | 5.16.25 tise Lite cyte und where the Cap to Equity investments is 25% ofthe total asset Ce eed ere |. Govt employee can exerie Auto Choice of Asset locaton fr LC 25 & LC £0 only [ics] 41, DECLARATION ON FATCA* (Foreign Account Tax Compliance Act) COMPLIANCE (Pieate refer io S: no 7 ofthe isinucton) Section I* usPerson” Yes [1] No [—] Section II* For the purposes of taxation, | am a resident in the folowing countries and my Tax Identification Number (TIN}functional equivalent in each county is set ‘ut below or have indicated that a TINsfunctonal equivalent is unavailable (kindly fil details of all countries of tax residence i more than one) Particulars County (1) ‘Country (2) Country (3) Countrylcountties of tax residency ‘Adress Line 1 ‘Address in the jurisdiction for Tax | iTown/ilage Residence State ZIPIPost Code “Tax Kentfication Number (TIN)Functional equivalent Number TIN Functional equivalent Number Issuing Country Vality of documentary evidence provided (Wherever applicable) “ort 42) I shall be my responsibity to educate myself and to comply at allies wit al rlevant laws eating to reporting under section 285BA of the Act read with the Rules *14F to 14H ofthe Income tax Rules, 1962 thereunder and the information provided in tha Form is in accordance withthe aforesaid rues, the information provided by me in te Farm, its supporing Annexures as wall asin te documentary evidence are, to the best of my knowledge and bel, tue, Comect and complete andthat have not wiiheld any material nformaton that may afect the assestmentcategorization of te account as @ Reportable account or olverise ©) I permilauthorie the NPS Trust to collet, store, communicate and process information relating tothe Account and al ransactions therein, by the NPS Trust tnd any of NPS intermediaries wherever situated nluding sharing, ranser and disclosure between them and to he authortes In andlor outside india of any confidential information for campeance with any iw er regulation whether domestic or foreign, 1) Lundertake the responsiity to declare and disclose within 30 days ftom the date of change, any changes that may take place inthe information provided in the Form, ts supporting Annexures a well atm the documentary evidence provided by me or any cariication becomes incorrect and to provide esh sl cetieation alongwith documentary evidence, «) Taleo agree thatin case of my fale to dscase any materia fat known to me, now orn future, the NPS Trust may report to any regulator andlor any authoety designated by the Government of india (GO!) IRBVIROAPFRDA for he purpose or take any other acton as may be deemed appropriate by the NPS Trust the {efcioncy isnot remedied by me witin the stpulated period 1) Thereby accept and acknowledge thatthe NPS Trust shal nave the right and autharty to carry ot investigations trom the infomation avaliable In pubic domain {or confirming the information provided by me othe NPS Trust 49) Faso agree to fumish such infrmation andlor documents as the NPS Trust may require fom time to time on account of any change in aw ether in Inia or abroad in the subject matter herein. th) Teall ingemiy NPS Trust for any ies that may arise tothe NPS Trust an account of providing incorrect or incomplete information, r 12, DECLARATION BY SUBSCRIBER' (Picase lero Sr. 8 of he insuctons ) Declaration & Authorization by all subscribers ‘have read and understood the tems and condos ofthe National Pension System and hereby agree tthe same along with the PFRDAAct, regulations amed thereunder and declare thatthe infomation and documents fished by me are rue and comec to the best of my knowlecge and bebe. | undeake to form immediately the Cel Record Keeping AgencyNatonal Pension Sysiem Twst f any change inte above information fumished by me, do ot hold any pre-existing account undet NPS. 1 understand that shale uy fale for evomiesion of any flee or ncorect mation or document, |urther agree o be bound by te terms and condos cf provision of services by CRA, fom ime to me and any amendment tert as approved by PEROA, whether complete c partis wihout any new decaraton being unshed by me. shall be bound bythe ems and conde forthe usage of LPN (io access CRA webu and vow ets) & TPN Declaration undor the Prevention of Money Laundering Act, 2002, | ereby dciare thet te conrbuton sai by mefen my behalf has been derived fom legally declared and aseosced sources cf income, | understand that NPS Trust hes {he ight to peruse my nancial profi or share the lformation, wih her goverment autores. futher ages that NPS Twust haste ight lose my PRAN incase lam found vilatng the provers of any law relating opreventon of money auncerng. 2 Date LCi 7 J | Place ‘Signature/Thumb Impression* of Subscriber in black ink | ( LTlin case of male and RT! in case of females) 18, DECLARATION BY EMPLOYER Applicable to Government Subscribers only (Subscribers Employment Details to be filled and attested by the Deptt. (All Details are Mandatory) Date of Joining EET EEE EGET) Date of Retirement Employee CovelO ( appicable)[ TT TT fates) [ [employee Godefo and PPAN ae onal. yeu intend PAN (If applicable) lethal [OPTI TE) rene. menton anyone Group of Employee (Tick as eppicable) Group 1] Group I Group] Grow I Office Be Ses] I Deparment Pilea TT res ae eee pees Ministry ee esa Tease e ea] ES a DDO Registration Number I Lt DTOIPAOICDDOIDTAIPrAO Registration Number [|_| Basic Pay a Pay Scale et (| It is crtfied that the details provided in this subscriber registration form by ‘employed with us, including the address and employment detals provided above are as per the service Tecord of the employee Maintained by Us. Also tis further cert that helshe hes read entries/entres have been read over to him/her by us and got confirmed by him/her. | Soames htiwnn | Ring SawedapO | Sewn THeAS_| RA Soph TOOTH (inthe box above) {nthe box above) (nthe box above) [E brwPra0 tin ne box above) | Designation ofteAuhosedPeson [| ________] Deegnation ofthe Authorised Person [__ =a] Name oftte000 [ ||Neme otororsoicooopTamao pepeaaiey ee Eee) 14, DECLARATION BY EMPLOYER! CORPORATE Applicable to Corporate Subscribers only (Subscribers Employment Details to be filed and atlested by Corporate (All Details are Mandatory)) Date of Joining eae Te Ts] Date of Retirement [T TeT TTT TTT) Enpoyee Cold COECEo amore Reg aber OHO Ney ates yeRA LTT TL 11111 t ttt ttt ttt 80 Wot CRA a Cried that the detalis provided in tis subscriber registration form by ‘employed with us, including the ‘employment details provided above are as per the service record ofthe employee maintained by us. Ako, is urher certified that he/she has read the entries / entries have been read over o him / her by us and got confiemed by him / her. Signature ofthe Authrises person (nthe box above) | Designation ofthe Autoised Person Rubber Stamp ofthe Corporate (Inthe box above) 45, DECLARATION BY THE AGGREGATOR ‘Applicable to NPS Lite Subscribers: ‘Authorisation by Aggregator's office (NL - AO) Certified that the subscribers registered withthe aggregator and helshe has opted to join NPS. thereby declare that the subscribers ebgible to join NPS {and the above declaration has been signed thumb impressed before me by _after (s)he has read the ents! entries have been read over to herihim by me. ‘pee lie haben pn te bra) Name ofthe Aggregator | ‘Membership No. allted by Aggregator (any) pel I false Proce | _j om [ePetdet tet Ltd 416, TO BE FILLED BY POP-SP- receetno.c17 dot | TTT TI1I Tr] PoP-sP Repisvation Number I | Document accepted for date of Birth Proof Copy of PAN card submitted YES [] No [] kyC Compliance YES [_] No [—] Documents Received (Originals Varied) SelfGerified | (Attested) Tre Copies Identity Verification Done Existing Customer: we hereby cerifyicontiem that ShriSmKum suns i8 an existing KYC verified customer The above applicant is having an operative Bank! Demat/Foti nr -nmnn8000Unt (spect nature ofthe account) having account numbericient IO. maintained e......branchiofice, ‘The KYC documents available with us for this customericient matches the requirement for opening NPS account and are in compkance with PMLA RulestWe further confirm thatthe Savings Bank alc of ShiSmvKum is nota ‘Basic Savings Bank Deposit Account (applicable in case of Bank PoP) Tobe filed by POP-SP POPP ea Smaweenmonsiney [ome {To be filled by CRA - Facilitation Centre (CRA-FC}] caarcrepsratnnincer | -Aekeomledgement Number (oy CRAFO) Ee] cee Ns i Siboc oe nw] se ef FL [ms [Pt [saa Date of Receipt of Application and Contribution Amount: [- Contribution Amount Remitted: ‘Stamp and Signature of the Employer/PoP: General Guidelines Plaae it the form n ogible nandwrting so a avo errs in nd soch conection shoul be courterignedby te apart lan bor ser each wore incase, you menton the KYC number submision of root Sor wherever provided, should eatin or the same i necessary. [nolan or the appleabon frm sprinted back to back "The subscrber shud not sign acces te photograph. The phlograph shoul not be stapled or clipped to thu der vey of he face othe aubsctior, te soetn shall a be accepted. Cops ofthe document "The subuorbers thumbs impression shoud be vtfed bythe designated ofc of POP-SP / Nodal Ofice I | ‘i. it [_Prremtonane |b Se ee I [ifmaried, spouse name ie mandaioy. Tater name mandate i fans nome os mre Ti Mather’ name is mancatry ‘Natonat | Other Court Inaviduae (0G!) and Pers pause Name Fathers Name Moshers Name ‘ate of Birdy |Peabe ensure thal he date of eh meiches as indesign te document INSTRUCTIONS FOR FILLING THE SUBSCRIBER REGISTRATION FORM pplication processing, Pleats donot overaie. Coecons shouldbe mace by canceling and re-wrng Topless incomplete nanyTespeet ancl not secampsmed by required Gocumonts are lable 10 be rejected. The applications lable to be ejected if mandatory fel re submited bythe appicant shuld be sltattested and accompanied by xignal for verfcation by the nodal ofc ‘eine anc Adress ote appear medoned on be frm, shoul match wi te documentary proof somites Instructions 1. Tis Fars apoleabe ony fr Resided dian. Thor sa separate Form fr Non Resident inane & Overseas Gitzen ands mann aha nome and Maher's har and sal selec! th ‘han 20 apts, you may Annexure Il fr tho sae, ji. totes name haa mee han 20 ips, you may il Annexare I fr the ae, ony one charac ephabet/rumber punctuation mar ea fo thee ary mark on the photograph such that ders ono ndan Opn (10) are To awed o open PRAN pon be printed on PRAN Cara. provcedinhe wuppar. SNo|___ Proof of py of any one) 'SNo] Passpor aovea by Goversmar of nda 1 ‘Proof of Address (Copy af any one) Pasaporlaued by Governmert of nda Ration cos wih photograph, Banc Pats book or cantata wih Praiowaon (Ceiteate fhe POF fran ensng cusioio Raton card wth protograph ond vesidenda aasiess | Sg Pass Book or cata wi ptogrsh an esol \Ceniata he POP Toran eng customer ‘Voters lent ear wih photograph and restora adores. Vales Ident care wh photogresh and resident! adress vate riving teense wit hoiogaph ab Oring Noose with photograph and residential aiess ‘erat of ieity wih photograph saned by @ ember Sitar Mane Cogesve Aesomty tes fom any recogrized publ autoriy at the Tevel 3 (Gazeted cca ks bec Magiate, Dusonalcammssione, ‘500, Tehsiar Mandsi Revende flee, udical Magistrate ee PAN Cara ened by cove tax daparmant

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