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 Annexures A1 & A2 categorically will be used for Government employees and for All Citizen Model & Corporate.
Copies of the annexures are attached herewith for information and use.
Annexure A1
DECLARATION
(Declaration in
case if the applicant is illiterate, incapable of writing or blind)
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.
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.
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
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.
impression in case of female.
Annexure A2
DECLARATION
(Declaration in
case if the applicant is illiterate, incapable of writing or blind)
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.
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.
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
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.
impression in case of female.
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