Declaration in case if the applicant is visually impaired/challenged person or incapable of writing/ illiterate person

Declaration in case if the applicant is visually impaired/challenged person or incapable of 
writing/ illiterate person
I hereby declare that I have fully explained the terms and conditions for registration under
National Pension System (NPS) 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 signatures/thumb impression on the S1 form after duly understanding the contents
thereof.

Name of the Declarant: ………………………….. Signature of the Declarant: ………………………
Address of the declarant ………………………………………...........................
……………………………………………………………………………………
Declaration by Applicant: I hereby declare that I have understood the terms and conditions for
registration under NPS as explained to me and I agree to the standard terms and conditions of National
Pension System (NPS).

Name of the Applicant: ………………………….. Signature/ Thumb Impression* of the Applicant
Address of the Applicant ………………………………………...........................
1. Signature of Witness: 2. Signature of Witness:

Name of Witness: Name of Witness:
Address of Witness:


Address of Witness:

Office Name: …………………… Signature of DDO/DTO/PAO: ………………………
Name of the DDO/DTO/PAO: ………………………………..
Stamp:
* Left thumb impression in case of male and right thumb impression in case of female.
Note: In case if the applicant is illiterate or is visually impaired/challenged 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.