8/18/2019 Guntur Swm Form

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Annexure N5

NPS-Lite

CONTRIBUTION SUBMISSION FORM

[Under National Pens ion System (NPS)]

ransaction ID Num ber (Given by NPS-Lite) 1500048200115

L-AO/NL-OO Reg. No. 8000672

L-AO/NL-OO NAME(Departm ent/Office)

LLA SAMAKYA GUNTUR

L-AO/NL-OO Address

at/Unit No. Block No.RST FLOOR

ame of Premise/Building/Village

ALL CENTRE DRDA OPP IBBUNGLOW

rea/Locality/Talukka

KULAVARI THOTA

str ict/Tow n/City

UNTUR

ate / Union Terr itory

ndhra Pradesh

ountry India Pin Code 522004

hone Num ber 08632241326

otal Contribution Am ount (in Rs. only)

ubscriber Contribution 1615000.00

o-Contribution 0.00

otal 1615000.00

otal in words Sixteen Lakh Fifteen Thousand Rupees only

ETAILS OF PAYMENT (To be filled by NL-AO/NL-OO)

RORES LACS THOUSANDS HUNDREDS TENS UNITS

aid in Cash/Debit to A/c/Cheque No.   Dated  

raw n On  

(Name of the Bank & Branch)

ate:  

(Signature of pers on making payment)

FOR USE IN RECEIVING BANK

 Cash / Debit to A/c / Cheque Credited

on

- -

D D M M Y Y

 SPACE FOR BANK SEAL

Rs.

NL-AOs/NL-OOs Counter foil

NL-AO/NL-OO Reg. No. 8000672

On Account of Pension Fund Contribution Rece ived from (NL-

AO/NL-OO Name )ZILLA SAMAKYA GUNTUR

Cash/Debit to

A/c/Cheque No.

To be filled up by

NL-AO/NL-OO )

  For Rs. 1615000.00

Rs.(In Words ) Sixteen Lakh Fifteen Thousand Rupees only

Draw n On  

(Name of the Bank & Branch)

Transaction ID Num ber (Given by NPS-

Lite)

1500048200115

 

SPACE FOR BANK SEAL

Rs.

This Transaction ID is ID given by Central Recordkeeping Agency (CRA) after submission of Subscribers' Contribution file.Cheques/DDs should be draw n in favour of Ax is Bank - NPS Trust Account - A/c Number 8000672

In case of Electronic Fund Transfer PAOFIN80006721500048200115 should be w ritten in Field 7495 (Sender to receiver information, line

No.4) of RTGS Message or in Field 7002 (Origination of remittance) of NEFT Message. RTGS remittances should be done by R-41 RTGS

format only.

IFSC for Axis Bank is UTIB0NPS001. For any query please contact on phone no. 022-24253639/28 or e-mail id npstrust@axisbank.com.