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ENROLMENT FORM
FOR NATIONAL PENSION & PROVIDENT FUND PLAN
1. Personal Details
a)
Name
First
b)
Sex
M
Middle
Surname
(Tick the correct one)
F
c) Date of Birth
(As per Service records)
Day
Month
Year
d) Nationality
e) Citizen ID Card No.
f) Date of Issue
g) House No.
h) Thram No.
i)
Permanent Address
j) Present Address
Village
Gewog
Dzongkhag
k) Contact No.
l)
E-mail_
Father’s Name
m) Mother’s Name
n) Date of Appointment in service
Day
Month
o) Grade/Designation
p) Name of Agency
q) Place of Posting
r)
Basic Salary
s)
RCSC/Agency Employment No.
t)
Date of joining NPPFP (First installment date)
2. Spouse Details (Attach a separate sheet, if there are more than one spouse).
a)
Name
First
b) Sex
M
Middle
F
c) Date of Birth
d) Nationality
e) Citizen ID Card No.
g) Permanent Address
Village
Gewog
h) Father’s Name
i)
Mother’s Name
Surname
(Tick the correct one)
Day
Month
f)
, Dzongkhag
Year
Date of Issue
Year
FORM – 1
Photo
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j)
Marriage Certificate No.
Date
k) Occupation
l)
If working NPPFP No.
RCSC/Agency Employment No.
3. Children Details (For only below 18 years & attach Family Tree/Birth Certificate/Health Card copy of Children)
Sl.No.
Name
Date of
Birth
Sex
Name of the
Spouse from whom
born
Remarks
4. a) Nomination for Provident Fund (Tier 2) only.
Sl. No.
Relationship with the
Member
Name of Nominee
b) Extraordinary/Study Leave Availed
Fro
Sl. No.
m Month
Day
Year
Day
Share of PF Payable
(Percentage %)
T
o
Month
Duration
Year
I hereby certify that the aforementioned information given herein is true, correct and complete to the best of my
knowledge and belief.
Name
Applicant
signature on
Legal
Stamp
Designation
Organization
Date
Note: Please enclose copy of appointment letter and Citizenship ID Card No.
To be filled by the Employer
This is to certify that the information hereby furnished in respect of Mr. /Mrs. /Ms.
complete and verified from the service record maintained in this office. This information may be used by the NPPF.
is
Name of HRO/Head of Agency/ Gup for L G
Date ____________________________
Signature & Seal: ____________________________
----------------------------------------------------------------------------------------------------------------------------- -------------------To be filled by NPPF
Data Entered by
NPPFP No. allotted
Date :
Contact details:
National Pension & Provident Fund
Post Box. 1046, Thimphu
Tele: 324140/325758/325638/325512
Fax: 324306/324790
Hotline: 1039