ARN Name Sub-Broker Code M O Code UTI CR / CA Code Bank Branch Bank Sr. No. RM No.
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1 COMMON APPLICATION FORM FOR OPEN-END EQUITY AND BALANCED SCHEMES PLEASE USE SEPARATE FORM FOR EACH SCHEME (PLEASE READ INSTRUCTIONS CAREFULLY TO HELP US SERVE YOU BETTER) Sr.No. 2008/ Registrar Sr. No DISTRIBUTOR INFORMATION (only empanelled Distributors/Brokers will be permitted to distribute Units) RECEIVING ENTITY INFORMATION ARN Sub-Broker Code M O Code UTI CR / CA Code Bank Bank Sr. No. RM No. Have you invested in UTI MF earlier, Yes No If yes, please provide: Scheme : Folio No. (Optional) APPLICANT'S PERSONAL DETAILS (Please fill in Block Letters) of first applicant (Mr/Ms/Mrs) Address for correspondence (PO box address is not sufficient) City Pin State Furnishing PIN code is mandatory Date of Birth d d m m y y y y Compulsory field in case of Minor Guardian name (if minor) (Contact person - for institutional applicants) Telephone Number Res Mobile No. Off Fax If you wish to receive the following via Please ( ) (Refer instruction k) Account Statement Annual Report Transaction Confirmation Communication of change of address, bank details, etc. Overseas address of 2nd applicant (Mr/Ms/Mrs) of 3rd applicant (Mr/Ms/Mrs) PAN * Sole / 1st Applicant Enclosed PAN Card Copy (Please ) * All PAN details are mandatory (Refer Instruction (j) ) BANK PARTICULARS [for dividend / redemption / refund / direct credit (Mandatory as per SEBI guidelines)] Bank Address MICR Code City PIN (this is a 9-digit number next to your cheque number) Furnishing of PIN Code is mandatory IFS Code Account type: Current Savings NRO NRE Account No.: PAYMENT DETAILS Cheque / DD* No. Date Bank Amt. of investment (i) DD Charges if any (ii) Net amount paid (i-ii) Amt in words *Please mention the application No. on the reverse of the cheque/dd. Cheque/DD must be drawn in favour of "The of the scheme" & crossed "A/c Payee Only" (Application form continued on the reverse) Received from Mr / Ms / M/s An application under along with Cheque / DD No.* Drawn on (Bank) for Rs. (in figures) * Cheques and drafts are subject to realisation. City State Country Pin (Overseas address is mandatory for NRI/FII applicants in addition to mailing address in India) 2nd Applicant ACKNOWLEDGEMENT (To be filled in by the Applicant) 25 PAN Card Copy dated (scheme name) 3rd Applicant PAN Card Copy Account Type Please ( ) Current Savings NRE NRO DD issued from abroad Sr.No. 2008/ Stamp of UTI AMC Office/Authorised Collection Centre
2 INVESTMENT DETAILS (Please ) UTI-Balanced Fund UTI-Leadership Equity Fund UTI-Nifty Index Fund UTI-Banking Sector Fund UTI-Master Growth Unit Scheme UTI-Opportunities Fund UTI-Contra Fund UTI-Master Index Fund UTI-Pharma & Healthcare Fund UTI-Dividend Yield Fund UTI-Master Plus Unit Scheme S&P CNX NIFTY UTI NOTIONAL DEpository UTI-Energy Fund UTI-Mastershare Unit Scheme Receipts Scheme (SUNDER) UTI-Equity Fund UTI-Master Value Fund UTI-Services Industries Fund UTI-Index Select Fund UTI-Mid Cap Fund UTI-Software Fund UTI-Infrastructure Fund UTI-MNC Fund UTI-Transportation & Logistics Fund Plan available only under UTI-Banking Sector Fund Retail Plan Institutional Plan (Minimum is Rs.5 crore) (Default is Regular Plan. However, if the application is for amounts of Rs.5 crore and above the default Plan is the Institutional Plan.) OPTION (for all schemes) Growth Dividend Payout Dividend Reinvestment (Default is growth option) I wish to Opt for Systematic Investment Plan (SIP). I wish to Opt for Automatic Trigger Facility. Investor opting for Systematic Investment Plan (SIP)&/or Automatic Trigger Facility may fill in separate form/s prescribed for the same & attach with this application form. G E N E R A L I N F O R M A T I O N - Please ( ) wherever applicable Status Resident Individual Minor through guardian HUF Partnership Trust Company Sole Proprietorship Society Body Corporate AOP BOI FII NRI Others Mode of Holding Single Anyone or survivor Joint Occupation Business Student Agriculture Self-employed Professional Housewife Retired Service Others ONLINE ACCESS (Not available under UTI Equity Fund, UTI Mastershare Unit Scheme and UTI Master Plus Unit Scheme): I/We wish to access the account online through invest@uti at I/We have read and understood terms & conditions available at and agree to abide by the same concerning all my/our folios. NOMINATION DETAILS I/We hereby nominate the undermentioned Nominee to receive the amounts to my / our credit in the event of my / our death. I/We also understand that all payments and settlements made to such Nominee and signature of the Nominee acknowledging receipt thereof, shall be a valid discharge by the AMC / Mutual Fund / Trustee. and address of Nominee To be furnished in case nominee is a minor of the guardian: Date of Birth (in case nominee is a minor) Address Address of guardian Signature of guardian (Mandatory) Investors who wish to nominate two or three persons may fill in the separate form prescribed for the same and attach with this application form. DECLARATION AND SIGNATURES OF APPLICANT/s I/We have read and understood the contents of the Offer Document/Scheme Information Document/Statement of Additional Information and Key Information Memorandum, addenda issued till date and apply to the Trustee of UTI Mutual Fund as indicated above. I/We agree to abide by the terms and conditions, rules and regulations of the scheme as on the date of investment. I/We undertake to confirm that this investment has been duly authorised by appropriate authorities in terms of all relevant documents and procedural requirements. I/We have not received nor been induced by any rebate or gifts, directly or indirectly in making investments. *I/We confirm that we are Non-Residents or Indian Nationality/Origin and that the funds are remitted from abroad through approved banking channels or from my / our NRE / NRO Account. I/We undertake to provide further details of source of funds and any such other relevant documents, if called for by UTI Mutual Fund. * Applicable to NRI s Signature of 1st Applicant / Guardian of the 1st Authorised Signatory Signature of 2nd Applicant of the 2nd Authorised Signatory Signature of 3rd Applicant of the 3rd Authorised Signatory Designation Designation Designation Notes: 1. If the application is incomplete and any other requirement is not fulfilled, the application is liable to be rejected. 2. In case the applicant does not receive the Statement of Account within 30 days from the date of acceptance of the application, he/she may please write to the Registrar quoting serial number, date of acknowledgement and the name of the accepting authority. 3. Please ensure that all PAN details are given, failing which your application will be rejected. 4. All communications relating to issue of Statement of Account, Nomination, change in, Address or Bank Particulars, Redemption, Death Claims, etc., may please be addressed to the Registrar : M/s. Karvy Computershare Private Limited, Narayani Mansion, H. No /10/E, Vittalrao Nagar, Madhapur, Hyderabad Tel: to 47 Fax: customercare@karvy.com
3 AGENT s and ARN UTI Mutual Fund, Mumbai 51. I / We hereby apply for making payment to SIP through Auto Debit [RBI s ECS (Debit Clearing)/Direct Debit] for the following Scheme/Plan. INVESTOR AND SIP DETAILS Sole / First Investor Application No. / Existing Mobile No. Folio No. Scheme/Plan SYSTEMATIC INVESTMENT PLAN (SIP) MANDATE FORM FOR AUTO DEBIT (Please read instructions) 1st 7th 15th 25th Start from Mth Year End on Mth Year PAN* of 1st Applicant Enclosed PAN Card Copy DETAILS OF OTHER APPLICANTS of 2nd applicant PAN* of 2nd applicant of 3rd applicant PAN* of 3rd applicant * PAN is mandatory as per SEBI guidelines. I / We hereby, authorise UTI Mutual Fund and their authorised service providers, to debit my/our following bank account by Direct Debit/ECS Debit for collection of SIP Payments. PARTICULARS OF BANK ACCOUNT Bank Account Number A/C Type Savings Current NRE NRO 9 Digit MICR Code Please provide the MICR Code of the bank branch from where the ECS/Direct Debit is to be effected. MICR code starting or ending with 000 are not valid for ECS. Accountholder as in Bank Account I/We hereby declare that the particulars given above are correct and express my willingness to make payments referred above through participation in Auto Debit. If the transaction is delayed or not effected at all for reasons of incomplete or incorrect information, I/we would not hold the user institution responsible. I/We will also inform UTI Mutual Fund, about any changes in my bank account. I/we have read and agreed to the terms and conditions mentioned on page no. 29 & 30. I have attached cancelled blank cheque or its Photocopy. Investor s Signature Date Certified that the signature of the account holder and the details of Bank account are correct as per our records. IFS Code (Optional) First Account Holder's Signature Second Account Holder's Signature Third Account Holder's Signature Banker s Attestation (For bank use only) ID: Signature of Authorised Official from Bank with Stamp and Date To, The Manager TEAR AWAY Authorisation of the Bank Account Holder (to be signed by the Investor) (To be retained by the Bank) PIN This is to inform that I/We hereby register for the RBI s Electronic Clearing Service (Debit Clearing)/Direct Debit and that my/our payment towards my investment in UTI Mutual Fund shall be made from my/our below mentioned bank account with your bank. I authorise you to honour such payments. I/We also authorise the representative carrying this Direct/ECS Debit Mandate Form to get it verified & executed, if necessary.the verification charges, if any, may be debited to my/our account. Bank Account Number First Account Holder's Signature Second Account Holder's Signature Third Account Holder's Signature
4 AGENT s and ARN UTI Mutual Fund, Mumbai 51. SYSTEMATIC INVESTMENT PLAN (SIP) MANDATED FORM FOR SIP THROUGH POST DATED CHEQUES (Please read instructions) I / We hereby apply for making payment to SIP through Post dated Cheques for the following Scheme/Plan. INVESTOR AND SIP DETAILS Sole / First Investor Application No. / Existing Folio No. Scheme/Plan Mobile No. Initial Investment Amount 1st 7th 15th 25th Start from Mth Year End on Mth Year Post Dated SIP Cheque Amount Account No. Cheque Nos. From Drawn on No. of Cheques To PIN Code PAN* of 1st Applicant Enclosed PAN Card Copy ID: DETAILS OF OTHER APPLICANTS of 2nd applicant PAN* of 2nd applicant of 3rd applicant PAN* of 3rd applicant * PAN is mandatory as per SEBI guidelines. Signature : First Investor Second Investor Third Investor Date : 28
5 A G E N T s Code No. ARN No. SYSTEMATIC INVESTMENT PLAN (SIP) ENROLMENT CUM AUTO DEBIT FORM (Please read instructions attached) UTI Mutual Fund UTI Tower, Gn Block, Bandra-Kurla Complex, Bandra (E), Mumbai Date : INVESTOR AND SIP DETAILS Sole / First Investor Application / Investor ID No. PAN Scheme / Plan st 7th 25th Start from Mth Year End on Mth Year By Cheque ECS Debit Direct Debit Payment Mechanism : (tick any one box) (Please fill details overleaf) (Please fill the details in the Tear away portion below) I/We hereby, authorise UTI Mutual Fund and their authorised service providers, to debit my/our following bank account through ECS Debit/Direct Debit for collection of SIP payments. PARTICULARS OF BANK ACCOUNT Bank Account Number 9 Digit MICR Code (for ECS Debit) A/C Type Savings Current I/We hereby declare that the particulars given above are correct and express my willingness to make payments referred above through participation in Auto Debit. If the transaction is delayed or not effected at all for reasons of incomplete or incorrect information, I / We would not hold the user institution responsible. I / We will also inform UTI Mutual Fund, about any changes in my bank account. I / We have read and agreed to the instructions mentioned attached. 1st Account Holder s Signature 2nd Account Holder s Signature 3rd Account Holder s Signature & TEAR AWAY & To, The Manager Systematic Investment Plan (SIP) Mandate Form For ECS/Direct Debit Date PIN This is to inform that I/We hereby register for the RBI s Electronic (Debit) Clearing Service/Direct Debit and that my/our payment towards my investment in UTI Mutual Fund shall be made from my / our below imentioned bank account with your bank. I / We authorise the representative carrying this ECS/Direct Debit Mandate Form to get it verified & executed, if necessary. Sole / First Investor st 7th 25th Account Number 9 Digit MICR Code (for ECS Debit) Start from Mth Year End on Mth Year A/C Type Savings Current 1st Account Holder s Signature 2nd Account Holder s Signature 3rd Account Holder s Signature Inward No. / Investor ID For Office Use only Scheme Code
6 SIP Through Cheques Initial Investment Amount Post Dated SIP Cheque Amount No. of Cheques Cheque Nos. From To Drawn on
7 ANNEXURE III Scheme: To UTI Mutual Fund/ SU-UTI Mumbai. FORM OF APPLICATION FOR REPURCHASE OF UNITS Date: I/We am /are the registered member(s)/survivor(s)nominee/heir(s)/legal representative(s) of the deceased member(s)* of all the units under the Scheme contained in the Membership Advice No./Membership Certificate No./Statement of Account folio no. for units and am/are / desirous of selling to UTI Mutual Fund/SU-UTI all/ units out of units comprised in the certificate/membership advice/statement of account (SOA) at the repurchase price prevailing / determined by UTI Mutual Fund/SU-UTI on the date of acceptance of this application and a unit certificate/membership advice/statement of account for the balance of units may be sent to the address already recorded with you / given below. The relative Membership Advice/MC/SOA is enclosed. The bank Account Details (if not already recorded with UTI Mutual Fund/SU-UTI) to be printed on cheque to avoid fraudulent encashment are furnished below. In the event of non-furnishing of bank account particulars, cheque will be issued in the name and address of the unitholder at his/her risk. Type of A/c & A/c No. : Bank Bank Address : Bank Pin Code Signature(s) / Thumb impression(s) Address of Member to which the of the Member(s) cheque has to be despatched 1. 2 Pin: 3 Telephone Nos. Note : (1) Request for repurchase at future date is not acceptable. (2) Post dated cheques/warrants, if any issued should be surrendered alongwith this form ATTESTATION Signature attestation by Bank / in case sign varies / differs. 1) of attesting official with the designation and code number : 2) of bank and branch : 3) Complete Address : 4) Savings/Current A/c No.:
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