Individual Self-Certification under FATCA

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3 Iividual Self-Certification uer FATCA (INDIVIDUAL / NRI / HUF / ON BEHALF OF MINOR / PROPRIETORSHIP FIRM) Tax Regulations require us to collect information about each inveor s tax residency. In certain circumances (including if we do not receive a valid self-certification from you) we may be obliged to share information on your account with relevant tax authorities. If you have any queions about your tax residency, please contact your tax advisor. Should any information provided change in the future, please ensure you advise us of the changes promptly. Name PAN Country of Tax Residency Tax Reference Number Guraian Name (If Applicable) Guaian PAN Guaian Country of Tax Residency Guaian Tax Reference Number Power Of Attorney(POA) Name (If Applicable) POA PAN POA Country of Tax Residency POA Tax Reference Number Applicant 1 Applicant 2 Applicant 3 Declaration I declare that the information provided on this form is to the be of my knowledge a belief, accurate a complete. I agree to notify Pramerica Asset Managers Private Limited immediately in the event the information in the selfcertification changes. I/We hereby authorise you to disclose, share, remit in any form, mode or manner, all / any of the information provided by me/ us, including all changes, updates to such information as a when provided by me/ us to Mutual Fu, its Sponsor, Asset Management Company, truees, their employees ('the Authorised Parties') or any Iian or foreign governmental or atutory or judicial authorities / agencies including but not limited to the Financial Intelligence Unit-Iia (FIU-IND), the tax / revenue authorities a other inveigation agencies without any obligation of advising me/us of the same. (Applicant 1 ) ( Applicant 2 ) (Applicant 3) Name & Signature Name & Signature Name & Signature ( To be signed as per the mode of holding) Date:-

4 Declaration for Ultimate Beneficial Ownership [UBO] Maatory for non-iividual inveors (company / tru / society / partnership firm etc.) Annexure II This declaration is not needed for Companies that are lied on any recognized ock exchange or is a Subsidiary of such Lied Company or is a beneficial owner of such Companies A: Applicant Details Applicant Name: PAN: B. Category (tick applicable category) Unlied Company Partnership Firm Limited Liability Partnership Unincorporated association / body of iividuals Public Charitable Tru Religious Tru Private Tru / Tru created by a Will Others [please specify] C. Details of Ultimate Beneficial Owners Name of Beneficial Owner (Natural Persons / Lied company with non controlling intere) PAN (for Residents/NRIs) ID Proof (Foreign / PAN Exempt Iividuals) Country / Countries of Tax Residency Ownership %age a Nature of Ownership I/We hereby acknowledge a confirm that the information provided in this Annexure is/are true a correct to the be of my/our knowledge a belief. In case any of the above specified information is fou to be false or untrue or misleading or misrepresenting, I/We shall be liable for it. I/We also uertake to keep you informed in writing about any changes/ modification to the above information in future a also uertake to provide any other additional information as may be required at your e. I/We hereby authorise you to disclose, share, remit in any form, mode or manner, all / any of the information provided by me/ us, including all changes, updates to such information as a when provided by me/ us to Mutual Fu, its Sponsor, Asset Management Company, truees, their employees ('the Authorised Parties') or any Iian or foreign governmental or atutory or judicial authorities / agencies including but not limited to the Financial Intelligence Unit-Iia (FIU-IND), the tax / revenue authorities a other inveigation agencies without any obligation of advising me/us of the same. Authorized Signatories [with Company/Tru/Firm/Body Corporate seal] Inructions :- Pursuant to guidelines on identification of Beneficial Ownership issued vide SEBI circular no. CIR/MIRSD/2/2013 dated January 24, 2013, inveors (other than Iividuals) are required to provide details of Ultimate Beneficial Owner(s) ( UBO ). The Ultimate Beneficial Owner means Natural Person, who, whether acting alone or together, or through one or more juridical person, exercises control through ownership or who ultimately has a controlling ownership intere of / entitlements to: i. more than 25% of shares or capital or profits of the juridical person, where the juridical person is a company; ii. more than 15% of the capital or profits of the juridical person, where the juridical person is a partnership; or iii. more than 15% of the property or capital or profits of the juridical person, where the juridical person is an unincorporated association or body of iividuals. In case of a Tru, the settler of the tru, the truees, the protector, the beneficiaries with 15% or more of intere in the tru a any other natural person exercising ultimate effective control over the tru through a chain of control or ownership is considered as the UBO. The provisions w.r.t. Identification of UBO are not applicable to the inveor or the owner of the controlling intere is a company lied on a ock exchange, or is a majority-owned subsidiary of such a company.

5 SIP AUTO DEBIT FACILITY REGISTRATION CUM MANDATE FORM All sections to be completed legibly in English in Black/Blue coloured ink a in BLOCK letters. INVESTORS SUBSCRIBING TO THE SCHEME THROUGH SIP AUTO DEBIT FACILITY TO COMPLETE THIS FORM COMPULSORILY ALONGWITH COMMON APPLICATION FORM (Refer General Guidelines 2A) 1. DISTRIBUTOR INFORMATION (Refer Inruction No. 1) ARN - 3. SIP DETAILS (Fir SIP cheque a subsequent via Auto Debit Facility in select cities only) (Refer Inruction No. 3) Scheme Name Option Growth* Divide Bonus Default Option Divide Facility Payout Re-invement (Default) # SIP Frequency (Please üany one) Daily Monthly Quarterly # Only for Pramerica Dynamic Asset Allocation Fu & Pramerica Large Cap Equity Fu. Facility available only through select banks. Refer Terms a Coitions - Point 3 Inalment Amount (In figures) ` Please refer to Inruction 3d (Applicants mu sign as per Common Application Form) Sole/1 Applicant/Guaian/Authorised Signatory/POA Divide Frequency SIP Date for (Monthly / Quarterly) 1 7th 10th 15th 25th All 5 Dates 'Please read the Scheme Information Document of the respective scheme for minimum SIP inalment, minimum SIP period a aggregate amount of invement.' 4. PARTICULARS OF BANK ACCOUNT (MANDATORY) Account Number Account Type Name of Sole / 1 Account Holder Name of 2 Account Holder Name of 3 Account Holder Name of Bank Branch & City 2 Applicant/Guaian/Authorised Signatory/POA MICR Code (Maatory) IFSC Code (9 digit code next to the cheque no. MICR code arting a / or eing with 000 is not valid for ECS). (11 digit no. appearing on your cheque leaf) 3 Applicant/Guaian/Authorised Signatory/POA DECLARATION & SIGNATURE : - I/We hereby, authorise Pramerica Mutual Fu a its authorised service providers, to debit my/our above mentioned bank account directly or by ECS (debit clearing) for collection of SIP payments. (as in Bank recos) ARN code Upfront commission shall be paid directly by the inveor to the AMFI regiered Diributors based on the inveors assessment of various factors including services reered by the diributor. 2. APPLICANT INFORMATION (Refer Inruction No. 2) Application No. / Exiing Folio No. Name of Sole/1 Applicant ARN - CA SB NRO NRE FCNR Sole/1 Account Holder as in Bank Recos Sub broker ARN code Incase the Employee Unique Identification Number (EUIN) box has been left blank please refer point 3 related to EUIN. 5. BANKER S ATTESTATION (Maatory, if your Fir SIP inalment is through a Dema Draft/Pay Oer) Certified that the signature of account holder a the Details of Bank account are correct as per our recos Signature verification reque (To be retained by the Cuomer's Bank) Sub broker code (as allotted by ARN holder) SIP Period : (please üa or B) Till I/We inruct to discontinue the SIP (A) No. of Inalments (B) 2 Account Holder as in Bank Recos Employee Unique Identification Number (EUIN) Please mention Enrolment Period From To M M Y Y M M Y Y Please Pif the EUIN space is left blank: I/We hereby confirm that the EUIN box has been intentionally left blank by me/us as this is an execution-only transaction without any interaction or advice by the employee/relationship manager/sales person of the above diributor or notwithaing the advice of in-appropriateness, if any, provided by the employee/relationship manager/sales person of the diributor a the diributor has not charged any advisory fees on this transaction. Pin Maatory to submit a cancelled cheque leaf of the bank account mentioned here. (Refer General Guidelines 2B) * (Refer Inruction No. 4) Mention your Core Banking Syem (CBS) Account Number (if applicable). Please check with your bank, if you do not have the same. 3 Account Holder as in Bank Recos Signature of Authorised Official from Bank (Bank amp a date) (Refer Inruction No. 4(e)) AUTHORISATION OF THE BANK ACCOUNT HOLDER The Branch Manager, This is to inform you that I/We have regiered for making payment towas my invements in Pramerica Mutual Fu by debit to my /our above account directly or through ECS (Debit Clearing). I/We hereby authorize to honour such payments a have signed a eorsed the Maate Form. Further, I authorize my representative (the bearer of this form) to get the above Maate verified & executed. Maate verification charges, if any, may be charged to my/our account. Thanking you, (as in Bank recos) Sole/1 Account Holder as in Bank Recos 2 Account Holder as in Bank Recos 3 Account Holder as in Bank Recos 21