A I A I R (To be used / distributed with Key Information Memorandum)

Transcription

1 I I R (To be used / diributed with Key Information Memoraum) Inveors mu read the Key Information Memoraum, Inructions a Product Labeling before completing this Form. Please read the inructions before filling up the pplication Form. Tick ( ) whichever is applicable, rike out whichever is not required. DISTRIUTOR INFORMTION RN code pplication Incase the EUIN box has been left blank, please refer the point related to EUIN in the Declaration & Signatures section overleaf. Upfront commission shall be paid directly by the inveor to the MFI regiered diributor, based on the inveor's assessment of various factors, including the service reered by the diributor. TRNSCTION CHRGES FOR PPLICTIONS THROUGH DISTRIUTORS ONLY (Please any one of the below) I confirm that I am a Fir time inveor in Mutual Fus. OR I confirm that I am an exiing inveor in Mutual Fus. EXISTING FOLIO NUMER SOLE / FIRST PPLICNT'S DETILS Mr Ms M/s RI code RN - RN - Sub broker RN code Sub broker code (as allotted by RN holder) Employee Unique Identification Number (EUIN) RN E07739 E07739 The details in our recos uer the folio number mentioned alongside will apply for this application. Date of irth (DO) (Maatory for Minor) Proof of DO of Minor enclosed (please ) Passport irth Certificate Other please specify (if Sole/ Fir applicant is a Minor) / Contact Person (For Non Iividuals) Mr Ms M/s Mailing ddress [P. O. ox ddress is not sufficient] City Pincode (Maatory) State Country Phone (Off.) Fax Mobile Phone (Res) ID Overseas ddress (Maatory in case of NRI/ FII applicant, in addition to mailing address) State Country Zip Code Status of the Fir pplicant (Maatory, please ) Resident Iividual NRI-Repatriation NRI-Non Repatriation Partnership Tru HUF OP PIO Company FIIs Minor through guaian ody Corporate Society/Club Sole Proprietorship Non Profit Organisation Others (please specify) MODE OF HOLDING Single OR nyone or Survivor OR Joint (Default option) SECOND PPLICNT'S DETILS Mr Ms THIRD PPLICNT'S DETILS Mr Ms POWER OF TTORNEY (PO) HOLDER DETILS (If invement is being made by a Conituted ttomey) Mr Ms Iividual client who has regiered uer Central Recos Regiry (CR) has to fill the 4 digit C Identification Number (CIN) FIRST PPLICNT'S NK CCOUNT DETILS (Maatory) (Please attach copy of cancelled cheque) of the ank ranch ccount ccount Type Savings Current NRO NRE Others ank ddress Pincode State City MICR Code (9 digits) *IFSC Code for NEFT / RTGS *This is an Digit Number, kily obtain it from your ank ranch. CKNOWLEDGMENT SLIP (To be filled in by the inveor) n pplication for scheme long with Cheque / DD / UTR Dated Drawn on (ank) DHFL PRMERIC mount ` pplication Signature, Stamp & Date V

2 Details (Maatory) Gross nnual Income [Please tick ( )] Others [Please tick ( )] elow Lac -5 Lacs 5-0 Lacs 0-5 Lacs >5 Lacs- crore > crore OR Net worth (Maatory for Non-Iividuals) ` elow Lac -5 Lacs 5-0 Lacs 0-5 Lacs >5 Lacs- crore > crore OR Net worth ` elow Lac -5 Lacs 5-0 Lacs 0-5 Lacs >5 Lacs- crore > crore OR Net worth ` INVESTMENT & PYMENT DETILS The name of the fir/ sole applicant mu be pre-printed on the cheque. (Inveors applying uer Direct Plan mu mention "Direct" again the Scheme name.) Scheme DHFL PRMERIC Option Growth* Divide *Default Option Divide Facility Payout Re-Invement Divide Sweep Facility (DSF) Divide Frequency: To Scheme DHFL PRMERIC ( Please refer to SID / addeum thereof for schemes available for DSF) Mode of Invement Lump Sum Only SIP Only (Fir invement cheque is optional) Lump Sum with SIP Micro Invement Payment Type [Please ] Non-Thi Party Payment Thi Party Payment (Please attach Thi Party Payment Declaration Form ) mount of Cheque / DD / Payment Inrument / RTGS/ NEFT in figures (`) Occupation [Please tick ( )] DD Charges, if any Net Cheque/ DD mount as on Professional griculturi Retired Professional griculturi Retired Professional griculturi Retired Cheque / DD / Payment Inrument & Date (Not older than year) For Iividuals [Please tick ( )]: I am Politically Exposed Person (PEP)^ I am Related to Politically Exposed Person (RPEP) Not applicable For Non-Iividuals [Please tick ( )] (Please attach maatory Ultimate eneficial Ownership (UO) declaration form - Refer Inruction 4 (F)): (i) Foreign Exchange / Money Changer Services YES NO; (ii) Gaming / Gambling / Lottery / Casino Services YES NO; (iii) Money Leing / Pawning - YES NO I am Politically Exposed Person (PEP)^ I am Related to Politically Exposed Person (RPEP) Not applicable I am Politically Exposed Person (PEP)^ I am Related to Politically Exposed Person (RPEP) Not applicable ^ PEP are defined as iividuals who are or have been entrued with prominent public functions in a foreign country, e.g., Heads of States or of Governments, senior politicians, senior Government/judicial/ military officers, senior executives of ate owned corporations, important political party officials, etc. Drawn on ank / ranch SIP Invement (Please any one) Monthly Quarterly SIP THROUGH UTO DEIT (ECS/Direct Debit/NCH) Please also fill a attach the SIP uto Debit Facility Form OR SIP THROUGH POST-DTED CHEQUE Seco & subsequent Inalment cheque Details Cheque Nos. From To Dated From D D MMYYYY To DDMMYYYY DEMT CCOUNT DETILS Depository Participant DP ID National Securities Depository Limited Mr / Ms / M/s eneficiary /c Seco & Subsequent Inalment Details: (ll subsequent inalment amounts should be same as the fir inalment.) Inalment mount ` SIP Date (Please ): 7th 0th 5th 5th 8th ll 7 dates SIP Period (Please ): Till I/We inruct to discontinue the SIP of inalments Please mention Enrolment Period: From MMYY Y Y To M MYYY Y Depository Participant Target ID Central Depository Services (Iia) Limited Mr / Ms / M/s NOMINTION DETILS (To be filled in by iividuals singly or jointly. Maatory only for Inveors who opt to hold units in Non-Demat Form) I/We do not wish to nominate OR I/We do hereby nominate the uermentioned Nominee(s) to receive the Units allotted to my/our credit in my/our folio in the event of my/our death. I/We also uera that all payment a settlements made to such Nominee(s) a Signature of the Nominee(s) acknowledging receipt thereof, shall be a valid discharge by the MC/Mutual Fu/Truees. a ddress of the Nominess(s) Nominee Nominee Nominee 3 DECLRTION ND SIGNTURES Date of irth & ddress of (to be furnished in case the nominee is minor) Signature of / Nominee I / We hereby confirm a declare as uer :- I/We have read a uerood the contents of the Statement of dditional Information of DHFL Pramerica Mutual Fu a the Scheme Information Document(s)/Key Information memoraum of the respective Scheme(s) a ddea thereto, issued from time to time a the Inructions. I/We, hereby apply to the Truee of DHFL Pramerica Mutual Fu for allotment of units of the respective Scheme(s) of DHFL Pramerica Mutual Fu, as iicated above a agree to abide by the terms, coitions, rules a regulations of the relevant Scheme(s). I/We have neither received nor been iuced by any rebate or gifts, directly or iirectly in making this invement. I/We declare that I am/we are authorised to make this invement a the amount inveed in the Scheme is through legitimate sources only a is not designed for the purpose of contravention or evasion of any ct, Regulation, Rule, Notification, Directions or any other applicable laws enacted by the Government of Iia or any Statutory uthority. The RN holder has disclosed to me/us all the commissions (in the form of trail commission or any other mode), payable to him for the different competing Schemes of various Mutual Fus from among which the Scheme(s) is/are being recommeed to me/us. I/We declare that the information given in this application form is correct, complete a truly ated. In the event of my/our not fulfiling the process to the satisfaction of the MC/DHFL Pramerica Mutual Fu, I/We hereby authorise the MC/DHFL Pramerica Mutual Fu to redeem the units again the fus inveed by me/us at the applicable NV as on the date of such redemption. I/We agree that DHFL Pramerica Mutual Fu can debit from my Folio Transaction Charges as applicable. I/We agree tonotifydhflpramerica sset ManagersPrivate Limited (erwhilepramerica sset Managers Private Limited)immediately inthe event the information inthe self-certificationchanges. For inveors inveing in Direct Plan: I/We hereby agree that the MC has not recommeed or advised me/us regaing the suitability or appropriateness of the product/scheme/plan. pplicable to Micro Inveors: I/We hereby declare that I/We do not have any exiing Micro invements which together with the current application will result in aggregate invements exceeding ` 50,000 in a year. pplicable to NRls: I/We confirm that I am/we are Non-Resident(s) of Iian Nationality/Origin a I/We hereby confirm that the fus for subscription have been remitted from abroad through normal banking channels or from fus in my/our Non-Resident External/Oinary ccount/fcnr ccount(s). FTC a CRS Declaration: I/We hereby acknowledge a confirm that the information provided in this form is 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, sset Management Company, truees, their employees ('the uthorised Parties') orany Iianorforeign governmentaloratutory orjudicialauthorities/agenciesincluding but not limited tothe Financial IntelligenceUnit-Iia(FIU-IND),the tax /revenueauthorities a other inveigation agencieswithout any obligationofadvisingme/us ofthe same. Please if 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. Please I/We would not like to regier for INVEST NOW to transact online as per the terms & coitions for this facility. y providing Id, I/We agree to receive the IPIN for INVEST NOW regiration on the same. Proportion (%) by which the units will be shared by each nominee (% to aggregate to 00%) pplicant Signature / Signature / PO Signature / Thumb Impression Signature / PO Signature / Thumb Impression 3 pplicant Signature / PO Signature / Thumb Impression DHFL Pramerica sset Managers Private Limited (erwhile Pramerica sset Managers Private Limited) Nirlon House, floor, Dr. nnie esant Road, Worli, Mumbai Tel Fax CIN : U74900MH008FTC8709

3 dditional Information a FTC & CRS nnexure for Iividual ccounts (Including Sole Proprietor) (Refer to inructions) FIRST / SOLE PPLICNT / GURDIN OR Exempt Ref (PEKRN) Nationality: Iian U.S. Tax Residence ddress (for address): Residential Regiered re you a tax resident (i.e., are you assessed for Tax) in any other country outside Iia? If Yes, please fill for LL (other than Iia) in which you are a Resident for tax purposes i.e., where you are a Citizen / Resident / Green Ca Holder / Tax Resident in the respective (TIN or other, please specify) the reason, or C (as defined below) : The country where the ccount Holder is liable to pay tax does not issue Tax Identification Number to its residents. : No TIN required. (Select this reason Noly if the authorities of the respective country of tax residence do not require the TIN to be collected) C : others; please ate the reason threof. Occupation Details Service Private Sector Public Sector Professional Gross nnual Income elow Lac - 5 Lacs 5-0 Lacs 0-5 Lacs >5 Lacs - Crore > Crore OR Net-worth (Maatory for Non-Iividuals) ` as on (Not older than year) *PEP are defined as iividuals who are or have been extrued with prominent publications in a foreign country, e.g., Heads of States or of Governments, senior politicians, senior Government/judicial/ military officers, senior executives of ate owned corporations, important political party officials, etc. SECOND PPLICNT OR Exempt Ref (PEKRN) Nationality: Iian U.S. Tax Residence ddress (for address): Residential Regiered re you a tax resident (i.e., are you assessed for Tax) in any other country outside Iia? If Yes, please fill for LL (other than Iia) in which you are a Resident for tax purposes i.e., where you are a Citizen / Resident / Green Ca Holder / Tax Resident in the respective (TIN or other, please specify) the reason, or C (as defined below) : The country where the ccount Holder is liable to pay tax does not issue Tax Identification Number to its residents. : No TIN required. (Select this reason Noly if the authorities of the respective country of tax residence do not require the TIN to be collected) C : others; please ate the reason threof. Occupation Details Service Private Sector Public Sector Professional Gross nnual Income elow Lac - 5 Lacs 5-0 Lacs 0-5 Lacs >5 Lacs - Crore > Crore OR Net-worth (Maatory for Non-Iividuals) ` as on (Not older than year) *PEP are defined as iividuals who are or have been extrued with prominent publications in a foreign country, e.g., Heads of States or of Governments, senior politicians, senior Government/judicial/ military officers, senior executives of ate owned corporations, important political party officials, etc.

4 THIRD PPLICNT OR Exempt Ref (PEKRN) Nationality: Iian U.S. Tax Residence ddress (for address): Residential Regiered re you a tax resident (i.e., are you assessed for Tax) in any other country outside Iia? If Yes, please fill for LL (other than Iia) in which you are a Resident for tax purposes i.e., where you are a Citizen / Resident / Green Ca Holder / Tax Resident in the respective (TIN or other, please specify) the reason, or C (as defined below) : The country where the ccount Holder is liable to pay tax does not issue Tax Identification Number to its residents. : No TIN required. (Select this reason Noly if the authorities of the respective country of tax residence do not require the TIN to be collected) C : others; please ate the reason threof. Occupation Details Service Private Sector Public Sector Professional Gross nnual Income elow Lac - 5 Lacs 5-0 Lacs 0-5 Lacs >5 Lacs - Crore > Crore OR Net-worth (Maatory for Non-Iividuals) ` as on (Not older than year) *PEP are defined as iividuals who are or have been extrued with prominent publications in a foreign country, e.g., Heads of States or of Governments, senior politicians, senior Government/judicial/ military officers, senior executives of ate owned corporations, important political party officials, etc. POWER OF TTORNEY (PO) HOLDER OR Exempt Ref (PEKRN) Nationality: Iian U.S. Tax Residence ddress (for address): Residential Regiered re you a tax resident (i.e., are you assessed for Tax) in any other country outside Iia? If Yes, please fill for LL (other than Iia) in which you are a Resident for tax purposes i.e., where you are a Citizen / Resident / Green Ca Holder / Tax Resident in the respective (TIN or other, please specify) the reason, or C (as defined below) : The country where the ccount Holder is liable to pay tax does not issue Tax Identification Number to its residents. : No TIN required. (Select this reason Noly if the authorities of the respective country of tax residence do not require the TIN to be collected) C : others; please ate the reason threof. Occupation Details Service Private Sector Public Sector Professional Gross nnual Income elow Lac - 5 Lacs 5-0 Lacs 0-5 Lacs >5 Lacs - Crore > Crore OR Net-worth (Maatory for Non-Iividuals) ` as on (Not older than year) *PEP are defined as iividuals who are or have been extrued with prominent publications in a foreign country, e.g., Heads of States or of Governments, senior politicians, senior Government/judicial/ military officers, senior executives of ate owned corporations, important political party officials, etc. CERTIFICTION I hereby confirm that the information provided hereinabove is true, correct, a complete to the be of my knowledge a belief a the I shall be solely liable a responsible for the information submitted above. I also confirm that I have read a uerood the FTC & CRS Terms a Coitions below a hereby accept the same. I also uertake to keep you informed in writing about any changes / modification to the above information in future within 30 days of the same being effective a also uertake to provide any other additional information as may be required any intermediary or by domeic or overseas regulators / Tax authorities. SIGNTURES Fir / Sole pplicant / Seco pplicant Thi pplicant Date Place

5 SIP UTO DEIT FCILITY REGISTRTION CUM MNDTE FORM Please read the Scheme information Document of the respective scheme for minimum SIP inalment, minimum SIP period a aggregate amount of invement.. DISTRIUTOR INFORMTION RN code RI code RN RN - RN - Sub broker RN code Sub broker code (as allotted by RN holder) Employee Unique Identification Number (EUIN) Incase the Employee Unique Identification Number (EUIN) box has been left blank please refer point 3 related to EUIN. Upfront commission shall be paid directly by the inveor to the MFI regiered Diributors based on the inveors' assessment of various factors including services reered by the diributor.. PPLICNT INFORMTION pplication / Exiing Folio of Sole/ pplicant 3. SIP DETILS (Fir SIP cheque a subsequent via uto Debit Facility) Scheme DHFL PRMERIC *Option Growth Divide *Divide Facility Payout Re-Invement Divide Sweep Facility (DSF) *Divide Frequency SIP Frequency (Please any one) Monthly Quarterly SIP Date : 7th 0th 5th 5th 8th ll 7 dates Inalment mount (In figures) ` * Please refer SID for default option Please refer to SID / addeum thereof for schemes available for DSF SIP Period (Please or ) Till I/We inruct to discontinue the SIP () of Inalments () E07739 Please mention Enrolment Period: From M M YYY Y To M MYY Y Y DECLRTION & SIGNTURE: l/we hereby declare that the particulars given above are correct a express my willingness to make payments referred above to debit my/our account directly or through participation inuto Debit. If the transaction his delayed or not effected at all for reasons of incomplete or incorrect information. l/we would not hold the user initution responsible. l/we will also inform MC, about any changes in my/our bank account. l/we have read a agreed to the terms a coitions mentioned. l/we confirm that thern Holder has disclosed to me/us all the commissions (in the form of trail commission or any Other mode), payable to him for different competing Schemes of various Mutual Fus from among which the Scheme is recommeed to me/us. For inveors inveing in Direct Plan: l/we hereby agree that the MC has not recommeed or advised me/us regaing the suitability or appropriateness of the product/scheme/plan. pplicable to Micro Inveors (Delete if not applicable): l/we hereby declare that l/we do not have any exiing Micro Invements which together with the current application will result in aggregate invements exceeding ` 50,000 in a year. Please if 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. uthorisation to ank: This is to inform that l/we have regiered for ECS / NCH (Debit Clearing) / Direct Debit / Staing inructions facility a that my/ourpayment towas my/our invement in DHFL Pramerica Mutual Fu shall be made from my/our below mentioned bank account with your ank. l/we authorize the representatives of DHFL Pramerica Mutual Fu carrying this maate form to get it verified a executed. l/we authorize the bank to debit my account for any charges towas maate verification, regiration, transactions, returns, etc. as applicable. SIGNTURE (S) (pplicants mu sign as per Common pplication Form) Sole/ pplicant//uthorised Signatory/PO //uthorised Signatory/PO 3 pplicant//uthorised Signatory/PO 4. NKER S TTESTTION (Maatory, if an original cancelled cheque leaf of SIP maate is not provided) Certified that the signature of account holder a the Details of ank account are correct as per our recos Signature verification reque (To be retained by the Cuomer's ank) Signature of uthorised Official from ank (ank amp a date) CRETE MODIFY CNCEL UMRN Sponsor ank Code I/We hereby authorize ank a/c number* MNDTE INSTRUCTION FORM (Please read Inruction no. 4 overleaf) (*Maatory field) Utility Code With ank* of cuomers bank IFS MICR* an amount of Rupees* SIP inalment amount in wos ` In Figures FREQUENCY* Mthly Qtly H-Yrly s & When presented DEIT TYPE* Fixed mount Maximum mount Reference - pplication no. / Folio number Date* DHFL PRMERIC MUTUL FUND to debit (Please ) S / C / CC / S-NRE / S-NRO / Other Phone No Reference - ID I agree for the debit of maate processing charges by the bank whom I am authorizing to debit my account as per late schedule of charges of the bank. PERIOD* From Signature of fir account holder Signature of seco account holder Signature of thi account holder To OR Until Cancelled of fir account holder* of seco account holder* of thi account holder* This is to confirm that the declaration has been carefully read, uerood & made by me/us. I am authorizing the User entity/ Corporate to debit my account. I have uerood that I am authorized to cancel/ame this maate by appropriately communicating the cancellation / amement reque to the User entity/ corporate or the bank were I have authorized the debit.