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

Transcription

1 A I A I R (To be used / diributed with Key Information emoraum) Inveors mu read the Key Information emoraum, Inructions a Product Labeling before completing this Form. Please read the inructions before filling up the Application Form. Tick ( ) whichever is applicable, rike out whichever is not required. ISTRIBUT INFATION ARN code ARN-008 TRANSACTION CHARGES F APPLICATIONS THROUGH ISTRIBUTS ONL I confirm that I am a Fir time inveor in utual Fus. EXISTING FOLIO NUBER RIA code Application. Incase the EUIN box has been left blank, please refer the point related to EUIN in the eclaration & Signatures section overleaf. Upfront commission shall be paid directly by the inveor to the AFI regiered diributor, based on the inveor's assessment of various factors, including the service reered by the diributor. SOLE / FIRST APPLICANT'S ETAILS ARN - Sub broker ARN code Sub broker code (as allotted by ARN holder) (Please any one of the below) I confirm that I am an exiing inveor in utual Fus. Please ensure /OB/Pin Code/obile/Geer mention is exact match as per Aadhaar reco. Employee Unique Identification Number (EUIN) The details in our recos uer the folio number mentioned alongside will apply for this application. Geer # (please ) ale Female ate of Birth (OB) # Proof of OB of inor enclosed (please ) Passport Birth Certificate Other please specify CKC I. Aadhaar/UIAI Enrollment. # (if Sole/ Fir applicant is a inor) / Contact Person (For n Iividuals) r s /s ailing Address [P. O. Box Address is not sufficient] Pincode (aatory) State Country City Phone (Off.) Fax. obile. # As per Aadhaar Phone (Res) I Overseas Address (aatory in case of NRI/ FII applicant, in addition to mailing address) State Country Zip Code # Status of the Fir Applicant (aatory, please ) Resident Iividual NRI-Repatriation NRI-n Repatriation Partnership Tru HUF AOP PIO Company FIIs inor through guaian Body Corporate Society/Club Sole Proprietorship n Profit Organisation Others (please specify) OE OF HOLING Single Anyone or Survivor Joint (efault option) # aatory SECON APPLICANT'S ETAILS r s THIR APPLICANT'S ETAILS r s POWER OF ATTNE (POA) HOLER ETAILS (If invement is being made by a Conituted Attomey) r s Iividual client who has regiered uer Central KC Recos Regiry (CKCR) has to fill the 4 digit CKC Identification Number (CIN) # aatory FIRST APPLICANT'S BANK ACCOUNT ETAILS (aatory) (Please attach copy of cancelled cheque) of the Bank Branch Account. Account Type Savings Current NRO NRE Others Bank Address Pincode State City ICR Code (9 digits) *IFSC Code for NEFT / RTGS *This is an igit Number, kily obtain it from your Bank Branch.

2 KC etails (aatory) Occupation [Please tick ( )] Professional Agriculturi Retired Professional Agriculturi Retired Professional Agriculturi Retired Gross Annual Income [Please tick ( )] Others [Please tick ( )] Below Lac -5 Lacs 5-0 Lacs 0-5 Lacs >5 Lacs- crore > crore Net worth (aatory for n-iividuals) ` Below Lac -5 Lacs 5-0 Lacs 0-5 Lacs >5 Lacs- crore > crore Net worth ` Below Lac -5 Lacs 5-0 Lacs 0-5 Lacs >5 Lacs- crore > crore Net worth ` INVESTENT & PAENT ETAILS The name of the fir/ sole applicant mu be pre-printed on the cheque. (Inveors applying uer irect Plan mu mention "irect" again the Scheme name.) Scheme HFL PRAERICA Option Growth* ivide *efault Option ivide Facility Payout Re-Invement ivide Sweep Facility (SF) ivide Frequency: To Scheme HFL PRAERICA ( Please refer to SI / addeum thereof for schemes available for SF) ode of Invement Lump Sum Only SIP Only (Fir invement cheque is optional) Lump Sum with SIP icro Invement Payment Type [Please ] n-thi Party Payment Thi Party Payment (Please attach Thi Party Payment eclaration Form ) Amount of Cheque / / Payment Inrument / RTGS/ NEFT in figures (`) Charges, if any Net Cheque/ Amount as on Cheque / / Payment Inrument. & ate (t older than year) For Iividuals [Please tick ( )]: I am Politically Exposed Person (PEP)^ I am Related to Politically Exposed Person (RPEP) t applicable For n-iividuals [Please tick ( )] (Please attach maatory Ultimate Beneficial Ownership (UBO) declaration form - Refer Inruction. 4 (F)): (i) Foreign Exchange / oney Changer Services ES NO; (ii) Gaming / Gambling / Lottery / Casino Services ES NO; (iii) oney Leing / Pawning - ES NO I am Politically Exposed Person (PEP)^ I am Related to Politically Exposed Person (RPEP) t applicable I am Politically Exposed Person (PEP)^ I am Related to Politically Exposed Person (RPEP) t 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. rawn on Bank / Branch SIP Invement (Please any one) onthly Quarterly SIP THROUGH AUTO EBIT (ECS/irect ebit/nach) Please also fill a attach the SIP Auto ebit Facility Form SIP THROUGH POST-ATE CHEQUE Seco & subsequent Inalment cheque etails Cheque s. From To ated From To EAT ACCOUNT ETAILS National Securities epository Limited epository Participant P I. r / s / /s Beneficiary A/c. Seco & Subsequent Inalment etails: (All subsequent inalment amounts should be same as the fir inalment.) Inalment Amount ` SIP ate: (Any date of the month except 9/30/3) Till I/We inruct to discontinue the SIP Please mention Enrolment Period: From To Central epository Services (Iia) Limited epository Participant r / s / /s Target I. NOINATION ETAILS (To be filled in by iividuals singly or jointly. aatory only for Inveors who opt to hold units in n-emat Form) I/We do not wish to nominate I/We do hereby nominate the uermentioned minee(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 minee(s) a Signature of the minee(s) acknowledging receipt thereof, shall be a valid discharge by the AC/utual Fu/Truees. a Address of the miness(s) minee minee minee 3 ECLARATION AN SIGNATURES ate of Birth & Address of (to be furnished in case the nominee is minor) Signature of / minee Proportion (%) by which the units will be shared by each nominee (% to aggregate to 00%) I/We hereby confirm a declare as uer:- I/We have read a uerood the contents of the Statement of Additional Information of HFL Pramerica utual Fu a the Scheme Information ocument(s)/key Information memoraum of the respective Scheme(s) aaddea thereto, issued from time to time a the Inructions. I/We, hereby apply to thetruee of HFL Pramerica utualfu for allotment of units of the respective Scheme(s) of HFL Pramerica utual 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 Act, Regulation, Rule, tification, irections or any other applicablelaws enacted by the Government of Iia or any Statutory Authority. The ARN 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 utual 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 KC process to the satisfaction of the AC/HFL Pramerica utual Fu, I/We hereby authorise the AC/HFL Pramerica utual Fu to redeem the units again the fus inveed by me/us at the applicable NAV as on the date of such redemption. I/We agree that HFLPramerica utual Fu can debit from my Folio Transaction Charges as applicable. I/We agree to notify HFL Pramerica Asset anagers Private Limited (erwhile Pramerica Asset anagers Private Limited) immediately in the event the information in the self-certification changes. For inveors inveing in irect Plan: I/We hereby agree that the AC has not recommeed or advised me/us regaing the suitability or appropriateness of the product/scheme/plan. Applicable to icro Inveors: I/We hereby declare that I/We do not have any exiing icro invements which together with the current application will result in aggregate invements exceeding Rs. 50,000 in a year. Applicable to NRls: I/We confirm that I am/we are n-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 n-resident External/Oinary Account/FCNR Account(s). FATCA a CRS eclaration: 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 utual Fu, its Sponsor, Asset anagement 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-IN), the tax /revenue authorities a other inveigation agencies without any obligation of advising me/us of the same. Aadhaar Updation Consent: I/We hereby provide my/our consent in accoance with Aadhaar Act, 06 a regulation made thereuer, for (i) collecting, oring a usage (ii) validating/authenticating a (iii) updating my/our Aadhaar number(s) in accoance with the Aadhaar Act, 06 (a regulations made thereuer) a PLA. I/We hereby provide my/our consent for sharing/disclosing of my Aadhaar number(s) including demographic information with the asset management companies of SEBI regiered mutual fu a their Regirar a Transfer Agent (RTA) for tha purpose of updating the same in my/our folios. 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. By providing Id, I/We agree to receive the IPIN for INVEST NOW regiration on the same. Signature(s) Applicant Signature / Signature / POA Signature / Thumb Impression Applicant Signature / POA Signature / Thumb Impression 3 Applicant Signature / POA Signature / Thumb Impression : / PEKRN / CKIN (aatory) HFL Pramerica Asset anagers Private Limited (erwhile Pramerica Asset anagers Private Limited) Nirlon House, floor, r. Annie Besant Road, Worli, umbai Tel Fax CIN : U74900H008FTC8709

3 One Time aate Form (Including SIP regiration/sip Top up facility) Inveors mu read the Key Information emoraum a the inructions before completing this Form.. ISTRIBUT INFATION ARN code ARN-008 RIA code ARN - Sub broker ARN code Sub broker code (as allotted by ARN holder) Employee Unique Identification Number (EUIN) In case 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 AFI regiered iributors based on the inveors' assessment of various factors including services reered by the diributor. 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.. APPLICANTS ETAILS (ANAT) (aatory to submit FATCA & CRS declaration form if not submitted earlier or in case of change in atus.) (Refer Section uer inructions) Sole/Fir Unit Holder Fir iddle La Folio. 3. SIP ETAILS (ANAT) New SIP Regiration SIP renewal Change in OT (for a SIP regiered earlier) OT ebit aate is already regiered in the folio. ebit Bank OT ebit aate to be regiered in the folio. Scheme Plan Option ( ) Growth ivide Payout ivide Reinvement ivide Sweep ivide Frequency Payment Type [Please ( )] Inalment etails Amt. (`) n-thi Party Payment Account. Thi Party Payment (Please attach Thi Party Payment eclaration Form ) Chq/. ated: rawn on: SIP Invement (Please any one) onthly SIP THROUGH AUTO EBIT (ECS/irect ebit/nach) Quarterly SIP THROUGH POST-ATE CHEQUE Seco a subsequent Inalment cheque etails Cheque s. From To ated From To Seco a Subsequent Inalment etails: (All subsequent inalment amounts should be same as the fir inalment.) Inalment Amount ` SIP ate: (Any date of the month except 9 / 30 / 3) Till I/We inruct to discontinue the SIP Please mention Enrolment Period: From To SIP Top Up (Optional) - Available only for invements effected through Auto ebit. Top Up Amount ` Refer Inructions Top Up Frequency Half early early* Top Up to continue till SIP amount reaches^ ` Top Up to continue till# ^ SIP Top Up will cease once the mentioned amount is reached. *efault option if not selected # It is the date from which SIP Top Up amount will cease ** PEKRN required for icro invements upto Rs. 50,000 in a year (Please any one) ECLARATION & SIGNATURE: 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 in Auto ebit. 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 AC, about any changes in my/our bank account. l/we have read a agreed to the terms a coitions mentioned. l/we confirm that the ARN 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 utual Fus from among which the Scheme is recommeed to me/us. For inveors inveing in irect Plan: l/we hereby agree that the AC has not recommeed or advised me/us regaing the suitability or appropriateness of the product/scheme/plan. Applicable to icro Inveors (elete if not applicable): l/we hereby declare that l/we do not have any exiing icro Invements which together with the current application will result in aggregate invements exceeding ` 50,000 in a year. SIGNATURE(S) (Applicants mu sign as per Common Application Form) Sole/ Applicant//Authorised Signatory/POA //Authorised Signatory/POA 3 Applicant//Authorised Signatory/POA 4. OT EBIT ANATE F F NACH / ECS / AUTO EBIT ONE TIE ANATE F (Please read Inruction no. 4 overleaf) (*aatory field) CREATE OIF CANCEL URN Sponsor Bank Code I/We hereby authorize Bank a/c number* For office use CITI000PIGW HFL PRAERICA UTUAL FUN CITI With Bank* of cuomers bank IFSC* ICR* an amount of Rupees* Amount in wos ` In Figures FREQUENC* thly Qtly H-rly As & When presented EBIT TPE* Fixed Amount aximum Amount Reference - Reference - Application no. / Folio number Utility Code to debit (Please ) Phone I 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. PERIO* From To Signature of fir account holder Signature of seco account holder Until Cancelled of fir account holder* of seco account holder* ate* SB / CA / CC / SB-NRE / SB-NRO / Other Signature of thi 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.

4 Additional KC Information a FATCA & CRS Annexure for Iividual Accounts (Including Sole Proprietor) (Refer to inructions) FIRST / SOLE APPLICANT / GUARIAN Exempt KC Ref. (PEKRN) Iian U.S. Tax Residence Address (for KC address): Residential Regiered Are you a tax resident (i.e., are you assessed for Tax) in any other country outside Iia? es If es, please fill for ALL (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. A : The country where the Account Holder is liable to pay tax does not issue Tax Identification Number to its residents. B : TIN required. (Select this reason ly 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. SECON APPLICANT Exempt KC Ref. (PEKRN) Iian U.S. Tax Residence Address (for KC address): Residential Regiered Are you a tax resident (i.e., are you assessed for Tax) in any other country outside Iia? es If es, please fill for ALL (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.

5 THIR APPLICANT Exempt KC Ref. (PEKRN) Iian U.S. Tax Residence Address (for KC address): Residential Regiered Are you a tax resident (i.e., are you assessed for Tax) in any other country outside Iia? es If es, please fill for ALL (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. POWER OF ATTNE (POA) HOLER Exempt KC Ref. (PEKRN) Iian U.S. Tax Residence Address (for KC address): Residential Regiered Are you a tax resident (i.e., are you assessed for Tax) in any other country outside Iia? es If es, please fill for ALL (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. CERTIFICATION 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 FATCA & 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. SIGNATURES Fir / Sole Applicant / Seco Applicant Thi Applicant ate Place