APPLICATION FORM (Please fill in BLOCK Letters)

Transcription

1 Canara Robeco utual Fund nvestment anager : Canara Robeco Asset anagement Co. Ltd. CN No : U6599H1993PLC713 Construction House, 4th Floor, 5, Walchand Hirachand arg, Ballard Estate, umbai 4 1. Tel.: , Fax: , Application No. APPLCATON FOR (Please fill in BLOCK Letters) Broker Name ARN Sub Broker Code ARN Employee Unique dentification Number Bank Serial No. Branch Stamp Receipt Date Upfront commission shall be paid directly by the investor to the AF registered Distributors based on the investors assessment of various factors including the service rendered by the distributor. Declaration for execution-only transaction (only where EUN box is left blank) (Refer nstruction 28): We hereby confirm that the EUN box has been intentionally left blank by meus as this transaction is executed without any interaction or advice by the employeerelationship manager sales person of the above distributorsub broker or notwithstanding the advice of in-appropriateness, if any, provided by the employee relationship managersales person of the distributorsub broker. Signature of 1st Applicant Guardian Signature of 2nd Applicant Signature of 3rd Applicant TRANSACTON CHARGES FOR APPLCATONS THROUGH DSTRBUTORS AGENTS ONL (Refer nstruction 25) confirm that am a First time investor across utual Funds. (` 15 deductible as Transaction Charge and payable to the Distributor) confirm that am an existing investor in utual Funds. (` 1 deductible as Transaction Charge and payable to the Distributor) n case the purchase subscription amount is ` 1, or more and your Distributor has opted to receive Transaction Charges, the same are deductible as applicable from the purchase subscription amount and payable to the Distributor. Units will be issued against the balance amount invested. EXSTNG UNT HOLDER NFORATON [Please fill in your Folio Number and proceed to nvestment Details and Payment Details] Folio No. The details in our records under the folio number mentioned will apply for this application. PANPEKRN AND KC COPLANCE STATUS DETALS - andatory [Refer nstruction Nos. 12 & 26] PAN PEKRN # (refer instruction) First Sole Second Applicant Third Applicant Name of 1st Unit Holder KC Compliance Status ** (if yes, attach proof) es es f the firstsole applicant is a inor, then please provide details of Natural Legal Guardian. **Refer instruction 12 APPLCANT(S) NFORATON [Refer nstruction 1] NAE OF FRST SOLE APPLCANT NOR (incase of minor their shall be no joint holder) DATE OF BRTH (andatory in case of inor) D D Father Husband's Name 1. Gross Annual ncome Details Please tick ( ) Below 1 Lac 1-5 Lacs 5-1 Lacs 1-25 Lacs 25 Lacs - 1 Crore 1 Crore & above Net-worth in ` as on (date) D D Foreign Exchange oney Changer Services ES NO Gaming Gambling Lottery Services (e.g. casinos, betting syndicates) ES NO oney Lending Pawning ES NO NAE OF SECOND APPLCANT 1. Gross Annual ncome Details Please tick ( ) Below 1 Lac 1-5 Lacs 5-1 Lacs 1-25 Lacs 25 Lacs - 1 Crore 1 Crore & above Net-worth in ` as on (date) D D Foreign Exchange oney Changer Services ES NO Gaming Gambling Lottery Services (e.g. casinos, betting syndicates) ES NO oney Lending Pawning ES NO

2 NAE OF THRD APPLCANT 1. Gross Annual ncome Details Please tick ( ) Below 1 Lac 1-5 Lacs 5-1 Lacs 1-25 Lacs 25 Lacs - 1 Crore 1 Crore & above Net-worth in ` as on (date) D D Foreign Exchange oney Changer Services ES NO Gaming Gambling Lottery Services (e.g. casinos, betting syndicates) ES NO oney Lending Pawning ES NO NAE OF THE GUARDAN (n case of first Applicant is a inor) Relation with inor Please ( ) other Father Legal Guardian Proof of DOB ( Any one andatory) Birth Certificates School Certificates ark Sheet Pass Port 1. Gross Annual ncome Details Please tick ( ) Below 1 Lac 1-5 Lacs 5-1 Lacs 1-25 Lacs 25 Lacs - 1 Crore 1 Crore & above Net-worth in ` as on (date) D D Foreign Exchange oney Changer Services ES NO Gaming Gambling Lottery Services (e.g. casinos, betting syndicates) ES NO oney Lending Pawning ES NO ode of Holding Please ( ) Anyone or Survivor Single Joint (Default option is Anyone or Survivor) POWER OF ATTORNE (PoA) HOLDER DETALS Name of POA PAN KC [Please ( ) (andatory)] Proof Attached 1. Gross Annual ncome Details Please tick ( ) Below 1 Lac 1-5 Lacs 5-1 Lacs 1-25 Lacs 25 Lacs - 1 Crore 1 Crore & above Net-worth in ` as on (date) D D Foreign Exchange oney Changer Services ES NO Gaming Gambling Lottery Services (e.g. casinos, betting syndicates) ES NO oney Lending Pawning ES NO DEAT ACCOUNT DETALS (This section to be filled only if investor wish to hold units in demat form) (Client aster List (CL) to be enclosed) (Refer instructions No. 23) Depository Participant Name DP D No. N National Securities Depository Limited (NSDL) Depository Participant Name Target D No. Central Depository Services (ndia) Limited (CDSL)

3 FATCACRS DETALS For individuals & HUF (andatory) (Refer instruction no. 29) The below information is required for all applicant(s) guardian Address Type: Residential Business Registered Office (for address mentioned in form existing address appearing in Folio) Do you have non-ndian Country[ies] of Birth Citizenship and Tax Residency? es No Please tick as applicable and if yes, provide the below mentioned information (mandatory) Sole First Applicant Guardian es No Second Applicant es No Third Applicant es No or POA es No Date of Birth Date of Birth Date of Birth Place of Birth Place of Birth Place of Birth Country of Birth Country of Birth Country of Birth Country of Citizenship Are you a US Specified Person? es No please provide Tax Payer d Country of Citizenship Are you a US Specified Person? es No please provide Tax Payer d Country of Citizenship Are you a US Specified Person? es No please provide Tax Payer d [other than ndia] Taxpayer dentification No [other than ndia] Taxpayer dentification No [other than ndia] # Please indicate all countries in which you are a resident for tax purpose and associated Taxpayer dentification number. n case of applications with PoA, the PoA holder should fill separate form to provide the above details mandatorily. ALNG ADDRESS [Please provide Full Address. P.O. Box No. may not be sufficient. Overseas nvestors will have to provide ndian Address] Local Address of 1st Applicant Taxpayer dentification No City State Pin Code Tel Office Residence obile P L E A S E U S E B L O C K L E T T E R S Overseas Correspondence address (andatory for NR F Applicant) City State Pin Code COUNCATON (Please ) We wish to receive Account StatementsAnnual ReportsQuarterly StatementsNewsletterUpdates or any other Statutory nformation via E- mailss alerts in lieu of Physical Documents. BANK ACCOUNT DETALS - andatory Name of the Bank Account No. Ac Type (please ) SAVNGS NRE CURRENT NRO FCNR Branch Address Bank Branch City State Pin Code CR Code (Please enter the 9 digit number that appears after your cheque number) FSC CODE (RTGSNEFT) (andatory for Credit via NEFTRTGS) Please attach a cancelled cheque OR a clear photo copy of a cheque (11 Character code appearing on your cheque leaf. f you do not find this on your cheque leaf, please check for the same with your Bank) REDEPTON DVDEND RETTANCE [Refer nstruction 2] t is the responsibility of the nvestor to ensure the correctness of the FSC code CR code for Electronic Payout at recipient Electronic Payment destination branch corresponding to the Bank details. f CR and FSC code for RedemptionDividend Payout is available all payouts will be automatically processed as Electronic Payout-RTGSNEFTDirect CreditNECS. SP ENROLLENT DETALS SP Amount (Rs.) Cheque Payment Enrollment Period REGULAR SP : Start onth - End onth - Frequency Please ( ) onthly Quarterly PERPETUAL SP : Start onth ear until further instruction (or) End on onth 1 2 ear SP Top Up : Rs. (in multiplies of Rs. 5-) Frequency Please ( ) Half early early PAENT ECHANS : Debit through ECS Auto Debit facility (Fill up SP Registration cum mandate form for NACHECSDirect Debit) ACKNOWLEDGENT SLP (TO BE FLLED N B THE SOLEFRST APPLCANT) Canara Robeco utual Fund nvestment anager : Canara Robeco Asset anagement Co. Ltd. Construction House, 4th Floor, 5, Walchand Hirachand arg, Ballard Estate, umbai 4 1. Application No. Received from r. s. s. An application for purchase of units of along with cheque DD as detailed overleaf. Cheques Drafts are subject to realisation. Date Stamp, Signature & Date

4 NVESTENT DETALS AND PAENT DETALS (Payment through CashOutstation Cheques not accepted) Separate cheque demand draft must be issued for each investment, drawn in favour of respective scheme name. Please write appropriate scheme name as well as the PlanOptionSub Option. Scheme Name Plan Option Growth Weekly Dividend Reinvestment Weekly Dividend Payout onthly Dividend Reinvestment onthly Dividend Payout Amount nvested (`) ChequeDD No.UTR No. (incase of NEFTRTGS) # (Type of Account Saving Current NRE NRO FCNR NRSR) * All purchases are subject to realization of chequedd. Bank and Branch and Account Number Details of Beneficial Ownership (Please tick applicable category). Ownership details to be provided if the Ownership percentageinterest in the trust of any Beneficiary is as per the threshold limit provided below. Details to be provided for each such beneficiary. (andatory for Non-ndividual) Category Unlisted company Partnership Firm Unincorporated Association Body of ndividuals Trust Foreign nvestor $$$ Ownership per >25% >15% >15% Ownership percentage of sharescapitalprofitsproperty of juridical personinterest in the Trust as on the date of the application shall be furnished by the investor. $$$ n the case of Foreign investors, the beneficial ownership will be determined as per SEB guidelines. For details refer to SArelevant Addendum. n case of any change in the beneficial ownership, the investor will be responsible to intimate CRAC its Registrar KRA as may be applicable immediately about such change. Details of Beneficial Ownership (Please attach a separate sheet with this format if the space provided is insufficient) Sr. Name Address Details of dentity such as PAN Passport % of ownership [Please attach self attested copy of PANPassport (proof of photo identity) along with application form] NONATON DETALS for ndividuals [inor HUF POA Holder Non ndividuals cannot Nominate Refer nstruction No. 13] We do here by nominate the undermentioned Nominee(s) to receive the units to my our credit in this folio no. in the event of my our death. We also understand that all payments and settlements made to such Nominee(s) and Signature of the Nominee(s) acknowledging receipt thereof, shall be a valid discharge by the AC utual Fund Trustees. We do not wish to nominate No. Nominee(s) Name Date of Birth (in case of inor) Name of the Guardian (in case of inor) Relationship with Unit % of Share 1 D D D D D D - - First Sole Applicant Guardian Second Applicant Third f the percentage of share is not mentioned then the claim will be settled equally amongst all the indicated nominee(s) DECLARATON To the trustees Canara Robeco utual Fund. We have read and understood the contents of the SA, SD and Key nformation emorandum of the Scheme. We hereby apply to the Trustees of Canara Robeco utual Fund for allotment of units of the Scheme, as indicated above and agree to abide by the terms, conditions, rules and regulations of the Scheme. We hereby declare that We are authorised to make this investment in the above mentioned Scheme (s) and that the amount invested in the scheme (s) is through legitimate sources only and does not involve and is not designed for the purpose of any contravention or evasion of any Act, Rules, Regulations, Notifications or Directions of the provisions of ncome Tax Act, Anti oney Laundering Act, Anti Corruption Act or any other applicable laws enacted by the government of ndia from time to time and we undertake to provide all necessary proof documentation, if any, required to substantiate the facts of this undertaking. have not received nor been induced by any rebate or gifts, directly or indirectly in making this investment. We authorize the Fund to disclose details of myour account and all myour transactions to the intermediately whose stamp appears on the application form. also authorize the Fund to disclose details as necessary, to the Registrar & Transfer agent(s), call centers, banks, custodians, depositories andor authorised external third parties who are involved in transaction processing, despatches, etc. for the purpose of effecting payments to meus. The ARN holder has disclosed to meus all the commissions (in the form of trail commission or any other mode), payable to him for the different competing Schemes of various utual Funds from amongst which the Scheme is being recommended to meus. We hereby declare that currently there is no subsisting orderrulingjudgment etc., in force which has been passed by of any court, tribunal, statutory authority or regulator, including SEB prohibiting or restraining meus from dealing in securities. That in the event, the above information andor any part of it isare found to be falseuntruemisleading. We will be liable for the consequences arising therefrom. We will indemnify the fund, AC, Trustee, RTA and other intermediaries in case of any dispute regarding the eligibility, validity, and authorization of myour transaction. Applicable to NRs only : We confirm that amwe are Non Resident of ndian Origin and We hereby confirm that the funds for subscription have been remitted from abroad through approved banking channels or from funds in myour Non Resident External Ordinary Account FCNR NRSR Account. nvestment in the scheme is made by me us on: Repatriation basis Non Repatriation basis. We have understood the information requirements of this Form (read along with the FATCA & CRS nstructions) and hereby confirm that the information provided by meus on this Form is true, correct, and complete. We also confirm that We have read and understood the FATCA & CRS Terms and Conditions below and hereby accept the same. First Sole Applicant Guardian Second Applicant Third Applicant To be furnished by partnership firms To, The Trustees of Canara Robeco utual Fund, Sub : Our Subscription to the Schemes of We, the undersigned, being the partner of s. a Partnership firm formed under ndian Partnership Act, 1932 do hereby jointly and severally authorise r. to subscribe an amount of ` for allotment of units of Scheme on behalf of and in the name of our firm. He is They are also authorised to encash disinvest the above units. We undertake to intimate you in writing about any change in the constitution or composition of our firm and upon such change, also arrange to lodge the specimen signatures of the partners authorised to deal with the above units. We enclose the copy of the Partnership Deed alongwith this application for subscription. Name of the partners Signatures Scheme Name Plan Option Canara Robeco Short Term Fund Growth Weekly Dividend Reinvestment Weekly Dividend Payout onthly Dividend Reinvestment onthly Dividend Payout Amount nvested (`) ChequeDD No.UTR No. (incase of NEFTRTGS) Payment Details Bank and Branch s. Karvy Computershare Pvt. Limited Karvy Plaza Karvy Selenium, Tower B, Plot No 31 & 32, Gachibowli, Financial District, Nanakramguda, Serilingampally, Hyderabad 5 32 Tel No. : crmf@karvy.com

5 SP Registration cum andate Form For investment through NACHDirect Debit (nvestors applying under Direct Plan must mention Direct in ARN column.) All sections to be completed in ENGLSH in BLACKBLUE COLORED NK and in BLOCK LETTERS Distributor Broker ARN RA Code# Sub-Broker ARN Code ARN nternal Sub-BrokerEmployee Code Employee Unique dentification No.(EUN) E48533 (of ndividual ARN holder or of employee Relationship anager Sales Person of the Distributor) #By mentioning RA Code, We authorize you to share with the nvestment Adviser the details of myour transactions in the scheme(s) of Canara Robeco ututal Fund. Declaration for execution-only transaction (only where EUN box is left blank) - We hereby confirm that the EUN box has been intentionally left blank by meus as this is an execution-only transaction without any interaction or advice by the employeerelationship managersales person of the above distributor or notwithstanding the advice of in-appropriateness, if any, provided by the employeerelationship managersales person of the distributor and the distributor has not charged any advisory fees on this transaction. Signature of SoleFirst Applicant Signature of Second Applicant Signature of Third Applicant n case the subscription (lumpsum) amount Rs. 1,- or more and your Distributor has opted to receive transactions charges, Rs. 15- (for first time mutual fund investor) or Rs. 1- (for investor other than first time mutual fund investor) will be deducted from the subscription amount and paid the distributor. Units will be issued against the balance amount invested. Upfront commission shall be paid directly by the investor to the AF registered Distributors based on the investors assessment of various factors including the service rendered by the distributor. Please tick ( ) New Registration Existing URN Cancellation The Trustee, Canara Robeco utual Fund, We have read and understood the contents of the Scheme nformation Document of the following Scheme and the terms and conditions of the SP Enrolment. NVESTOR DETALS SP DETALS Sole First Applicant s Name onthly SP Frequency : Folio No. PAN DEAT ACCOUNT DETALS (Optional) Please (ü) NSDL OR CDSL Depository Participant (DP) D Beneficiary Account Number (NSDL only) Depository Praticipant (DP) D (CDSL only) Quarterly (Default SP frequency is onthly) n case of Quarterly SP, only early frequency is available under SP TOP UP. SP Date : 1st (The application form should mandatorily accompany the latest Client investor master Demat account statement.) Scheme Name 5th 15th (Default) 2th 25th SP Start onthear SP End onthear SP TOP UP (Optional) (Tick to avail this facility) Plan Regular OPTON SUB-OPTON : Dividend Frequency: TOP UP Amount: Rs. *TOP UP amount has to be multiples of Rs. 5 only (inimum Rs. 5). Please refer instructions and Key Scheme Features for options. Sub-options and other facilities available under each scheme of the fund. SP nstallment Amount Rs. FRST NSTALLENT PAENT DETAL Half early TOP UP Frequency : Rs. in words : Cheque DD No. Date early Default Frequency is Annual t is mandatory to submit NACH (OT) NACH mandate should be provided for maximum amount in line with your Top Up mandate & SP tenure. Note : Drawn on Bank Branch City Amount Rs. OUR CONFRATON DECLARATON: we hereby declare that we do not have any existing icro SPs which together with the current application will result in a total investments exceeding Rs. 5, in a year as described in the nstruction of the common application form. The ARN holder has disclosed to meus all the commissions (in the form of trail commission or any other mode), payable to him for the different competing Schemes of various utual Funds from amongst which the Scheme is being recommended to meus. The AC would not be liable for any delay in crediting the scheme collection accounts by the Service Providers which may result in a delay in application of NAV. Signature(s) (As in Bank Records) Signature of Second Applicant Signature of Third Applicant DEBT ANDATE FOR URN Sponsor Bank Code 3 Please (ü) 7 CREATE ODF CANCEL Bank Account Number With Bank An amount of Rupees 12 Frequency C We hereby authorize 5 1 T O O O P G W Utility Code 4 to debit (Please ü) 6 Canara Robeco utual Fund C SB T CA CC FSc 1 onthly D SB-NRE SB-NRO Or CR 11 n Words 14 Date 2 D 8 Bank Name 9 Quarterly Half early early Amount in Figures 13 As & When presented Folio No. 16 Phone 18 PAN Debit Type 15 Fixed Amount ` aximum Amount agree for the debit of mandate processing charges by the bank whom am authorizing to debit my account as per latest schedule of charges of the bank. 2 PEROD NACH ANDATE NSTRUCTON FOR (Refer nstruction over leaf before Filling) Signature of SoleFirst Applicant From DD To DD Or Until Cancelled Signature Primary Account Holder Signature Account Holder Signature Account Holder This is to confirm that the declaration has been carefully read, understood & made by me us. am authorizing the user entity Corporate to debit my account. have understood that am authorized to cancel amend this mandate by appropriately communicating the cancellation amendment request to the User entity corporate or the bank where have authorised the debit.