Name & ARN Code CK-6, 2nd Flo, Sect-II, Saltlake City, Kolkata-700 091 Website : www.shriramamc.com Sub Broker Code / ARN Internal code f sub Agent/Employee Application Fm f SHRIRAM EQUITY AN EBT OPPORTUNITIES FUN EUIN Bank Serial No./Bank Stamp/ Receipt ate Upfront commission shall be paid directly by the invest to the AMFI registered istributs based on the invests assessment of various facts including the service rendered by the distribut. In case purchase/subscription amount is Rs. 10,000/- me and the invest s istribut has opted to receive Transaction Charges the same are deductable as applicable from the purchase/subscription amount and payable to the distribut. Units will issued against the balance amount invested. o 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 advice by the employee/relationship manager/sales person of the above distribut notwithstanding the advice of in-appropriateness, if any, provided by the employee/relationship manager/sales person of the distribut and the distribut has not charged any advisy fees on this transaction. s First / Sole Applicant / Guardian Second Applicant Third Applicant 1. INVESTOR EXISTING FOLIO NUMBER INFORMATION (Please fill in your folio Number and proceed to Investment etails) Folio No. 2. APPLICANT S PERSONAL ETAILS Name of First / Sole Applicant / Min* (as appearing in I proof) M A N A T O R Y ate of Birth (Mandaty in case of Min) / M M / Y Y Y Y Name of Second Applicant Name of Third Applicant Name of the Guardian # Relationship with Min (Please ü) Mother Father Legal Guardian KYC is mandaty f all invests except invests residing in the state of Sikkim and Micro SIP applicants *If the first/sole applicant is a Min, then please provide details of Natural/Legal Guardian. # (In case first applicant is a min)/contact person name (in case of non-individual) Mode of Holding (Please ü) Anyone Surviv Single Joint (efault option is Anyone Surviv) Occupation (Please ü) Status (Please ü) Business Resident Individual Min The details in our recds under the folio number mentioned will apply f this application. Service Professional Retired Student Housewife Others NRI/PIO Trust HUF Bank FIs Sole Proprietship NRO Other Company/Body Cpate FIIs Partnership Firm AOP/BOI Society 3. MAILING ARESS (Please provide Full Address, P.O. Box No. may not be sufficient, Overseas Invests will have to provide Indian Address) Local Address of 1st Applicant - Mr. Ms. M/s. City State Pincode Tel. Off. E-mail Resi. Mobile Overseas Crespondence Address (Mandaty f NRI/FII Applicant) City Country Pincode 4. COMMUNICATION (Please ü) I/We wish to receive Account Statement/Annual Repts/Quarterly Statements/Newsletter/Updates any other Statuty Infmation via E-mail/SMS alerts in lieu of Physical ocuments. I/We would like to know me about Shriram MF products over the telephone / Mailer. 5. BANK ACCOUNT ETAILS - MANATORY (F multiple banks registration please submit the Multiple Bank Registration Fm) Name of the Bank Branch Address Bank Branch City State Pincode Account No. A/C. Type (Please ü) Savings NRE Current NRO FCNR 9 digit MICR Code 11 digit IFSC Code (Mandaty f credit via NEFT/RTGS) Please attach a cancelled cheque OR a clear photo copy of a cheque ACKNOWLEGEMENT SLIP (To be filled in by the Sole / First Applicant) CK-6, 2nd Flo, Sect-II, Salt Lake City, Kolkata-700 091 Website : www.shriramamc.com SHRIRAM EQUITY AN EBT OPPORTUNITIES FUN Received from Mr. / Ms. / M/s. ate / / Stamp, & ate an application f purchase of units of SHRIRAM EQUITY AN EBT OPPORTUNITIES FUN f Rs. on date / M M / Y Y Y Y (9)
6. n UNITS IN EMAT MOE (Please ü) n NSL n CSL P I Beneficiary Account No./Client I P Name Note : Please attach the deposity transaction statement P master data indicating the P account number of the applicant. Please ensure that sequence of names as mention in the Application Fm match with that of the account held with the P. 7. POWER OF ATTORNEY (POA) POA Name PAN KYC Yes No - if investment is being made by a constitutional Attney, please submit the notarized copy of the POA 8. INVESTMENT ETAILS AN PAYMENT ETAILS-Cheque//RTGS/NEFT/Transfer (outstation cheques will be rejected) Please ü wherever applicable. Scheme Name : SHRIRAM EQUITY AN EBT OPPORTUNITIES FUN Plan : Regular * irect Option : * Growth ividend Mode of dividend : Payout * Re-investment * efault Plan / option / mode of dividend. Please refer to Item 7 of of page 7. Investment Amount (Rs.) Charges if any (Rs.) Net Amount (in wds) Mode of Payment (Please ü) Cheque Funds Transfer RTGS/NEFT Rs. (amt. in Rs.) (in wds) ) rawn on Bank Branch & City Account No. Cheque / No. ate M M Y Y Y Y IFSC Code *A/c Type - S/B NRE* Current NRO FCNR* *Kindly provide photocopy of the payment Instrument Feign Inward Remittance Certificate (FIRC) evidencing source of funds Cheque/.. to be crossed Account Payee only and should be drawn payable to :- SHRIRAM EQUITY AN EBT OPPORTUNITIES FUN A/C xxxxxx (Invest PAN) SHRIRAM EQUITY AN EBT OPPORTUNITIES FUN A/C XXXXXX (Name of the Firstholder) 9. NOMINATION ETAILS [Min / HUF / POA Holder / Non Individuals Cannot Nominate] I/We do hereby nominate the undermentioned Nominee(s) to receive the units to my/our credit in the folio no. in the event of my/our death. I/We also understand that all payments made to such Nominee(s) and of the Nominee(s) acknowledging receipt thereof, shall be a valid discharge by the AMC / Mutual Fund / Trustees. No. 1 2 3 No. 1 2 3 Nominee(s) Name Relationship % of Share* ate of Birth (in case of Min) Nominee(s) Name of the Guardian (In case of Nominee is Min) * If the percentage of share is not mentioned then the claim will be settled equally amongst all the indicated nominee(s) M M Y Y Y Y M M Y Y Y Y M M Y Y Y Y Guardian(s) I/We do not wish to nominate anybody on my/our behalf. of the declarant 10. ECLARATION I / We have read and understood the contents of the SI and Key Infmation Memandum of the Scheme. I/We hereby apply to the Shriram Mutual Fund f allotment of units of the Scheme, as indicated above and agree to abide by the terms, conditions, rules and regulations of the Scheme. I / We hereby confirm and certify that the source of these funds is not directly / indirectly a result of "proceeds of crime" as defined in "The Prevention of Money Laundering Act, 2002" and I/we undertake to provide all necessary proof/ documentation, if any, required to substantiate the facts of this undertaking. I/We have not received n been induced by any rebate gifts, directly indirectly in making this investment. I / We authize the Fund to disclose details of my/our account and all my/our transactions to the intermediary whose stamp appears on the application fm. I/We also authize the Fund to disclose details as necessary, to the Fund's and invest's bankers f the purpose of effecting payments to me/ us. Applicable to NRIs only : I/We confirm that I am/we are Non-Resident of Indian Nationality/Origin and I/we hereby confirm that the funds f subscription have been remitted from abroad through approved banking channels from funds in my/our Non-Resident External / Ordinary Account/FCNR/NRSR Account. Investment in the scheme is made by me / us on : o Repatriation basis o Non Repatriation basis. The ARN holder has disclosed to me/us all the commissions (in the fm of trail commission any other mode), payable to him f the different competing Schemes of various Mutual Funds from amongst which the Scheme is being recommended to me/us. First / Sole Applicant / Guardian Second Applicant Third Applicant Scheme Name : SHRIRAM EQUITY AN EBT OPPORTUNITIES FUN Plan : Regular irect (Please ü any one). Option : Sub Option : Cheque / No. ate : Amount Rs. : Bank and Branch : REGISTRAR & TRANSFER AGENTS Computer Age Management Services Pvt. Ltd., (SEBI Registration No. : INR000002813) New No. 10, Old No. 178, M.G.R. Salai, Nungambakkam, Chennai - 600 034 Email enq_sh@camsonline.com, Website : www.camsonline.com (10)
Shriram Equity and ebt Opptunities Fund (An Open Ended Equity Oriented Asset Allocation Scheme) ASBA Application Fm (Application Suppted by Blocked Amount) To be submitted to Sell Certified Syndicate Bank [SCSB] Broker Name (ARN) Sub Broker Code / ARN SCSB Stamp / Code / Sr. No. 1. APPLICANT(S) INFORMATION (Existing Unit Holder - Please FiII Folio Number and Name) Folio No. Name of 1st Unit Holder NAME OF 1st / SOLE APPLICANT / CORPORATE INVESTOR / MINOR ATE OF BIRTH (Mandaty in case of Min) M M Y Y Y Y Mr. / Ms. / M/s. Contact Name (In case of Cpate invest) esignation NAME OF 2nd APPLICANT Mr. / Ms. / M/s. NAME OF 3rd APPLICANT Mr. / Ms. / M/s. NAME OF THE GUARIAN (In case 1st Applicant is a Min) / NAME OF POA HOLER Mr. / Ms. / M/s. Relationship with Min Please (ü) Mother Father Legal Guardian 2. PAN ETAILS 1st / Sole Applicant @ 2nd Applicant 3rd Applicant Guardian/POA Holder 3. EPOSITORY PARTICIPANT (P) ETAILS # National Securities eposity Limited (NSL) P I I N Beneficiary A/C No. # Central eposity Services (India) Limited (CSL) P I Beneficiary A/C No. @ If the 1st / sole applicant is a Min then please provide details of Natural / Legal Guardian. # Please ensure that the sequence of names as mentioned under section 1 above, matches with P etails. 4. INVESTMENT ETAILS - (Please (ü) Plan / Option you wish to invest - Growth ivident (iv.) Plan : Regular * irect Option : * Growth ividend Mode of dividend : Payout * Re-investment * efault Plan / Option / Mode of dividend 5. SCSB ACCOUNT ETAILS - Attn : NRI Invests : Payment should be made through NRE Accounts only Name of the Bank Ce Banking A/c No. Branch Name Bank Branch City Amount to be blocked (`) Address State In Wds A/c. Type Please (ü) NRE CURRENT SAVINGS NRO Undertaking by ASBA Invest & A/c Holder, eclaration & (s) : 1. I/We hereby Undertake that, I/we have read and understood the instructions contained in this Fm and Terms and Conditions concerning ASBA as contained in the Scheme Infmation ocument (SI) / Key Infmation Memandum (KIM) of the above mentioned Scheme and Statement of Additional Infmation (SAI) of Shriram Mutual Fund. Further, I/we understand that if the details as provided by me/us in this Fm are different from those in the NFO Application Fm, then in such a case, the infmation as provided by me/us herein will be relied upon. 1.A. I/we further confirm and undertake that I am/we are eligible ASBA applicant(s) as per the relevant provisions of the SEBI (Issue of Capital and isclosure Requirement) Regulations, 2009. 2. In accdance with provisions of ASBA in the SEBI ICR Regulations, 2009 and as disclosed in the SAI. I/We authize - (a) the SCSB to do all acts as are necessary to make an application in the New Fund Offer of above mentioned Scheme, including uploading of application details, blocking the amount to the extent mentioned above under SCSB BANK ACCOUNT ETAILS unblocking of funds in the bank account maintained with the SCSB specified above, transfer of funds of the Shriram Mutual Funds account on receipt of instructions from the Registrar to Shriram Mutual Fund after finalisation of the basis of allotment, entitling me/us to receive mutual fund units on such transfer of funds, etc. (b) Registrar to issue instructions to the SCSB to unlock the funds in the bank account specified above upon finalisation of the basis of allotment and to transfer the requisite money to the Shriram Mutual Fund s account. 3. In case the amount available in the bank account specified above is insufficient, the SCSB shall reject the application. Further, I/We also authize the SCSB to make relevant revisions as may be required to be done during the NFO. In the event of any modification due to any infmation required. 4. If the P I, Beneficiary PAN is not provided by me/us the details on the same as furnished in the fm are increct incomplete not matching with the deposity recds, my/our application shall be rejected and Shriram Mutual Fund SCSB shall not be liable f losses, if any. of 1st Applicant / Guardian / Auth. Signaty / POA / Karta (AS IN BANK RECORS) of 2nd Applicant / Guardian / Auth. Signaty / POA / Karta (AS IN BANK RECORS) of 3rd Applicant / Guardian / Auth. Signaty / POA / Karta (AS IN BANK RECORS) ACKNOWLEGEMENT SLIP (To be filled and attached by the Applicant with the Application Fm) Shriram Equity and ebt Opptunities Fund (An Open Ended Equity Oriented Asset Allocation Scheme) Received from (sole / 1st applicant ASBA Application Fm details of which are as follows : App No - SCSB (Bank and Branch) ate of Submission Amount Blocked (`) Bank Account No. (11)
Third Party Payment eclaration Fm www.shriramamc.com Third Party Payment eclaration Fm should be completed in English and in BLOCK LETTERS only. (Please read the Third Party Payment Rules and Instructions carefully befe completing this Fm) eclaration Fm No. FOR OFFICE USE ONLY ate of Receipt Folio No. Branch Trans. No. 1. BENEFICIAL INVESTOR INFORMATION (Refer Instruction No. 2) Folio No. (F existing invest NAME OF FIRST/SOLE APPLICANT (BENEFICIAL INVESTOR) Mr. Ms. M/s. 2. THIR PARTY INFORMATION (Refer Instruction No. 3) NAME OF THIR PARTY (PERSON MAKING THE PAYMENT) Mr. Ms. M/s. Nationality #Mandaty f any amount. Please attach PAN Proof. Refer instruction No. 6. ** Refer instruction No. 8. NAME OF CONTACT PERSON & ESIGNATION (in case of non-individual Third Party) Mr. Ms. esignation MAILING ARES (P.O. Box Address may not be sufficient) KYC** [Please tick (ü) o Attached (Mandaty f any amount) CITY STATE PIN COE CONTACT ETAILS Tel. Off. ST Code Tel. Resi. Mobile Fax E-mail RELATIONSHIP OF THIR PARTY WITH THE BENEFICIAL INVESTOR (Refer Instruction No. 3) (Please tick (ü) as applicable) Status of the Beneficial Invest Relationship of Third Party with the Beneficial Invest o Father/Mother/Court appointed Legal Guardian (Please attach proof of relationship, if not already submitted) o Min o Grand Parent o Related Person (Please specify relationship) (Maximum investment - Rs. 50,000/- per transaction) o FII o Client Custodian - SEBI Registration No. of Custodian Registration Valid Till M M Y Y Y Y o Employee(s) Employer eclaration by Third Party I/We declare that the payment made on behalf of min is in consideration of natural love and aection as a gift. I/We declare that the payment is made on behalf of FII/ Client and the source of this payment is from funds provided to us by FII/Client. I/We declare that the payment is made on behalf of employee(s) under Systematic Investment Plans as lump sum/one-time subscription, through Payroll eductions. 3. THIR PARTY PAYMENT ETAILS (Refer Instruction No. 4) Mode of Payment Cheque Pay Order emand raft Banker s Cheque RTGS NEFT Fund Transfer Mandaty Enclosure(s)* In case the account number and account holder name of the third party is not pre-printed on the cheque then a copy of the bank passbook / statement of bank account letter from the bank certifying that the third party maintains a bank account. Certicate from the Issuing Banker stating the Bank Account Holder's Name and Bank Account Number debited f issue of the instrument Copy of the acknowledgement from the bank, wherein the instructions to debit carry the bank account details and name of the third party as an account holder are available Copy of the passbook/bank statement evidencing the debit f issuance of the instrument. Copy of the Instruction to the Bank stating the Bank Account Number which has been debited. * SHRIRAM Mutual Fund/SHRIRAM Asset Management Company Limited ("SHRIRAM AMC") reserves the right to seek infmation and / obtain such other additional documents/infmation from the Third Party f establishing the identity of the Third Party. in figures (Rs.) in wds Cheque//PO/UTR No. Pay-in Bank A/c No. Name of the Bank Cheque//PO/RTGS ate MM YYYY Branch Bank City Account Type SAVINGS CURRENT NRE NRO FCNR OTHERS (please specify) # including emand raft charges, if any. (13)
4. ECLARATIONS & SIGNATURE/S (Refer Instruction No. 5) THIR PARTY ECLARATION I/We confirm having read and understood the Third Party Payment rules, as given below and hereby agree to be bound by the same. I/We declare that the infmation declared herein is true and crect, which SHRIRAM Mutual Fund is entitled to verify directly indirectly. I agree to furnish such further infmation as SHRIRAM Mutual Fund may require from me/us. I/We agree that, if any such declarations made by me/us are found to be increct incomplete, SHRIRAM Mutual Fund/SHRIRAM AMC is not bound to pay any interest compensation of whatsoever nature on the said payment received from me/us and shall have absolute discretion to reject / not process the Application Fm received from the Beneficial Invest(s) and refund the subscription monies. I/We hereby declare that the amount invested in the Scheme is through legitimate sources only and does not involve and is not designed f the purpose of any contravention evasion of any Act, Rules, Regulations, Notifcations irections issued by any regulaty authity in India. I/We will assume personal liability f any claim, loss and/ damage of whatsoever nature that SHRIRAM Mutual Fund/SHRIRAM AMC may suer as a result of accepting the afesaid payment from me/us towards processing of the transaction in favour of the beneficial invest(s) as detailed in the Application Fm. Applicable to NRIs/OCIs only : I/We confirm that I am/we are Non-Resident of Indian Nationality/Origin and I/We hereby confirm that the funds f subscription have been remitted from abroad through nmal banking channels from funds in my / our Non-Resident External / Ordinary Account /FCNR Account. Please (ü) Yes No If yes, (ü) Repatriation basis Non-repatriation basis MM YYYY of the Third Party BENEFICIAL INVESTOR(S) ECLARATION I/We certify that the infmation declared herein by the Third Party is true and crect. I/We acknowledge that SHRIRAM Mutual Fund reserves the right in its sole discretion to reject/ not process the Application Fm and refund the payment received from the afesaid Third Party and the declaration made by the Third Party will apply solely to my/our transaction as the beneficial invest(s) detailed in the Application Fm. SHRIRAM Mutual Fund/ SHRIRAM AMC will not be liable f any damages losses any claims of whatsoever nature arising out of any delay failure to process this transaction due to occurrences beyond the control of SHRIRAM Mutual Fund/SHRIRAM AMC. Applicable to Guardian receiving funds on behalf of Min only : I/We confirm that I/We are the guardian of the Min registered in folio and have no objection to the funds received towards Subscription of Units in this Scheme on behalf of the min. MM YYYY SIGNATURE/S First / Sole Applicant / Guardian Second Applicant Third Applicant THIR PARTY PAYMENT RULES 1. In der to enhance compliance with Know your Customer (KYC) nms under the Prevention of Money Laundering Act, 2002 (PMLA) and to mitigate the risks associated with acceptance of third party payments, Association of Mutual Funds of India (AMFI) issued best practice guidelines on "risk mitigation process against third party instruments and other payment modes f mutual fund subscriptions". AMFI has issued the said best practice guidelines requiring mutual funds/asset management companies to ensure that Third-Party payments are not used f mutual fund subscriptions 2a. The following wds and expressions shall have the meaning specied herein : (a) Beneficial Invest is the first named applicant/invest in whose name the application f subscription of Units is applied f with the Mutual Fund. (b) Third Party means any person making payment towards subscription of Units in the name of the Benecial Invest. (c) Third Party payment is referred to as a payment made through instruments issued from a bank account other than that of the rst named applicant/ invest mentioned in the application fm. Illustrations Illustration 1 : An Application submitted in joint names of A, B & C alongwith cheque issued from a bank account in names of B, C & Y. This will be considered as Third Party payment. Illustration 2 : An Application submitted in joint names of A, B & C alongwith cheque issued from a bank account in names of C, A & B. This will not be considered as Third Party payment. Illustration 3 : An Application submitted in joint names of A, B & C alongwith cheque issued from a bank account in name of A. This will not be considered as Third Party payment. 2b. SHRIRAM Mutual Fund/SHRIRAM Asset Management Company Limited ( SHRIRAM AMC ) will not accept subscriptions with Third Party payments except in the following exceptional cases, which is subject to submission of requisite documentation/ declarations : (i) Payment by Parents/Grand-Parents/Related Persons* on behalf of a min in consideration of natural love and affection as gift f a value not exceeding Rs. 50,000/- f each regular Purchase per SIP installment. However, this restriction of Rs. 50,000/- will not be applicable f payment made by a Guardian whose name is registered in the recds of Mutual Fund in that folio (i.e. father, mother court appointed Legal Guardian). (ii) Payment by Employer on behalf of employee under Systematic Investment Plans as lump sum/one-time subscription, through Payroll deductions. (iii) Custodian on behalf of an FII a Client. * 'Related Person' means any person investing on behalf of a min in consideration of natural love and affection as a gift. 2c. Applications submitted through the above mentioned 'exceptional cases' are required to comply with the following, without which applications f subscriptions f units will be rejected / not processed / refunded. (i) Mandaty KYC f all invests (guardian in case of min) and the person making the payment i.e. third party. (ii) Submission of a complete and valid 'Third Party Payment eclaration Fm' from the invests (guardian in case of min) and the person making the payment i.e. third party. 2d. Invest(s) are requested to note that any application f subscription of Units of the Scheme(s) of SHRIRAM Mutual Fund accompanied with Third Party payment other than the above mentioned exceptional cases as described in Rule (2b) above is liable f rejection without any recourse to Third Party the applicant invest(s). The above mentioned Third Party Payment Rules are subject to change from time to time. Please contact any of the Invest Service Centres of SHRIRAM AMC visit our website www.shriramamc.com f any further infmation updates on the same. (14)
Enrolment Fm f SIP / Micro SIP [F Investment through ECS (ebit Clearing) / irect ebit Facility/Standing Instruction] (Please read terms & conditions overleaf) Imptant : Please strike out the Section(s) that is/are not used by you to avoid any unauthised use Enrolment Fm no. : S/ www.shriramamc.com SIP/ Micro SIP via ECS (ebit Clearing) in select cities via irect ebit/standing Instruction in select banks / branches only. KEY PARTNER / AGENT INFORMATION (Invests applying under irect Plan must mention irect in ARN column.) FOR OFFICE USE ONLY (TIME STAMP) ARN ARN Name Sub-Broker ARN / Internal Code Employee Unique Bank Branch Code f Sub-Agent/ Identication Number Employee (EUIN) ARN- eclaration f "execution-only" transaction (only where EUIN box is left blank) (Refer Item No. 3a) I / We hereby conrm that the EUIN box has been intentionally left blank by me / us as this is an execution-only transaction without any interaction advice by the employee / relationship manager/ sales person of the above distribut notwithstanding the advice of in-appropriateness, if any, provided by the employee / relationship manager / sales person of the distribut and the distribut has not charged any advisy fees on this transaction. Sign Here First/Sole Applicant/Guardian Sign Here Second Applicant Sign Here Third Applicant Transaction Charges f Applications through istributs only (Refer Item No. 16 and please tick (ü) any one) ate M M Y Y Y Y o I confirm that I am a First time invest across Mutual Funds. (Rs. 150 deductible as Transaction Charge and payable to the istribut) o I confirm that I am an existing invest in Mutual Funds. (Rs. 100 deductible as Transaction Charge and payable to the istribut) If the total commitment of investment through SIP (i.e. amount per SIP installment X no. of installments) amounts to Rs.10,000 me and your istribut has opted to receive transaction Charges, the same are deductible as applicable from the installment amount and payable to the istribut. In such cases Transaction Charge will be recoverable in 3-4 installments. Units will be issued against the balance of the installment amounts invested. Upfront commission shall be paid directly by the invest to the ARN Holder (AMFI registered istribut) based on the invests assessment of various facts including the service rendered by the ARN Holder. I/ We have read and understood the contents of the Scheme Infmation ocument(s) and Statement of Additional Infmation and the terms & conditions of enrolment f Systematic investment Plan (SIP) and of ECS (ebit Clearing) / irect ebit / Standing Instruction facilities and agree to abide by the same. I /We hereby apply to the Trustee of SHRIRAM Mutual Fund f SIP application under of the following Scheme(s)/ Plan(s) / Option(s) and agree to abide by the terms and conditions of the same. I/ We have not received n been induced by any rebate gifts, directly indirectly, in making this investment. The ARN holder has disclosed to me/us all the commissions (in the fm of trail commission any other mode), payable to him/them f the different competing Schemes of various mutual Funds from amongst which the Scheme is being recommended to me/us. Applicable to PEKRN Holders : I, the first / sole holder, also hereby declare that I do not hold a Permanent Account Number and hold only a single PAN Exempt Reference No. (PEKRN) issued by KYC Registration Authity and that my existing investments together with the current application will not result in aggregate investments exceeding Rs. 50,000/- in a rolling 12 months period in a financial year. Applicable to application under irect Plan : I/We hereby declare and confirm that I/We have read and understood the Scheme related documents pertaining to the "irect Plan" and also conrm that the investments in Scheme through "irect Plan" is/are made at my own discretion. SHRIRAM Mutual Fund/SHRIRAMAMC/Trustee shall not be liable f any consequences arising out of such investments. Please (ü) any one. In the absence of indication of the option the fm is liable to be rejected. NEW REGISTRATION CHANGE IN BANK ACCOUNT CANCELLATION (Refer Item No. 11) INVESTOR ETAILS Aplication No. (F New Invest) / Folio No. (F Existing Invest) Sole/1st Applicant Name of Guardian (in case Applicant is min) Second Applicant Third Applicant # Please attach Proof. If PAN/PEKRN/KYC is already validated please don t attach any proof. Refer Item No. 15 and 16. Scheme Plan (Invests applying under irect Plan must mention irect against the Scheme name). SIGNATURE (Refer Item No. 3(c)) Each SIP/ Micro SIP Amount (Rs.) Frequency * Monthly Quarterly (*efault Frequency) [Refer Item No. 6(iv)] Option ACKNOWLEGEMENT SLIP (To be filled in by the Unit holder) ate : Received from Mr./Ms./M/s. Scheme / Plan / Option Total Amount (Rs.) SHRIRAM MUTUAL FUN Administrative Head Office : CK-6, 2nd Flo, Sect-II, Salt Lake City, Kolkata-700 091 Enrolment Fm No. : S/ SIP/Micro SIP application f Please Note : All purchases are subject to realisation of cheques ISC Stamp & (17)
ä SIP Top-up (Optional) (Refer Item No. 7e) (Please ü to avail this facility) Top-up Amount (Rs.) (The amount should be in multiples of Rs. 500 only) SIP Top-up Frequency : o Half-yearly o Yearly (Quarterly SIP offers top-up frequency at yearly intervals only. SIP/Micro SIP ate 1st 5th * 15th 20th 25th (*efault ate) [Refer Item No. 6(iv)] SIP/Micro SIP Period Start From M M Y Y Y Y End On** M M Y Y Y Y **Please refer Item No. 6(ii) and 7(b) First SIP/ Micro SIP Transaction via Cheque No. Cheque ated M M Y Y Y Y Amount @ (Rs.) Mandaty Enclosure (if 1st Installment is not by cheque) Blank cancelled cheque Copy of cheque The name of the first / sole applicant must be pre-printed on the cheque. EMAT ACCOUNT ETAILS* (Optional - refer instruction 10) Invest opting to hold units in demat fm may provide a copy of the P statement to match the demat details as stated in the application fm. BANK ETAILS P Name P I Beneficiary Account No. NSL @ The first cheque amount should be same as each SIP Amount. I/we hereby authise SHRIRAM Mutual Fund/SHRIRAM Asset Management Company Limited and their authised service providers, to debit my/our following bank account by ECS (ebit Clearing) / irect ebit / Standing Instruction f collection of SIP/ Micro SIP payments. CSL Bank Name Branch Name Bank City Account Number 9 igit MICR Code (Please enter the 9 digit number that appears after the cheque number) Account Type (Please ü) Savings Current NRO NRE FCNR Others (please specify) Account holder Name as in Bank Account Authisation of the Bank Account Holder (to be signed by the Invest)** ** To, The Branch Manager, (Name of the Bank) This is to infm that I/We have registered f the RBI s Electronic Clearing Service (ebit Clearing) irect ebit / Standing Instruction and that my payment towards my investment in SHRIRAM Mutual Fund shall be made from my/our below mentioned bank account with your bank. I/We authise the representative carrying this ECS (ebit Clearing) irect ebit / Standing Instruction mandate Fm to get it verified & executed. Applicable to SIP Top-up facility (not available under Micro SIP) : Bank Account Number I/We hereby declare that the particulars given above are crect and express my/ our willingness to make payments referred above through participation in ECS (ebit Clearing) / irect ebit / Standing Instruction. If the transaction is delayed not effected at all f reasons of incomplete increct infmation, I/ We would not hold the user institution responsible. I / We will also infm SHRIRAM Mutual Fund/SHRIRAM Asset Management Company Limited, about any changes in my bank account. I/ We have read and agreed to the terms and conditions mentioned overleaf. I/We hereby agree to avail the top-up facility f SIP and authize my bank to execute the ECS/irect ebit/standing Instruction f a further increase in installment from my designated account. Please write SIP Enrolment Fm no. / Folio no. on the reverse of the cheque. 1st Account Holder s (As in Bank Recds) 2nd Account Holder s (As in Bank Recds) 3rd Account Holder s (As in Bank Recds) BANKER S ATTESTATION (FOR BANK USE ONLY) Certified that the signature of account holder and the details of Bank account and its MICR code are crect as per our recds F Office Use only (Not to be filled in by Invest) Recded on Recded by of Authised Official from Bank (Bank Stamp and ate) Scheme Code Credit Account Number Bank Account Number (18)