Distributor Code & ARN No. Sub-Broker Code & ARN No. Collection Centre (For Office use Only) (PLEASE READ THE INSTRUCTIONS CAREFULLY BEFE FILLING UP THE FM) COMMON APPLICATION FM For Resident Indians and NRIs/FIIs Application No. 1. EXISTING UNIT HOLDER INFMATION (Please fill in your Folio No. & Name and then proceed to section 4. Applicable details and Mode of holdings will be as per the existing Folio Number) Folio No. NAME OF FIRST / SOLE APPLICANT NAME OF GUARDIAN (in case of First / Sole Applicant is a Minor) / CONTACT PERSON & DESIGNATION (in case of non-individual Investors) 2. STATUS (of First / Sole Applicant) [Please tick ( )] Refer Inst. No. 2(iv) for documents to be submitted Individual HUF Minor through guardian Partnership Company Body Corporate Club/Society AOP BOI NRI Trust FIIs Others (please specify) 3. UNIT HOLDER INFMATION (Refer Instruction 2) NAME OF THE SECOND APPLICANT NAME OF THE THIRD APPLICANT MODE OF HOLDING [Please tick( )] Refer Inst. No. 2(v) Single Joint Anyone or Survivor MAILING ADDRESS OF FIRST / SOLE APPLICANT (P. O. Box Address may not be sufficient) (Indian Address in case of NRIs/FIIs)] DATE OF BIRTH (Mandatory in case of Minor) DD MM YYYY OCCUPATION (of First / Sole Applicant) [Please tick ( )] Service Student Professional Housewife Business Retired Agriculture Others (Please Specify) City State OVERSEAS ADDRESS (in case NRIs/FIIs) (P. O. Box Address may not be sufficient) Pin Code CONTACT DETAILS OF FIRST / SOLE APPLICANT STD Code Tele (Office) Tele (Resi.) Mobile Fax E-Mail 4. PAN & UIN DETAILS PAN Details of mandatory, as per SEBI Regulations (Refer Instruction No. 3) (PAN with supporting Form 60/61 with address proof is mandatory for an application amount of Rs. 50,000/- and above) PAN (with PAN supporting) Form 60/61 (with address proof) (Provided in this booklet) FIRST / SOLE APPLICANT / GUARDIAN (please tick ) Form 60/61 attached UNIQUE IDENTIFICATION NUMBER (UIN) SECOND APPLICANT (please tick ) Form 60/61 attached THIRD APPLICANT (please tick ) Form 60/61 attached 5. BANK ACCOUNT DETAILS Please note that as per SEBI Regulations it is mandatory for investors to provide bank account details of First / Sole applicant (Refer Instruction 3) Name of the Bank Account No. Bank Address Pin Account Type [Please tick ( )] SAVINGS CURRENT NRE NRO FCNR NRSR ACKNOWLEDGEMENT SLIP (To be filled in by the Investor) Received from Mr / Ms / M/s Sl. No. *Cheque / DD Favouring Name Plan / Option Invested Net Application No.... continued overleaf Payment Details Cheque / DD No. Bank and Signature & Stamp 1 2 3 *All purchases are subject to realisation of Cheque / DD.
6. INVESTMENT DETAILS No. 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 Plan / Option. Details of the same are available on page no. 6, 7 & 8 in the instruction section. (Please refer Instruction No. 9) Sl. No. *Cheque / DD Favouring Name(refer instruction 4) Plan / Option Invested Net Paid Cheque / DD No. Payment Details Bank and Type of Account # 1 2 3 # (Type of Account : Saving / Current / NRE / NRO / FCNR / NRSR) 7. REDEMPTION / DIVIDEND REMITTANCE (Refer Instruction no. 7) Unit holders having bank account with ABN Amro Bank, Citibank, Deutsche Bank, HDFC Bank, HSBC, ICICI Bank, IDBI Bank, Standard Chartered Bank, UTI Bank will receive their Redemption/Dividend Payments (if any) directly into their bank account. In case Unit holders wish to receive a cheque/demand draft (instead of a direct credit into their bank account), please indicate the preference below: I/We want to receive the redemption and dividend proceeds (if any) by way of a cheque. (Please in this box) ELECTRONIC CLEARING SERVICE (ECS) for Dividends only I authorise Birla Mutual Fund to credit my dividend payments through ECS (Please Tick ) Yes Please quote 9 Digit Code No. of your Bank and Corresponding to Bank Account Details given in Section 5 above. (This number appears on every leaf of your chequebook after your cheque number) IMPTANT: Please attach a blank cancelled Cheque or a clear photocopy of a cheque issued by your bank verifying of the Code No. 8. E-MAIL COMMUNICATION/ON LINE ACCESS (Refer Instruction no. 10 & 12) I/We wish to receive the following via e-mail Account Statement 9. NOMINATION (Refer instruction no. 6) } Quarterly Newsletter & Annual Report Transaction Confirmation I would like to get on-line access which is subject to the terms & conditions mentioned in instruction no.12 & I/We agree to abide by the same. Yes No I/We do hereby nominate the person more particularly described hereunder to receive the amount to my / our credit in event of my / our death : NOMINEE DETAILS Name : Name of Guardian (In case nominee is minor) : Address : Address of Guardian : Date of Birth : (In case nominee is minor) D D M M Y Y Y Y Relationship : Signature of the Guardian : Unit holder(s) : Witness(es) - (could be the same for all unit holders): Name Signature Name and Address Signature 1) 1) 2) 2) 3) 3) 10. DECLARATION DD MM YYYY Dear Sirs, Having read and understood the contents of the offer document(s) of the scheme(s), I/We hereby apply to the Trustee of Birla Mutual Fund for units of scheme(s) of Birla Mutual Fund as indicated above and agree to abide by the terms, conditions, rules and regulations of the scheme (s). I/We hereby declare that the particulars given herein are correct and complete. I/We confirm that I/we have not received and will not receive any commission or brokerage or any other incentive in any form, directly or indirectly, for subscribing to units issued under any of the scheme(s). I/We hereby declare 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 Income Tax Act, 1961, Prevention of Money Laundering Act, 2002, Prevention of Corruption Act, 1988 or any other applicable laws enacted by the Government of India from time to time. For NRIs/FIIs only: I/We confirm that I am/we are Non Residents of Indian Nationality/origin and that I/We have remitted funds from abroad through approved banking channels or from funds in my/our Non-resident External Account/FCNR account/nro/nrsr Account. SPECIMEN SIGNATURES( Refer Instruction no.1) First Applicant Second Applicant Third Applicant
APPLICATION FM F SIP SWP SYSTEMATIC INVESTMENT PLAN SYSTEMATIC WITHDRAWAL PLAN FOLIO NO. (For Existing Investors) Name of the First Applicant PAN DETAILS (Refer Instruction B-6) First Applicant (Mandatory if transaction amount STP SYSTEMATIC TRANSFER PLAN Distributor Code COMMON APPLICATION FM NO. (For New Investors) Second Applicant Guardian (In case applicant is a minor) Sub-broker Code is Rs. 50,000/- or above) Third Applicant To, I/We have read and understood the contents of the Offer Document of the respective (s) and the instruction overleaf. I/We hereby apply for enrolment for the SIP / SWP / STP (please tick your choice) of the following /Plan and agree to abide by the terms and conditions of the respective /Plan. SCHEME NAME PLAN OPTION START DATE : D D M M Y Y Y Y END DATE : D D M M Y Y Y Y NOTE : In case the End Date is not mentioned, for SWP / STP, same would continue till unit balance is available in the folio or request to discontinue the same is received, whichever is earlier. As regards SIP, the End Date must coincide with the date of the last cheque. INVESTMENT FREQUENCY MONTHLY QUARERLY 1ST OF EACH MONTH 1ST OF EACH QUARTER 10TH OF EACH MONTH 10TH OF EACH QUARTER 20TH OF EACH MONTH 20TH OF EACH QUARTER WITHDRAWAL FREQUENCY (Applicable for fixed withdrawals only) 1ST OF EACH MONTH 10TH OF EACH MONTH 20TH OF EACH MONTH TRANSFER FREQUENCY SPECIMEN SIGNATURES FIRST APPLICANT SYSTEMATIC WITHDRAWAL PLAN (SWP) FIXED WITHDRAWAL MONTHLY (Min. 6 Withdrawals) QUARTERLY (Min. 4 Quarters) AMOUNT PER INSTALMENT RS. IN RS. WDS (Minimum Rs. 500/- and in multiples of Rs 1/- thereafter) No. of GROW MONTHLY QUARTERLY (Min. 12/6 transfers) (Min. 4 quarters) 1ST OF EACH MONTH 1ST OF EACH QUARTER 10TH OF EACH MONTH 10TH OF EACH QUARTER 20TH OF EACH MONTH 20TH OF EACH QUARTER Total Amt. of Grow SYSTEMATIC TRANSFER PLAN (STP) TRANSFER TO FOLIO NO SCHEME PLAN SYSTEMATIC INVESTMENT PLAN (SIP)* INSTRUMENT DETAILS Cheque Nos. From From Bank & per Chq. Rs. Total Cheques Total OPTION TO TO Rs. in Words MINIMUM TRANSFER AMOUNT : A. Monthly Plan : Minimum of Rs. 500/- each and above for 12 transfers Rs. 1000/- each and above for 6 transfers. B. Quarterly Plan : Minimum of Rs. 1500/- each and above for minimum 4 quarters. SECOND APPLICANT APPRECIATION WITHDRAWAL MONTHLY (Distributed only on 1st of the following month) OUARTERLY (Distributed only on 1st of the following month) AMOUNT PER TRANSFER RS. WDS No. of Transfers TOTAL CHEQUES Total Amt. of Transfer MINIMUM NO. OF CHEQUES A] Monthly SIP : (i) Birla MIP, Birla MIP II & Birla Sunlife Monthly Income : Minimum 6 cheques of Rs. 5000/- each and above. (ii) Other s : Minimum 6 Cheques of Rs. 1000/- each and above Minimum 12 cheques of Rs. 500/- each and above. B] Quarterly SIP : (i) Birla MIP, Birla MIP II & Birla Sunlife Monthly Income : Minimum 4 cheques of Rs. 7500/- each and above (ii) Other s : Minimum 4 Cheques of Rs. 1500/- each and above. THIRD APPLICANT Acknowledgement Slip (To be filled in by the Investor) Received from Mr / Ms / M/s FOLIO NO. COMMON APPLICATION FM NO. (For Existing Investor) (For New Investor) FREQUENCY 1ST OF EACH MONTH AND/ 10TH OF EACH MONTH AND/ 20TH OF EACH MONTH Start Date End Date REQUEST F SIP* GROW STP *All SIP purchases are subject to realisation of Cheque / DD. Note : Please refer instruction overleaf for more details. Signature & Stamp 11
SIP through ECS facility REGISTRATION CUM MANDATE FM F ECS (DEBIT CLEARING) (APPLICATION SHOULD BE SUBMITTED AT LEAST TWENTY DAYS BEFE THE FIRST DEBIT THROUGH ECS) NEW REGISTRATION CHANGE IN BANK ACCOUNT Distributor Code FOLIO NO. APPLICATION NO. (For Existing Investors) (For New Investor) Refer Inst. No. 1 Name of the First Applicant PAN DETAILS (Refer Instruction C-20) First Applicant Second Applicant (Mandatory if transaction amount is Rs. 50,000/- or above) Third Applicant Guardian (In case applicant is a minor) Sub-broker Code To, I/We have read and understood the contents of the Offer Document of the respective (s) and the instruction overleaf. I/We hereby apply for enrolment for the SIP through ECS facility of the following /Plan and agree to abide by the terms and conditions of the respective /Plan. SCHEME NAME PLAN OPTION START DATE : D D M M Y Y Y Y END DATE : D D M M Y Y Y Y NOTE : The End Date must coincide with the date of the last Installment. INVESTMENT FREQUENCY MONTHLY QUARERLY 1ST OF EACH MONTH 1ST OF EACH QUARTER SYSTEMATIC INVESTMENT PLAN (SIP)* INSTRUMENT DETAILS F THE FIRST SIP TRANSACTION Cheque No. (Note:Cheque should be drawn on bank as per details provided below) Bank Name Name 10TH OF EACH MONTH 10TH OF EACH QUARTER 20TH OF EACH MONTH 20TH OF EACH QUARTER MINIMUM NO. OF SIP S A] Monthly SIP : (i) Birla MIP, Birla MIP II & Birla Sunlife Monthly Income : Minimum 6 cheques of Rs. 5000/- each and above. (ii) Other s : Minimum 6 Cheques of Rs. 1000/- each and above Minimum 12 cheques of Rs. 500/- each and above. B] Quarterly SIP : (i) Birla MIP, Birla MIP II & Birla Sunlife Monthly Income : Minimum 4 cheques of Rs. 7500/- each and above (ii) Other s : Minimum 4 Cheques of Rs. 1500/- each and Account No. Account Type Saving Current Cash Credit (CC) /Over Draft (OD) 9 Digit MICR No. Please enter the 9 digit number that appears after your cheque number Each SIP (Rs.) TotalNo. of SIP s above. I/We hereby declare that the par ticulars given above are correct and express my/our willingness to make payments referred above through participation in ECS. If the transaction is delayed or not effected at all for reasons of incomplete or incorrect information, I/We would not hold Birla Mutual Fund responsible. I/We will also inform Birla Mutual Fund, about any changes in my/our bank account. I/We have read and agreed to the terms and conditions mentioned overleaf. SPECIMEN SIGNATURES (As in your Bank Records) Account holder Name as in Bank Account FIRST APPLICANT Total Rs. in Words SECOND APPLICANT THIRD APPLICANT Authorisation of the Bank Account Holder (To be signed by the Account Holder(s) This is to inform I/We have registered for the RBI s Electronic Clearing Service (Debit Clearing) and that my payment towards our investment in Birla Mutual Fund shall be made from my/our mentioned bank account with your bank. I/We authorise the representative carrying this ECS mandate form to get it verified & executed. SPECIMEN SIGNATURES (As in Bank Records) FIRST APPLICANT SECOND APPLICANT Bank Account Number THIRD APPLICANT Acknowledgement Slip (To be filled in by the Investor) Received from Mr / Ms / M/s FOLIO NO. APPLICATION NO. (For Existing Investor) (For New Investor) FREQUENCY 1ST OF EACH MONTH AND/ 10TH OF EACH MONTH AND/ 20TH OF EACH MONTH Signature & Stamp Start Date End Date *All SIP purchases are subject to realisation of Cheque / DD / ECS Debit. Note : Please refer instruction overleaf for more details. 13
COMMON TRANSACTION FM (For existing investors) (F ONE TRANSACTION ONLY) Broker Code Sub Broker Code F BMF USE (A) Please strike off the transactions type that are not filled. UNIT HOLDERS INFMATION Folio No. NAME Form No. Permanant Account Number (PAN) (Supporting documents / Form 60 / Form 61 is must if transaction amount is Rs. 50,000 and above. Refer Instruction No. 7) (Mandatory) Unique Identification Number (UIN) First Holder Second Holder Third Holder (B) Guardian (In case of Minor) ADDITIONAL PURCHASE (Refer Instruction No. 3, 4 & 5) Rs. (figures) Plan Option Cheque/DD No. Dated D D M M Y Y Drawn on (Bank) (C) DD charge : Rs. (Refer Instruction No. 4) In case you do not mention the Plan and Option, units will be alloted under default option as per respective scheme(s) offer document(s). REDEMPTION (Refer Instruction No. 9) Rs. (figures) No. of Units Plan Option Direct Credit to existing bank account (Please refer Instruction No. 9 overleaf) : I/We request you to activate Direct Credit (DCR) facility for my Folio and remit the redemption/dividend proceeds through DCR. (Please in this Box ) (D) LATERAL SHIFT/SWITCH (Refer Instruction No. 6) Plan Option No. of Units Rs. (figures) To Folio No. Plan Option In case you do not mention the Plan and Option in the "To Folio", units will be alloted under default option as per respective scheme(s) offer document(s). ACKNOWLEDGEMENT Form No. Received for ADDITIONAL PURCHASE / REDEMPTION / LATERAL SHIFT/SWITCH / CHANGE OF BANK DETAILS / DIRECT CREDIT / CHANGE OF ADDRESS / EMAIL CONFIRMATION / ONLINE ACCOUNT ACCESS Folio No. from Mr./Ms./M/s. Signature & Stamp For Only Additional Purchase: Cheque / Draft No. for Rs. (Figures) drawn on (bank) 17
(E) CHANGE / UPDATION OF BANK DETAILS - First Holder (Please refer instruction No. 7) Bank Account No. Form No. Bank Name Address Pin Code Bank A/c. Type Savings Current NRE NRO FCNR NRSR (F) (G) REDEMPTION / DIVIDEND REMITTANCE Direct Credit available in : ABN Amro Bank, Citibank, Deutsche Bank, HSBC, HDFC Bank, ICICI Bank, IDBI Bank, Standard Char tered Bank, UTI Bank. Unit holders applying for change of bank as one of the above banks will receive their Redemption/Dividend Payments (if any) directly into their bank account. In case redemption transaction is submitted along with change of bank as one of these banks, a cancelled cheque leaf must be submitted in order to safeguard interest of the investors. In case Unit holders wish to receive a cheque (instead of a direct credit into their bank account ), please indicate the preference below : I/We want to receive the redemption and dividend proceeds (if any) by way of a cheque. (Please tick in this box) CHANGE / UPDATION OF ADDRESS Pin Tel.: (R) (O) Mobile: (H) E-MAIL CONFIRMATION : Please send me transaction confirmation and account statement on the following E-mail : E-mail : (I) ONLINE ACCOUNT ACCESS Please provide me the facility to access my account and to transact over the internet. I have read & understood the terms & conditions for the same in your Key Information Memorandum and agree to abide by the same. FACILITY REQUIRED (Please tick ) YES NO (J) DECLARATION AND SIGNATURE(s) Date Dear Sirs, D D M M Y Y Y Y First Holder Having read and understood the contents of the offer document(s) of the scheme(s), I/We hereby apply to the Trustee of Birla Mutual Fund for units of scheme(s) of Birla Mutual Fund as indicated above and agree to abide by the terms, conditions, rules and regulations of the scheme (s). I/We hereby declare that the particulars given herein are correct and complete. I/We confirm that I/we have not received and will not receive any commission or brokerage or any other incentive in any form, directly or indirectly, for subscribing to units issued under any of the scheme(s). Second Holder I/We hereby declare 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 Income Tax Act, 1961, Prevention of Money Laundering Act, 2002, Prevention of Corruption Act,1988 or any other applicable laws enacted by the Government of India from time to time. For NRIs/FIIs only: I/We confirm that I am/we are Non Residents of Indian Nationality/origin and that Third Holder I/We have remitted funds from abroad through approved banking channels or from funds in my/our Non-resident External Account/FCNR account/nro/nrsr Account. 1. It is necessary to mention the Ten-Digit Folio number for the purpose of any transaction. 2. Please strike off the transaction type that are NOT filled by you before INSTRUCTIONS submitting the form. 3. To make an additional purchase, please send us a local cheque / DD payable at any of our branch/ authorised centre. Please make the cheque/ DD payable in favour of the respective scheme e.g. Birla Advantage Fund, Birla Income Plus etc. 4. No stock invest, cash or outstation cheques will be accepted. D.D. charges would be borne by the fund only for the investors residing at places which are not covered by our offices/authorised centres. The maximum charges so borne by the fund would be restricted to limits as prescribed by State Bank of India. 5. For fresh purchases under new scheme, plan or option - please refer the respective Offer Document(s). 6. Redemptions/ Lateral Shifts/ Switches will be processed only if amount/ units is clearly mentioned. If there is no sufficient amount/ units, the balance available free units in the respective account will be redeemed/ shifted/ switched. 7. Bank Mandate and PAN Mandatory: It is mandatory for investors to mention in their application/redemption request, the bank name and account number, if not already provided. Application without these details will be rejected. An application for Purchase of Units amounting to Rs. 50,000/- or more should quote PAN of the applicant. (In case of Joint applicants, PAN of all holders) along with documentary proof of PAN (Photocopy of PAN card/pan Letter/refund order/assessment order/demand Notice from Income Tax Department). In case of a minor, PAN details of the Guardian must be submitted. In case a person does not have a PAN, a declaration in Form 60/Form 61 (as applicable) alongwith the address proof must be submitted. Application without this would be rejected by the Mutual Fund without any reference to the investor. 8. Unique Identification Number : As per SEBI (Central Database of Market Participants) regulations, 2003, no specified investor being a body corporate shall buy, sell or deal in units of a mutual fund unless such specified investor, its promoters and directors have been allotted UIN by December 31, 2004. Application Forms received without UIN of the Corporate will be considered incomplete and required to be rejected. All domestic investors not being bodies corporate, who carry out a single transaction of value Rs. 1.00 lac or more, need to obtain UIN by December 31, 2005. The requirement to quote UIN have been suspended by SEBI till further notice. 9. Unit holders whose bank account details available in our records is any one of the following banks will receive their Redemption/Dividend payment (if any) directly into their bank account : ABN Amro Bank, Citibank, Deutsche Bank, HSBC, HDFC Bank, ICICI Bank, IDBI Bank, Standard Chartered Bank, UTI Bank. However, if the remittance is delayed or not effected for reasons of incomplete or incorrect information, Mutual Fund cannot be held responsible. The Mutual Fund, however, reserves the right to issue a cheque / demand draft inspite of an investor opting for Direct Credit. Get NAVs of all Birla Mutual Fund schemes round the clock at www.birlasunlife.com or call on our Toll free no.: 1-600-22-7000 (9.00 a.m. to 7.00 p.m.) 18