ARN- ARN/RIA Application Form (Except for ETFs, HDFC Retirement Savings fu a HDFC Children s Gift Fu) Inveors mu read the Key Information Memoraum, the inructions a Product Labeling on cover page before completing this Form. The Application Form should be completed in English a in BLOCK LETTERS only. KEY PARTNER / AGENT INFMATION (Inveors applying uer Plan mu mention in ARN column.) (Refer Inruction 1) ARN/RIA Name Sub Agent s ARN Bank Branch Code Internal Code for Sub-Agent/ Employee Employee Unique Identification Number (EUIN) April 30, 2016 F OFFICE USE ONLY (TIME STAMP) EUIN Declaration (only where EUIN box is left blank) (Refer Inruction 1) I/We hereby confirm that the EUIN box has been intentionally left blank by me/us as this transaction is executed without any interaction or advice by the employee/relationship manager/sales person of the above diributor/sub broker or notwithaing the advice of in-appropriateness, if any, provided by the employee/relationship manager/sales person of the diributor/sub broker. TRANSACTION CHARGES F APPLICATIONS THROUGH DISTRIBUTS ONLY (Refer Inruction 2) In case the purchase/ subscription amount is Rs. 10,000 or more a your Diributor has opted in to receive Transaction Charges, the same are deductible as applicable from the purchase/ subscription amount a payable to the Diributor. Units will be issued again the balance amount inveed. Upfront commission shall be paid directly by the inveor to the ARN Holder (AMFI regiered Diributor) based on the inveors assessment of various factors including the service reered by the ARN Holder. 1. EXISTING UNIT HOLDER INFMATION (IF YOU HAVE EXISTING FOLIO, PLEASE FILL IN SECTIONS viz. 1, 5, 6, 10 AND 13 ONLY. Refer inruction 3). Folio No. Fir/ Sole / Guaian Seco Thi The details in our recos uer the folio number mentioned alongside will apply for this application. 2. MODE OF HOLDING [Please tick ( ) Single Joint Anyone or Survivor 3. UNIT HOLDER INFMATION (Refer inruction 4) DATE OF BIRTH@ NAME OF FIRST / SOLE APPLICANT (In case of Minor, there shall be no joint holders) Status of Fir/ Sole Iividual Non - Iividual [Please attach FATCA, CRS & Ultimate Beneficial Ownership (UBO) Self Certification Form] (Refer Inruction 4 & 19) Resident Iividual Body Corporate NRI-Repatriation NRI-Non Repatriation LLP Society / Club Foreign National Resident in Iia FPI Sole Proprietorship DD MM YYYY Partnership Tru HUF AOP PIO Company FIIs Minor through guaian BOI OCI Non Profit Organisation NAME OF GUARDIAN (in case of Fir / Sole is a Minor) / NAME OF CONTACT PERSON DEATION (in case of non-iividual Inveors) Mr. Ms. Designation Contact No. Proof of date of birth@ Please ( ) Attached Others (please specify) Relationship with Minor@ Please ( ) Father Mother Court appointed Legal Guaian Proof of relationship with minor@ Please ( ) Attached @ Maatory MAILING ADDRESS OF FIRST / SOLE APPLICANT (Refer Inruction 4a) CITY STATE PIN CODE CONTACT DETAILS OF FIRST / SOLE APPLICANT Country Code STD Code Telephone : Off. Res. Fax ealerts Mobile I/ We would like to regier for my/our HDFCMF Personal Identification Number (HPIN) to transact online as per the terms & coitions displayed on website:www.hdfcfu.com (Email id maatory). ^ On providing email-id inveors shall receive scheme wise annual report or an abridged summary thereof/ account atements/ atutory a other documents by email. (Refer Inruction 10 & 12) 4. JOINT APPLICANT DETAILS, If any (Refer inruction 4) (In case of Minor, there shall be no joint holders) 1. NAME OF SECOND APPLICANT 2. NAME OF THIRD APPLICANT 5. ADDITIONAL KYC DETAILS Maatory (Refer inruction 4b) edocs Email^ Non-Iividual Inveors involved/ providing any of the mentioned services Occupation details for 3 Guaian Private Sector Service Public Sector Service Government Service Business Professional Agriculturi Retired Housewife Student Proprietorship Others (Please specify) Please attach Proof. Refer inruction No 16 for PAN/PEKRN a No 18 for KYC. Foreign Exchange / Money Changer Services Money Leing / Pawning Gaming / Gambling / Lottery / Casino Services None of the above ACKNOWLEDGEMENT SLIP (To be flled in by the Inveor) [For any queries please contact our neare Inveor Service Centre or call us at our Cuomer Service Number 1800 3010 6767 / 1800 419 7676 (Toll Free)] HDFC MUTUAL FUND Head Office : HDFC House, 2 Floor, H.T. Parekh Marg, 165-166, Backbay Reclamation, Churchgate, Mumbai - 400 020. Received from Mr. / Ms. / M/s. an application for Purchase of Units of the Scheme(s) alongwith Cheque / DD / Payment Inrument as detailed overleaf. : Politically Exposed Person (PEP) details: Is a PEP Related to PEP Not Applicable 3 Guaian Authorised Signatories Promoters Partners Karta Whole-time ors Truee ISC Stamp & Signature... continued overleaf
5. ADDITIONAL KYC DETAILS, If any (Refer inruction 4b) Contd. Gross Annual Income Range (in Rs.) Below 1 lac 1-5 lac 5-10 lac Networth in Rs. (Maatory for Non Iividual) (not older than 1 year) 6. FATCA & CRS INFMATION (for Iividual including Sole Proprietor) (Self Certification) (Refer inruction 4) The below information is required for all applicant(s)/ guaian Address Type: Residential or Business Residential Business Regiered Office (for address mentioned in form/exiing address appearing in Folio) Is the applicant(s)/ guaian's Country of Birth / Citizenship / / Tax Residency other than Iia? Yes No If Yes, please provide the following information [maatory] Please iicate all countries in which you are resident for tax purposes a the associated Tax Reference Numbers below. Category Place/ City of Birth Country of Birth Country of Tax Residency Tax Payer Ref. ID No^ Country of Tax Residency 2 Tax Payer Ref. ID No. 2 Country of Tax Residency 3 Tax Payer Ref. ID No. 3 7. POWER OF ATTNEY (PoA) HOLDER DETAILS Name of PoA Mr. Ms. M/s. Fir (including Minor) Seco / Guaian Thi Please attach Proof. Refer inruction No 16 for PAN/PEKRN a No 18 for KYC. 8. BANK ACCOUNT DETAILS OF THE FIRST / SOLE APPLICANT (For redemption/ divide if any) (refer inruction 5) (Maatory to attach proof, in case the pay-out bank account is different from the bank account mentioned uer Section 10 below.) For unit holders opting to hold units in demat form, please ensure that the bank account linked with the demat account is mentioned here. Bank Name Branch Name Bank City Account Number MICR Code (The 9 digit code appears on your cheque next to the cheque number) Account Type (Please ) Savings Current NRO NRE FCNR Others (please specify) *** Refer Inruction 5C (Maatory for Credit via NEFT / RTGS) (11 Character code appearing on your IFSC Code*** cheque leaf. If you do not fi this on your cheque leaf, please check for the same with your bank) 9. MODE OF PAYMENT OF REDEMPTION / DIVIDEND PROCEEDS (refer inruction 11) 3 Guaian Gross Annual Income Range (in Rs.) To also include USA, where the iividual is a citizen/ green ca holder of USA. ^In case Tax Identification Number is not available, kily provide its functional equivalent. Unitholders will receive redemption/ divide proceeds directly into their bank account (as furnished in Section 8) via credit/ NEFT/ECS facility I/We want to receive the redemption / divide proceeds (if any) by way of a dema draft inead of direct credit / credit through NEFT syem / credit through ECS into my / our bank account 10. INVESTMENTS & PAYMENT DETAILS [Please ( )] (refer inruction 6 & 7 for Scheme details a inruction 8 & 9 for Payment Details) The name of the fir/ sole applicant mu be pre-printed on the cheque. 10-25 lac 25 lac- 1 cr > 1 cr as on DD MM YYYY 3 Guaian Plan (Purchase/ Subscription routed through Diributor) Mention valid ARN in Key Partner/ Agent Information Plan (Purchase/ Subscription made directly with the Fu) Mention DIRECT in Key Partner/ Agent Information Scheme/Plan/Sub Option Payment Type [Please ( )] Cheque/ DD/ Payment Inrument/ UTR No. Non-Thi Party Payment Cheque/ DD/ Payment Inrument/ UTR Amount of Cheque / DD / Payment Inrument / RTGS/ NEFT in figures (Rs.) Thi Party Payment (Please attach Thi Party Payment Declaration Form ) DD Charges, if any Net Cheque/ DD Amount Drawn on Bank / Branch Pay-In Bank (For Cheque Only) Particulars Scheme Name / Plan / Option / Sub-option / Payout Option Cheque / DD / Payment Inrument / UTR No. / Drawn on (Name of Bank a Branch) Amount in figures (Rs.) Please Note: All Purchases are subject to realisation of cheques / dema drafts / Payment Inrument.
11. UNIT HOLDING OPTION DEMAT MODE* PHYSICAL MODE (Default) *Demat Account details are maatory if the inveor wishes to hold the units in Demat Mode NSDL DP ID I N ( refer inruction 13) CDSL *Inveor opting to hold units in demat form, may provide a copy of the DP atement enable us to match the demat details as ated in the application form. 12. NOMINATION (refer inruction 15) (Maatory for new folios of Iividuals where mode of holding is single) (For Units in Non-Demat Form) [Please ( ) a sign] I/We do not wish to Nominate Fir / Sole Seco Thi I/We wish to nominate as uer: Name a Address of Nominee(s) Relationship with of Birth Name a Address of Guaian Signature of Nominee (Optional)/ Guaian of (to be furnished in case the Nominee is a minor) Nominee Proportion (%) in which the units will be shared by each Nominee (should aggregate to 100%) Nominee 1 Nominee 2 Nominee 3 13. DECLARATION & ATURE/S (refer inruction 14) I/We am/are not prohibited from accessing capital markets uer any oer/ruling/judgment etc., of any regulation, including SEBI. I/We confirm that my application is in compliance with applicable Iian a foreign laws. I / We hereby confirm a declare as uer:- (1) I / We have read, uerood a hereby agree to comply with the terms a coitions of the scheme related documents a apply for allotment of Units of the Scheme(s) of HDFC Mutual Fu ( Fu ) iicated above. (2) I/We am/are eligible Inveor(s) as per the scheme related documents a am/are authorised to make this invement as per the Conitutive documents/ authorization(s). The amount inveed in the Scheme(s) is through legitimate sources only a is not for the purpose of contravention a/or evasion of any act, rules, regulations, notifications or directions issued by any regulatory authority in Iia. (3) The information given in / with this application form is true a correct a further agree to furnish such other further/additional information as may be required by the HDFC Asset Management Company Limited (AMC)/ Fu a uertake to inform the AMC / Fu/Regirars a Transfer Agent (RTA) in writing about any change in the information furnished from time to time. (4) That in the event, the above information a/or any part of it is/are fou to be false/ untrue/ misleading, I/We will be liable for the consequences arising therefrom. (5) I/We hereby authorize you to disclose, share, remit in any form/manner/mode the above information a/or any part of it including the changes/updates that may be provided by me/us to the Mutual Fu, its Sponsor/s, Truees, Asset Management Company, its employees, agents a thi party service providers, SEBI regiered intermediaries for single updation/ submission, any Iian or foreign atutory, regulatory, judicial, quasi- judicial authorities/agencies including but not limited to Financial Intelligence Unit-Iia (FIU-IND) etc without any intimation/advice to me/us. (6) I/We will iemnify the Fu, AMC, Truee, RTA a other intermediaries in case of any dispute regaing the eligibility, validity a authorization of my/our transactions. (7) The ARN holder (AMFI regiered Diributor) has disclosed to me/us all the commissions (in the form of trail commission or any other mode), payable to him/them for the different competing Schemes of various Mutual Fus from among which the Scheme is being recommeed to me/us. (8) I/WE HEREBY CONFIRM THAT I/WE HAVE NOT BEEN OFFERED/ COMMUNICATED ANY INDICATIVE PTFOLIO AND/ ANY INDICATIVE YIELD BY THE FUND/AMC/ITS DISTRIBUT F THIS INVESTMENT. For Foreign Nationals Resident in Iia only: I/We will redeem my/our entire invement/s before I/We change my/our Iian residency atus. I/We shall be fully liable for all consequences (including taxation) arising out of the failure to redeem on account of change in residential atus. For NRIs/ PIO/OCIs only: I/We confirm that my application is in compliance with applicable Iian a foreign laws. ATURE(S) Fir / Sole / Guaian Seco Thi HERE (Please write Application Form No. / Folio No. on the reverse of the Cheque / Dema Draft / Payment Inrument.) Please ( ) Yes No If Yes, ( ) Repatriation basis Non-repatriation basis
APPLICATION FM F [For Invements through NACH/ ECS (Debit Clearing)/ Debit Facility/ Staing Inruction] Important: Please rike out the Section(s) that is/are not used by you to avoid any unauthorised use April 30, 2016 Please tick as applicable: OTM Debit Maate is already regiered in the folio. [No need to submit again]. Auto debit can art in 10 Days i.e. for debit date 1, form can be submitted till 4th of the month. OTM Debit Maate is attached a to be regiered in the folio. Auto debit will art after maate regiration which takes 10 to 30 days depeing on NACH or ECS modalities. KEY PARTNER / AGENT INFMATION (Inveors applying uer Plan mu mention in ARN column.) ARN/ RIA Code ARN/ RIA Name Sub-Agent s ARN Bank Branch Code Internal Code for Sub-Agent/ Employee ARN- Enrolment Form no. Employee Unique Identification Number (EUIN) F OFFICE USE ONLY (TIME STAMP) EUIN Declaration (only where EUIN box is left blank) (Refer Item No. 3a) I/We hereby confirm that the EUIN box has been intentionally left blank by me/us as this transaction is executed without any interaction or advice by the employee/relationship manager/sales person of the above diributor/sub broker or notwithaing the advice of in-appropriateness, if any, provided by the employee/relationship manager/sales person of the diributor/sub broker. Sign Here Sign Here Sign Here Fir/ Sole / Guaian Seco Thi Transaction Charges for Applications through Diributors only (Refer Item No. 17 a please tick ( ) any one) : D D I confirm that I am a Fir time inveor across Mutual Fus. (Rs. 150 deductible as Transaction Charge a payable to the Diributor) If the total commitment of invement through (i.e. amount per inallment X no. of inallments) amounts to Rs.10,000 or more a your Diributor has opted to receive transaction Charges, the same are deductible as applicable from the inallment amount a payable to the Diributor. In such cases Transaction Charge will be recoverable in 3-4 inallments. Units will be issued again the balance of the inallment amounts inveed. Upfront commission shall be paid directly by the inveor to the ARN Holder (AMFI regiered Diributor) based on the inveors assessment of various factors including the service reered by the ARN Holder. Please ( ) any one. In the absence of iication of the option the form is liable to be rejected. 1) INVEST DETAILS I confirm that I am an exiing inveor in Mutual Fus. (Rs. 100 deductible as Transaction Charge a payable to the Diributor) NEW REGISTRATION CHANGE OTM DEBIT MANDATE (Refer Item No. 7(e)(iv)) CANCELLATION (Refer Item No. 11) Application No. (For new inveor)/ Folio No. (For exiing Unitholder) Fir/ Sole Details Mobile No. Email Id NAME OF FIRST / SOLE APPLICANT NAME OF THE SECOND APPLICANT NAME OF THE THIRD APPLICANT PAN/ PEKRN KYC Maatory Sole / Fir Seco Thi Guaian/POA Holder Please attach Proof. If PAN/PEKRN/KYC is already validated please don t attach any proof. PEKRN maatory for Micro. Refer Item No. 15 a 16. NAME OF THE GUARDIAN (In case of minor) / CONTACT PERSON - DEATION / PoA HOLDER (In case of Non-iividual Inveors) RELATIONSHIP WITH MIN I/WE WOULD LIKE TO INVEST TO MEET MY/OUR FINANCIAL GOALS (choose anyone ( ) (Refer Item No. 19) Marriage Target Amount Dream Home Dream Car Children s Education Children s Marriage World Tour Retirement ACKNOWLEDGEMENT SLIP (To be filled in by the Unit holder) HDFC MUTUAL FUND : Head Office : HDFC House, 2 Floor, H.T. Parekh Marg, 165-166, Backbay Reclamation, Churchgate, Mumbai - 400 020. Application/ Folio No. Received from Mr./Ms./M/s. application Scheme / Plan / Option Scheme 1 Scheme 2 Scheme 3 Total Inalment Amount (Rs.) Please Note: All purchases are subject to realisation of cheques ISC Stamp & Signature
2) INVESTMENT DETAILS Inallment (TOP UP amount has to be in multiples of Rs.100 only. Please see Inruction 7(c){i}) Scheme Name (1) Plan Option/Sub-option Start Month/Year E Month/Year (Default Dec 2036)* Inallment (TOP UP amount has to be in multiples of Rs.100 only. Please see Inruction 7(c){i}) Default if not selected. In case of, only the Yearly option is available as Top-Up frequency. * CAP amount: Please refer Inruction 7(c){ii}] CAP Month-Year: Please refer Inruction 7(c){ii}] Maximum amount of debit (Top-up) uer direct debit facility for inveors with bank accounts with State Bank of Iia shall not exceed Rs. 5,00,000/- per inallment. CAP (Inveor has to choose only one option) 1 2 All 6 s Scheme Name (2) Plan Option/Sub-option Start Month/Year E Month/Year (Default Dec 2036)* Inallment (TOP UP amount has to be in multiples of Rs.100 only. Please see Inruction 7(c){i}) CAP (Inveor has to choose only one option) 1 Frequency 1 2 All 6 s Scheme Name (3) Plan Option/Sub-option Start Month/Year E Month/Year (Default Dec 2036)* CAP (Inveor has to choose only one option) 1 Frequency 1 2 All 6 s 1 Frequency Fir Transaction via Cheque No. Cheque d D D Amount@ (Rs.) Maatory Enclosure (if 1 Inallment is not by cheque) Blank cancelled cheque Copy of cheque @The fir cheque amount should be same The name of the fir/ sole applicant mu be pre-printed on the cheque. as each/total Amount. 3) BANK DETAILS OTM Bank Details to be debited for the (OTM already Regiered) Bank Name: Account Number: NOTE: In case the OTM is not regiered, please fill in the attached OTM Debit Maate. 4) UNIT HOLDING OPTION DEMAT MODE* PHYSICAL MODE (Default) (refer inruction 10) *Demat Account details are maatory if the inveor wishes to hold the units in Demat Mode NSDL DP ID I N CDSL *Inveor opting to hold units in demat form, may provide a copy of the DP atement enable us to match the demat details as ated in the application form. 5) DECLARATION AND ATURE(S) I / We hereby confirm a declare as uer:- I/ We have read, uerood a agree to comply with the terms a coitions of the scheme related documents of the Scheme a the terms & coitions of enrolment for Syematic Invement Plan () a of NACH/ ECS (Debit Clearing) / Debit / Staing Inruction facilities. The ARN holder has disclosed to me/us all the commissions (in the form of trail commission or any other mode), payable to him/them for the different competing Schemes of various mutual Fus from among which the Scheme is being recommeed to me/us. ATURE (S) Fir/ Sole Unit holder/ Guaian/ POA Holder Seco Unit holder Thi Unit holder Please note: Signature(s) should be as it appears on the Application Form a in the same oer. In case the mode of holding is joint, all Unit holders are required to sign.