10
Upfront commission shall be paid directly by the investor to the AMFI registered Distributors based on the investors’ assessment of various factors including the service rendered by the distributor. Having read and understood the contents of the Scheme Information Document and Statement of Additional Information, Key Information Memorandum, Instructions and addenda issued by DSP BlackRock Mutual Fund, I / We, hereby apply to the Trustee of DSP BlackRock Mutual Fund for Units of the relevant Scheme and agree to abide by the terms and conditions, rules and regulations of the Scheme. I / We declare that the amount invested in the Scheme is through legitimate neither received nor been induced by any rebate or gifts, directly or indirectly in making this investment. 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 Sole / First Unit Holder Second Unit Holder Third Unit Holder POA Holder, if any (To be signed as per Mode of Holding) Amount in Figures (Write Scheme Name, Plan / Option / Sub Option on top) Amount in Words Units in Figures Units in Words OR (Please note that the Redemption can be done either in Units or in Amount and not in both) Rs. Default Option may be applied in case of no information, ambiguity or discrepancy. (This should NOT be construed Bank Name Account No. Amount in Words OTM Facility (One Time Mandate) DD Funds trf () Amount in Figures (i) Total Amount (Rs.) (i) + (ii) Payment from Bank A/c No. Third Party Declaration Account Type Savings NRE NRO Other_____________ / / Pay In A/c No. (Mandatory) Rs. Rs. Rs. () Amount in Figures Amount in Words Units in Figures Units in Words OR Rs. Scheme / Plan / Option* / Sub Option* Third Applicant / Sole / First Applicant / Attached Attached Attached Second Applicant / P (Refer Instructions overleaf) PAN of the PoA holder Name of the PoA holder Attached Notarized copy of PoA Amount (Rs.) OR Units Total Amount (Rs.) No.(s) From To ARN-1781 NIL E078006

DSPBR MF Application forms

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Page 1: DSPBR MF Application forms

!"#$"%&!!%'(!)%*(%+,"%$-#."%-/'0*1"12%3()%#11*+*'(#!%1"+#*!$4('+*(5$4*($+/6.+*'($%'/%+,'$"%-/'0*1"1%#+%#%('(%1"$*5(#+"1%#/"#%'7%+,"%7'/8%8#)%('+%9"%":".6+"12%;*(1!)%$+/*<"%'77%+,"%6(6$"1%=".+*'($%'7%+,"%>'/8%+'%#0'*1%8*$6$"2 !"#$"%6$"%$"-#/#+"%?/#($#.+*'(%>'/8%7'/%"#.,%?/#($#.+*'(%#(1%7'/%"#.,%=.,"8"%4% !#(%#(1%;*(1!)%/"7"/%@($+/6.+*'($%'0"/!"#72

Upfront commission shall be paid directly by the investor to the AMFI registered Distributors based on the investors’ assessment of various factors including the service rendered by the distributor.

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Having read and understood the contents of the Scheme Information Document and Statement of Additional Information, Key Information Memorandum, Instructions and addenda issued by DSP BlackRock Mutual Fund, I / We, hereby apply to the Trustee of DSP BlackRock Mutual Fund for Units of the relevant Scheme and agree to abide by the terms and conditions, rules and regulations of the Scheme. I / We declare that the amount invested in the Scheme is through legitimate !"#$% &!'()&*'+& , &'!-&+% ,.'%+& /!#& -0%&1"#1! %&!/&$!'-#*2%'-,!'&!#&%2* ,!'&!/&*')&3$-4&5%."(*-,!'4&5"(%4&6!-,7$*-,!'4&8,#%$-,!' &!#&*')&!-0%#&*11(,$*9(%& (*: &%'*$-%+&9)& -0%&;!2%#'<%'-&!/& ='+,*&!#&*')&>-*-"-!#)&3"-0!#,-)?& =&@&A%&0*2%&neither received nor been induced by any rebate or gifts, directly or indirectly in making this investment. The ARN holder has disclosed to me/us all the commissions (in the form of trail commission or any other mode), payable to him for -0%&+,//%#%'-&$!<1%-,'.&>$0%<% &!/&2*#,!" &B"-"*(&C"'+ &/#!<&*<!'. -&:0,$0&-0%&>$0%<%&, &9%,'.&#%$!<<%'+%+&-!&<%@" ?&311(,$*9(%&-!&65= &!'()D&=@A%&$!'7#<&-0*-&=&*<@A%&*#%&6!'E5% ,+%'-F G&!/&='+,*'&6*-,!'*(,-)?

=/&HI=6&, &(%/-&9(*'J@'!-&<%'-,!'%+K&=@A%&0%#%9)&$!'7#<&-0*-&-0%&HI=6&9!L&0* &9%%'&,'-%'-,!'*(()&(%/-&9(*'J&9)&<%@" &* &-0, &, &*'&M%L%$"-,!'E!'()N&-#*' *$-,!'&:,-0!"-&*')&,'-%#*$-,!'&!#&*+2,$%&9)&-0%&%<1(!)%%@#%(*-,!' 0,1&<*'*.%#@ *(% &1%# !'&!/&-0%&*9!2%&+, -#,9"-!#&!#&'!-:,-0 -*'+,'.&-0%&*+2,$%&!/&,'E*11#!1#,*-%'% 4&,/&*')4&1#!2,+%+&9)&-0%&%<1(!)%%@#%(*-,!' 0,1&<*'*.%#@ *(% &1%# !'&!/&-0%&+, -#,9"-!#&*'+&-0%&+, -#,9"-!#&0* &'!-&$0*#.%+&*')&*+2, !#)&/%% &!'&-0, &-#*' *$-,!'?

Sole / First Unit Holder Second Unit Holder Third Unit Holder POA Holder, if any

FAIJ3H3?@DB%K%=@LB3?EHA= (To be signed as per Mode of Holding)

Amount in Figures

HAFAM ?@DB (Write Scheme Name, Plan / Option / Sub Option on top)

Amount in Words

Units in Figures Units in Words

OR (Please note that the Redemption can be done either in Units or in Amount and not in both)

Rs.

C Default Option may be applied in case of no information, ambiguity or discrepancy.

G#(<%3..'6(+%7'/%?,*$%H"1"8-+*'(% /'.""1$ (This should NOT be construed* &MO0*'.%&!/&P*'J&B*'+*-%N&#%Q"% -?&5%/%#&=' -#"$-,!' &!2%#(%*/?G=@A%&*.#%%&-0*-&-0%&#%+%<1-,!'&1#!$%%+ & 0!"(+&9%& %'-&%'-,#%()&*-&!"#&#, J&-!&-0%&/!((!:,'.&9*'J&*$$!"'-4&,/&*(#%*+)&#%., -%#%+&:,-0&-0%&/"'+&!#&-!&-0%&+%/*"(-&9*'J&*$$!"'-&,/&'!&9*'J&*$$!"'-&, &<%'-,!'%+&0%#%?

@8-'/+#(+%B'+"N&I'#%., -%#%+&9*'J&*$$!"'-&:,((&'!-&9%&$!' ,+%#%+4&%2%'&,/&<%'-,!'%+&0%#%?&R!&$0*'.%&9*'J& *$$!"'-4& ,'2% -!# & 0!"(+& *2*,(& <"(-,1(%& 9*'J& *$$!"'-& #%., -#*-,!'& /*$,(,-)& *'+& " %& *& 1%$,7$&+% ,.'*-%+&/!#<&/!#&-0, &1"#1! %?&=/&"',-&0!(+%#F G&1#!2,+%&*&'%:&*'+&"'#%., -%#%+&9*'J&<*'+*-%&:,-0&-0%&#%+%<1-,!'&#%Q"% -&F:,-0&!#&:,-0!"-&'%$% *#)& "11!#-,'.&+!$"<%'- G& "$0&9*'J&*$$!"'-&:,((&'!-&9%&$!' ,+%#%+&/!#&1*)<%'-&!/&#%+%<1-,!'&1#!$%%+ &*'+&:,((&'!-&9%&#%., -%#%+?

Bank Name

Account No.

AO@=?@BL%@BPA=?DH=%?H3B=3I?@DB%>DHM% >@B3BI@3J%?H3B=3I?@DB=

Amount in Words

S*)<%'-&B!+%D&& OTM Facility (One Time Mandate) O0%Q"%& DD

Funds trf 5R;>@6HCR

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Amount in Figures (i)

88&O0*#.% &F,,G

Total Amount (Rs.) (i) + (ii)

O0%Q"%&@&88&@&5R;>&@&6HCR&6!?

O0%Q"%&@&S*)<%'-&8*-%

Payment from Bank A/c No.

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P*'J&O%#-,7$*-%4&/!#&88&&&&&& & Third Party Declaration

Account Type Savings O"##%'-& NRE NRO CO65& Other_____________

/ /

Pay In A/c No. (Mandatory)

Rs.

Rs.

Rs.

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Amount in Figures Amount in Words

Units in Figures Units in Words

OR FS(%* %&'!-%&-0*-&-0%&>:,-$0&$*'&9%&+!'%&%,-0%#&,'&I',- &!#&,'&3<!"'-&*'+&'!-&,'&9!-0G

Rs.

=X*+.,Y*( ?' Scheme / Plan / Option* / Sub Option*

F= %G!#.<H'.<

3B%3BF%;ZI%E F3?@DB

Third Applicant / ;"*#+,*'

Sole / First Applicant / ;"*#+,*'

;ZI%JA??AH

Attached

Attached

Attached

Second Applicant / ;"*#+,*'

P'3%U 'X"/%'7%3++'/(")V%HAL@=?H3?@DB%FA?3@J=%(Refer Instructions overleaf)

PAN of the PoA holder

Name of thePoA holder

Attached WXO&Y%--%#&FB*'+*-!#)G

Notarized copy of PoA

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ARN-1781 NIL E078006

Page 2: DSPBR MF Application forms

Upfront commission shall be paid directly by the investor to the AMFI registered Distributors based on the investors’ assessment of various factors including the service rendered by the distributor.

From To

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Transfer Period !#-/'*&,'&='G#-&F&6/>/656&6 STP transactions)

";A03B2;%57<04

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Transfer Date &H%,I&& &),J&& &HK,J&& &LH%,&& &LM,J&& &<""&NG#&O$,#%

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D D / M M / Y Y D D / M M / Y Y

G Default Option may be applied in case of no information, ambiguity or discrepancy.

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Q/,J*-$($"&!#-/'* !#-/'*&,'&='G#-&F&6/>/656&6 SWP transactions)

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D D / M M / Y Y D D / M M / Y Y

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*A52(7B( 7?2(E(+8;34(R084:7?62;( R#$G#&%;$=#&@#,(##>&N-%,&E&6/**"#&E&"$%,&>$6#2 Mr. Ms. M/s. Others____________ +7?87(*<5@2;

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SIP Date &H%,&&& &),J&&& &HK,J&&& &LH%,&&& &LM,J

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D D / M M / Y Y D D / M M / Y Y

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̂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̀ &!-'=##*%&'7&$>+&-#*#6;,/'>&-#P5#%,&(/""&@#&%#>,&'>"+&,'&$&@$>V&$=='5>,&,J$,&/%&$"-#$*+&-#./%,#-#*&$>*&G$"/*$,#*&/>&,J#&7'"/'&$,&,J#&,/6#&'7&-#*#6;,/'>&,-$>%$=,/'>&;-'=#%%/>.9&̀ &a>/,&J'"*#- %2&6$+&=J''%#&,'&6#>,/'>&$>+&'7&,J#&#4/%,/>.&-#./%,#-#*&@$>V&$=='5>,%&(/,J&-#*#6;,/'>&-#P5#%,&7'-&-#=#/G/>.&-#*#6;,/'>&;-'=##*%9&X7&>'&-#./%,#-#*&@$>V&$=='5>,&/%&6#>,/'>#*?&*#7$5",&@$>V&$=='5>,&(/""&@#&5%#*9&̀ &&B(<084(:7?62;.3/(C;71862(A(02>(A06(<0;2=8342;26(@A0P(5A06A42(>84:(A(3C298U9(;2625C4870(;2T<234(.>84:(7;(>84:7<4(029233A;W(3<CC7;480=(679<52043/(3<9:(@A0P(A997<04(>8??(074(@2(9703862;26(B7;(CAW5204(7B(;2625C4870(C;792263D,F%()#Q& ")%"&F*[&[>"+&$&Z#>#-$"&!'(#-&'7&<,,'->#+&$.-##6#>,&(/,J'5,&$>+&-#%,-/=,/'>%&$>*&;#-#>>/$"&G$"/*/,+&/%&$==#;,#*9&1J#&!'<&65%,&@#&#4#=5,#*&'>&%,$6;&;$;#-&$>*&-#./%,#-#*&/>&X>*/$&$>*&$&*5"+&>',$-/b#*&=';+&%J'5"*&@#&#>="'%#*9&1J#&!'<&65%,&J$G#&%/.>$,5-#%&'7&,J#&/>G#%,'-&$%&(#""&,J#&!'<&J'"*#-9&X7&,J#&%/.>$,5-#&'7&!'<&J'"*#-&/%&>',&$G$/"$@"#?&,J#&75>*&6$+&=$""&7'-&$**/,/'>$"&*'=56#>,%&'-&*#="$-$,/'>%&'>&$&=$%#&,'&=$%#&@$%/%9&!'<&(/""&@#&-#./%,#-#*&(/,J/>&HD&('-V/>.&*$+%&'7&-#=#/;,&'7&$""&G$"/*&*'=56#>,%9 !"#$%"&'(&*M# "$#*"(,-%*(. &,/[&B/>/656&X>G#%,6#>,&<6'5>,&7'-&#$=J&0X!&/>%,$"6#>,&/%&8%9CDDEF9&0X!&3$=/"/,+&/%&$G$/"$@"#&'>"+&'>&%;#=/N=&*$,#%&'7&,J#&6'>,J&G/b9&H%,&E&),J&E&HK,J&E&LH%,ELM,J9&<""&:J#P5#%&%J'5"*&@#&'7&,J#&%$6#&*$,#&'7&6'>,J&E&P5$-,#-&$>*&'7&,J#&%$6#&$6'5>,&9&1J#&:J#P5#&%J'5"*&@#&*-$(>&/>&7$G'5-&'7&cU$6#&'7&,J#&0=J#6#&$>*&!"$>d&$%&$;;"/=$@"#9&<&%#;$-$,#&0X!&3'-6&65%,&@#&N""#*&7'-&#$=J&0=J#6#&E&!"$>9&!"#$%#&6#>,/'>&+'5-&7'"/'&>56@#-&$>*&>$6#&'>&-#G#-%#&'7&,J#&:J#P5#9&B/>/656&/>%,$""6#>,%&-#P5/-#*&/%&HL&/>%,$""6#>,%&/>&$""&$G$/"$@"#&0=J#6#%?&S&/>%,$""6#>,%&/>&O0!T8&1$4&0$G#-&35>*9 ! "#$%"&'(")%* +#)(,-%*(. ",/(E( ! "#$%"&'(H&"IJ)%H%-(,-%*(. H,/[&!"#$%#&$""'(&5;,'&)&*$+%&7'-&01!E&0Q!&,'&@#&-#./%,#-#*&$>*&N-%,&01!E&0Q!&,-$>%$=,/'>&,'&J$;;#>9&e#>=#&7'-6&%J'5"*&@#&%5@6/,,#*&$,"#$%,&)&*$+%&@#7'-#&01!&E&0Q!&%,$-,&*$,#9&01!E&0Q!&/%&$G$/"$@"#&/>&$""&,J#&%=J#6#%&'7&,J#&35>*9&!"#$%#&>',#&,J#&*#7$5",&';,/'>%&J/.J"/.J,#*&/>&,J#&7'-6&(J/=J&(/""&@#&5%#*&/>&=$%#&'7&/>='--#=,&*#,$/"%&/>&,J#&7'-69&3'-&/>G#%,'-%&$G$/"/>.&,J#&,-$>%7#-E&(/,J*-$($"&'7&]$;;-#=/$,/'> &̂';,/'>?&(J#-#&/>&$>+&(##V?&6'>,J&'-&P5$-,#-?&,J#-#&/%&>'&$;;-#=/$,/'>&'-&/%&"#%%&,J$>&8%9CDDEF?&%(/,=JE(/,J*-$($"&$%&6#>,/'>#*&$@'G#?&6$+&>',&@#&=$--/#*&'5,9&\'5&=$>&=J''%#&,'&*/%='>,/>5#&,J/%&7$=/"/,+&@+&./G/>.&fD&*$+%&(-/,,#>&>',/=#&,'&,J#&8#./%,-$-9&J&M&J#*J(")%* +#)(,-%*(.J",/[&!"#$%#&$""'(&5;,'&)&*$+%&7'-&O1!&,'&@#&-#./%,#-#*9&e#>=#&7'-6&%J'5"*&@#&%5@6/,,#*&$,"#$%,&)&*$+%&@#7'-#&,J#&-#='-*&*$,#&'7&$>+&7'-,J='6/>.&;-';'%#*&*/G/*#>*9&!"#$%#&-#7#-&,'&(((9*%;@"$=V-'=V9='6&g&0#-G/=#%&g&O/G/*#>*&1-$>%7#-&!"$>&7'-&"/%,&'7&0'5-=#&0=J#6#?&1$-.#,&0=J#6#%&$>*&*#,$/"#*&,#-6%&$>*&='>*/,/'>%9&1J#&B/>/656&$6'5>,&'7&*/G/*#>*&#"/./@"#&7'-&,-$>%7#-&5>*#-&O/G/*#>*&1-$>%7#-&!"$>&/%&8%9&CDDEF9

J834;8@<47;(*A52A06(%)*

<@(O;7P2;('762 <@(O;7P2;EO;A09:E)$(&042;0A?('762

#5C?7W22(R08T<2(&JD(*7D(.#R&*/ +7;(FBU92(<32(70?W

(To be signed as per Mode of Holding)

Having read and understood the contents of the Scheme Information Document and Statement of Additional Information, Key Information Memorandum, Instructions and addenda issued by DSP BlackRock Mutual Fund, I / We, hereby apply to the Trustee of DSP BlackRock Mutual Fund for Units of the relevant Scheme and agree to abide by the terms and conditions, rules and regulations of the Scheme. I / We declare that the amount invested in the Scheme is through "#./,/6$,#&%'5-=#%&'>"+&$>*& /%&>',&*#%/.>#*&7'-&,J#&;5-;'%#&'7&='>,-$G#>,/'>&'-&#G$%/'>&'7&$>+&<=,?&8#.5"$,/'>?&85"#?&U',/N=$,/'>?&O/-#=,/'>%&'-&$>+&',J#-&$;;"/=$@"#& "$(%&#>$=,#*&@+&,J#&Z'G#->6#>,&'7& X>*/$&'-&$>+&0,$,5,'-+&<5,J'-/,+9&I / We have neither received nor been induced by any rebate or gifts, directly or indirectly in making this investment. The ARN holder has disclosed to me/us all the commissions (in the form of trail commission or any other mode), ;$+$@"#&,'&J/6&7'-&,J#&*/77#-#>,&='6;#,/>.&0=J#6#%&'7&G$-/'5%&B5,5$"&35>*%&7-'6&$6'>.%,&(J/=J&,J#&0=J#6#&/%&@#/>.&-#='66#>*#*&,'&6#E5%9&<;;"/=$@"#&,'&U8X%&'>"+_&XEQ#&='>N-6&,J$,&X&$6EQ#&$-#&U'>F8#%/*#>, %2&'7&X>*/$>&U$,/'>$"/,+9

X7&WaXU&/%&"#7,&@"$>VE>',&6#>,/'>#*h&XEQ#&J#-#@+&='>N-6&,J$,&,J#&WaXU&@'4&J$%&@##>&/>,#>,/'>$""+&"#7,&@"$>V&@+&6#E5%&$%&,J/%&/%&$>&c#4#=5,/'>F'>"+d&,-$>%$=,/'>&(/,J'5,&$>+&/>,#-$=,/'>&'-&$*G/=#&@+&,J#&#6;"'+##E-#"$,/'>%J/;&6$>$.#-E%$"#%&;#-%'>&'7&,J#&$@'G#&*/%,-/@5,'-&'-&>',(/,J%,$>*/>.&,J#&$*G/=#&'7&/>F$;;-';-/$,#>#%%?&/7&$>+?&;-'G/*#*&@+&,J#&#6;"'+##E-#"$,/'>%J/;&6$>$.#-E%$"#%&;#-%'>&'7&,J#&*/%,-/@5,'-&$>*&,J#&*/%,-/@5,'-&J$%&>',&=J$-.#*&$>+&$*G/%'-+&7##%&'>&,J/%&,-$>%$=,/'>9

Sole / First Unit Holder Second Unit Holder Third Unit Holder POA Holder, if any

&,(.,J'/(E( ",(E( H,(E(J",

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Page 6: DSPBR MF Application forms
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SIP Registration/Renewal Form (for OTM registered investors only)

Broker ARN Code Sub Broker ARN Code Branch/RM/Internal Code EUIN For Office use only

Broker ARN Code Sub Broker ARN Code Branch/RM/Internal Code EUIN For Office use only

Sole / FirstApplicant's Signature Mandatory

*Default option

Declaration: Having read, understood and agreed to the contents of OTM Facility, the Scheme Information Document, Statement of Additional Information, Key Information Memorandum, Instructions and Addenda issued from time to time of the respective Scheme(s) of DSP BlackRock Mutual Fund mentioned within, I hereby declare that the particulars given above are correct and express my willingness to make payments towards SIP instalments referred above through participation in NACH/ECS/Direct Debit/Standing Instructions. The ARN holder, where applicable, has disclosed to me/us all the commissions (trail commission or any other mode), payable to him for the different competing Schemes of various Mutual Funds from amongst which the Scheme is being recommended to me/us.

Signatures [as per Mutual Fund Records/Application]

x FirstUnitHolder’sSignature

SecondUnitHolder’sSignature

ThirdUnitHolder’sSignature

Please tick as applicable: OTM Debit Mandate is already registered in the folio. [No need to submit again]. SIP Auto debit can start in FIVE Days i.e. for debit date 7th, form can be submitted till 2nd of the month. OTM Debit Mandate is attached and to be registered in the folio. SIP Auto debit will start after mandate registration which takes Ten to Thirty days depending on NACH or ECS modalities.The total of all installments in a day should be less than or equal to the amount as mentioned in One Time Mandate already registered or submitted, if not registered.

Attention: No need to attach OTM Debit Mandate again, if already registered earlier.

DEBIT MANADATE FORM SIP FORM

M M Y Y Y YM M Y Y Y Y

M M Y Y Y YM M Y Y Y Y

M M Y Y Y YM M Y Y Y Y

Scheme/Plan/Option/Sub-optionSIP Installment

Amount (`)SIP Date Frequency Start Month/Year

End Month/Year(Default Dec 2099)*

Sr.No.

1.

2.

3.

1st* 7th 14th

21st 28th

1st* 7th 14th

21st 28th

1st* 7th 14th

21st 28th

Monthly*

Quarterly

Monthly*

Quarterly

Monthly*

Quarterly

Acknowledgement DSP BlackRock Mutual FundInvestor Name: Folio No/Application No.

Sole / First Applicant / Guardian Second Applicant / Guardian Third Applicant / Guardian

Investor Name:

Existing Investor

Folio No.OR

New InvestorApplication no.

PAN/PEKRAN & KYC

I/We confirm that the EUIN box is intentionally left blank by me/us as this is an “execution-only”transaction without any interaction or advice by the distributor personnel concerned. Upfront commission shall be paid directly by the investor to the AMFI registered Distributors based on the investors’ assessment of various factors including the service rendered by the distributor.

ISC Stamp

The following Mandate needs to be submitted only once for registration with or without SIP form. Once the mandate is registered, investor need not submit mandate again and can do lump sum investments, start new SIP registrations, using Physical Forms, Call, SMS or Online.

Please attach a cancelled cheque/cheque copy

OTM Debit Mandate Form NACH/ECS/DIRECT DEBIT[Applicable for Lumpsum Additional Purchases as well as SIP Registrations]

Declaration: I/We hereby declare that the particulars given on this mandate are correct and complete and express my willingness and authorize to make payments referred above through participation in NACH/ECS/Direct Debit/Stand-ing Instructions. I/We hereby confirm adherence to the terms of OTM Facility offered by DSP BlackRock Mutual Fund and as amended from time to time and of NACH/ECS (Debits)/Direct Debits /Standing Instructions.Authorisation to Bank: This is to inform that I/We have registered for ECS / NACH (Debit Clearing) / Direct Debit / Standing instructions facility and that my/our payment towards my/our investment in DSP BlackRock Mutual Fund shall be made from my/our above mentioned bank account with your Bank. I/We authorize the representatives of DSP BlackRock Mutual Fund carrying this mandate form to get it verified and executed. I/We authorize the bank to debit my account for any charges towards mandate verification, registration, transactions, returns, etc, as applicable.

Bank Name & BranchWithBank:

Reference 1 Mobile

an amount of Rupees `FREQUENCY Mthly Qtly H. Yrly Yrly ! As & when presented DEBIT TYPE Fixed Amount ! Maximum Amount

Bank A/c No.:

OR MICRIFSC

Office use onlyUMRN

Office use onlySponsor Bank Code Office use onlyUtility Code

I/We hereby authorize: DSP BLACKROCK MUTUAL FUND Schemes to debit (tick") SB / CA / CC / SB-NRE / SB-NRO / Other

Date

Folio No:

Reference 2 Email idAppln No:

Tick(")

CREATE

MODIFY

CANCEL

Until Cancelled

From D D M M Y Y Y Y

3 1 1 2 2 0 9 9to

or

PERIOD

Name (mandatory)

Sign1. 2. 3.

Name (mandatory)

Sign

Name (mandatory)

Sign

D M M Y Y Y Y

Unique Benefits Debit Mandate Checklist: SIP Registration Checklist:

!"#$%&'#(!)*+&!,%'-%.!/!'0!12!345& !6.#!70(8!9!:;<'%=<#!)*+>&! !:;<'%=<#!)?-#8#&@!:;<'%=<#!A80;.'&@! !:;<'%=<#!B4'#&!C!:;<'%=<#!7(#D;#.?%#& !B#E%'!:4.34'#!F0(8!'0!E#!F%<<#3!G;&'!6HIJ!

!B%&'(%E;'0(!?03#!C!3#'4%<&@!%F!4.5@ !H48#@!70<%0!H0K!L!A==<%?4'%0.!H0K !)?-#8#L&!3#'4%<& !)*+!A80;.' !)*+!B4'#@!7(#D;#.?5!C!+#(%03 !)%$.4';(#L&

!B%&'(%E;'0(!?03#!C!3#'4%<&@!%F!4.5@ !M4.N!A??0;.'!H;8E#(@!M4.N!H48#@!*7)I!0(!:*I"!I03# !A80;.'!%.!,0(3&!AHB!%.!7%$;(#&@!4&!50;!,0;<3!%.!4!?-#D;#!

(your maximum limit) !70<%0!H0K!L!A==<%?4'%0.!H0KO!:0E%<#!C!J84%<!*3 !P0;(!HA:J!4.3!)*QHARS"J!4&!%.!50;(!E4.N!4??0;.'

Website : www.dspblackrock.com | E-mail : [email protected] | Contact Centre : 1-800-200-4499

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Instructions

! "#$%&'()&!*+(!+,$%!,-)eady submitted an OTM form or already registered for OTM facility should not submit OTM form

again as OTM registration is a one-time process only for each bank account. However, such investors if wish to add a

new bank account towards OTM facility may fill the form.

! .'+%)!/#$%&'()&0!*+(!+,$%!#('!)%1/&'%)%2!3()!.45!3,6/-/'70!8,7!3/--!'+%!.45!3()8!,#2!&9:8/'!29-7!&/1#%2!*/'+!'+%/)!

name mentioned.

! 5(:/-%!;98:%)!,#2!<8,/-! "2=!>#/'!+(-2%)?&@! &+(9-2!8,#2,'()/-7!A)($/2%!'+%/)!8(:/-%!#98:%)!,#2!%8,/-! /2!(#!'+%!

mandate form. Where the mobile number and email id mentioned on the mandate form differs from the ones as

already existing in the folio, the details provided on the mandate will be updated in the folio. All future

communication whatsoever would be, thereafter, sent to the updated mobile number and email id.

! >#/'!+(-2%)?&@!#%%2!'(!A)($/2%!,-(#1!*/'+!'+%!8,#2,'%!3()8!,#!()/1/#,-!6,#6%--%2!6+%B9%!?()!,!6(A7@!*/'+!#,8%!,#2!

account number pre-printed of the bank account to be registered or bank account verification letter for registration

of the mandate failing which registration may not be accepted. The Unit holder(s) cheque/ bank account details are

&9:C%6'!'(!'+/)2!A,)'7!$%)/3/6,'/(#D

! "#$%&'()&!,)%!2%%8%2!'(!+,$%!)%,2!,#2!9#2%)&'((2!'+%!'%)8&!,#2!6(#2/'/(#&!(3!.45!E,6/-/'70!F"G!)%1/&'),'/(#!'+)(91+!

OTM facility, the Scheme Information Document, Statement of Additional Information, Key Information Memorandum,

Instructions and Addenda issued from time to time of the respective Scheme(s) of DSP BlackRock Mutual Fund.

Instructions

! With the introduction of One Time mandate (OTM) facility, the mandate registration and SIP registration through OTM

facility has been delinked. There are two separate forms, 1) for onetime mandate registration and 2) for SIP

Registration.

! H+%)%!,!(#%'/8%!8,#2,'%!/&!,-)%,27!)%1/&'%)%2!/#!,!3(-/(!3()!,!:,#I!,66(9#'0!'+%!>#/'!J(-2%)?&@!*/--!+,$%!'(!3/--!(#-7!

the SIP Registration Form and there is no need of a separate cheque to be given along with the SIP Registration Form.

! H+%)%!'+%!8,#2,'%!3()8!,#2!'+%!F"G!)%1/&'),'/(#!3()8!,)%!&9:8/''%2!'(1%'+%)0!2%:/'&!3()!'+%!F"G!8,7!+,AA%#!(#-7!(#!

successful registration of the mandate by the Unit holder(s) bank. The Fund / AMC would present the SIP transactions

or lump sum purchase transactions without waiting for the confirmation of the successful registration from the Unit

holder(s)’ bank.

! "#!6,&%!'+%!(#%'/8%!8,#2,'%!/&!&966%&&39--7!)%1/&'%)%20!#%*!F"G!)%1/&'),'/(#!*/--!',I%!9A'(!3/$%!2,7&D!4+%!3/)&'!2%:/'!

may happen any time thereafter, based on the dates opted by the Unit holder(s).

! H+/-%!'+%!E9#2!,#2!K4L!)%&%)$%!'+%!)/1+'!'(!%#+,#6%!'+%!F"G!A%)/(2!'(!%#&9)%!8/#/898!/#&',--8%#'&!,&!A%)!)%&A%6'/$%!

scheme offer documents, even if the investor has submitted the form late or requested for a period less than minimum

/#&',--8%#'&0!'+%7!8,7!)%C%6'!'+%!,AA-/6,'/(#&!3()!-%&&!'+,#!8/#/898!/#&',--8%#'&D

! "3!&',)'!2,'%!3()!F"G!A%)/(2!/&!#('!&A%6/3/%20!F"G!*/--!:%!)%1/&'%)%2!'(!&',)'!,#7'/8%!3)(8!,!A%)/(2!,3'%)!3/$%!2,7&!3)(8!

'+%!2,'%!(3!)%6%/A'!(3!,AA-/6,'/(#!:,&%2!(#!'+%!F"G!2,'%!,$,/-,:-%!M!8%#'/(#%20!&9:C%6'!'(!8,#2,'%!:%/#1!)%1/&'%)%2D!

If end date is not specified, SIP will be registered till December 2099 or end date of mandate, whichever is earlier.

! "3!,#7'/8%!29)/#1!'+%!F"G!A%)/(20!'+%!(#%'/8%!8,#2,'%!/&!8(2/3/%2!'(!)%296%!'+%!$,-/2/'7!A%)/(20!39'9)%!/#&',--8%#'&!

of all SIPs registered under the mandate will be deemed to have the end period coinciding with the mandate.

! "#!6,&%!(3!5/6)(!F"G!,AA-/6,'/(#!*/'+(9'!GL;0!'+%!/#$%&'()M&!+%)%:7!2%6-,)%!'+,'!'+%7!2(!#('!+,$%!,#7!%N/&'/#1!5/6)(!

SIPs with DSP BlackRock Mutual Fund which together with the current application will result in aggregate investments

%N6%%2/#1!K&D!OP0PPP!/#!,!7%,)D

! E()!2%',/-%2!'%)8&!,#2!6(#2/'/(#&!(#!F"G0!/#6-92/#1!3()!.45!3,6/-/'70!A-%,&%!$/&/'!(9)!*%:&/'%!***D2&A:-,6I)(6ID6(8!

and also refer to scheme related documents.

Page 9: DSPBR MF Application forms

!

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