Embed Size (px)
DESCRIPTION
UTI Mutual Fund Common Application Form for Equity oriented Schemes
Citation preview
Sr.No. 2014/
Registrar Sr. No.
PLEASE USE SEPARATE FORM FOR EACH SCHEME
(OCBs & US PERSONS INCLUDING QUALIFIED FOREIGN INVESTORS REGISTERED IN USA AND CANADA AND RESIDENTS OF CANADA ARE NOT ALLOWED TO
INVEST IN UNITS OF ANY OF THE SCHEMES OF UTI MF)
PLEASE FILL IN ALL COLUMNS IN CAPITAL LETTERS ONLY
(PLEASE READ INSTRUCTIONS CAREFULLY TO HELP US SERVE YOU BETTER)
OPTION FOR DESPATCH OF STATEMENT OF ACCOUNT
Applicant’s address (for NRIs) At my Overseas address as mentioned above / To be despatched to my resident relative’s address in India as given above
!"#$%&'($))*++*$%'+,-..'/0'!-*1'1*#0(&.2'/2'&,0'*%30+&$#'&$'&,0'4567'8'97:5'(0#&*;01' <7'56'#0=*+&0#01'>*+&#*/?&$#+'/-+01'$%'&,0'*%30+&$#+@'-++0++)0%&'$"'
3-#*$?+'"-(&$#+'*%(.?1*%='&,0'+0#3*(0'#0%10#01'/2'&,0'1*+&#*/?&$#A'
B' 78C0'($%;#)''&,-&'&,0'D 79'/$E'*+'*%&0%&*$%-..2'.0"&'/.-%F'/2')08?+'-+'&,*+'*+'-%'G0E0(?&*$%H$%.2I'&#-%+-(&*$%'J*&,$?&'-%2'*%&0#-(&*$%'$#'-13*(0'/2'&,0'
1*+&#*/?&$#'!0#+$%%0.'($%(0#%01'$#'%$&J*&,+&-%1*%='&,0'-13*(0'$"'*%H-!!#$!#*-&0%0++K'*"'-%2K'!#$3*101'/2'+?(,'1*+&#*/?&$#'!0#+$%%0.'-%1'&,0'1*+&#*/?&$#'
,-+'%$&'(,-#=01'-%2'-13*+$#2'"00+'"$#'&,*+'&#-%+-(&*$%A' L 'M.0-+0'&*(F'-%1'+*=%'/0.$J'J,0%'D 79'/$E'*+'.0"&'/.-%FN'L#0"0#'*%+&#?(&*$%'O3@NA
TRANSACTION CHARGES TO BE PAID TO THE DISTRIBUTOR (Please tick any one of the below) (Refer Instruction ‘i’)
I AM A FIRST TIME INVESTOR IN MUTUAL FUNDS OR
I AM AN EXISTING INVESTOR IN MUTUAL FUNDS
` 150 will be deducted as transaction charges per Subscription of ` 10,000 and above ` 100 will be deducted as transaction charges per Subscription of ` 10,000 and above
DE*+&*%=' %*&'P$.10#'*%"$#)-&*$% Scheme Name: Folio Number:
9-)0'$"'6*#+&'4!!.*(-%&'(as appearing in ID proof given for KYC)
6*#+&'4!!.*(-%&@+'411#0++ (Do not repeat the name) 9-)0'Q'411#0++'$"'#0+*10%&'#0.-&*30'*%'7%1*- !"#$ %&'() !*+,+ -#. %#+ /( 0#1 (2"34/501)
Village/Flat/Bldg./Plot*
City/Town* State Pin*
Street/Road/Area/Post
F I R S T M I D D L E
L A S T Date of Birth Mandatory for minors d d m m y y y y
Enclosed PAN Card Copy Know Your Customer (KYC)* Acknowledgement Copy Please ( )
4MMR7S49<@:'MDT:U94R'>D<47R:' Mr. Ms. Mrs. * Denotes Mandatory Fields
*PAN OF 1ST APPLICANT/FATHER/MOTHER/GUARDIAN (whose particulars are furnished in the form) AADHAR CARD NO.
:*=%-&?#0'$"'V+&'4!!.*(-%&'8'W?-#1*-% :*=%-&?#0'$"'X%1'4!!.*(-%& :*=%-&?#0'$"'Y#1'4!!.*(-%&
ZM49'$"'Y#1'4!!.*(-%&
9-)0'$"'X%1'4!!.*(-%&' Mr. Ms. Mrs. Date of Birth of 2nd Applicant
Date of Birth of 3rd Applicant
d d m m y y y y
d d m m y y y y
ZM49'$"'X%1'4!!.*(-%&
9-)0'$"'Y#1'4!!.*(-%&' Mr. Ms. Mrs.
F I R S T M I D D L E L A S T
Enclosed PAN Card Copy Know Your Customer (KYC)* Acknowledgement Copy Please ( )
F I R S T M I D D L E L A S T
Enclosed PAN Card Copy Know Your Customer (KYC)* Acknowledgement Copy Please ( )
DETAILS OF OTHER APPLICANTS
AADHAR CARD NO.
AADHAR CARD NO.
BDA / CA Code
' 4T9' 9-)0'$"'6*%-%(*-.'413*+$#' :?/'4T9'S$10' :?/'S$108' ''''5'U'S$10'' D 7'9$A@ UTI RM No. Bank Branch Code
DISTRIBUTOR INFORMATION (only empanelled Distributors/Brokers will be permitted to distribute Units) (refer instruction ‘h’)
City*
State Country* Zip/Pin*
OVERSEAS ADDRESS (Overseas address is mandatory for NRI / FII applicants in addition to mailing address in India)
Amt. in words
PAYMENT DETAILS (Refer Instruction ‘x’)
Account No.
Date
Bank
Branch
Amt. of investment (i)
DD Charges if any (ii)
Net amount paid (i-ii)
# Please mention the application No. on the reverse of
the cheque / DD, NEFT / RTGS advice. Cheque / DD
must be drawn in favour of G<,0'9-)0'$"'&,0':(,0)0I
& crossed G48('M-200'U%.2I'
'7%30+&)0%&'-)$?%&'+,-..'/0'T+A'X'.-(+'-%1'-/$30'
*%'(-+0'$"'!-2)0%&+'&,#$?=,'9D6<'8'T<W:A
#Cheque/DD/ NEFT/ RTGS Ref. No. / Unique Serial No. (For Cash) Account type Savings Current NRE
(please ) NRO DD issued from abroad
Cash
$ Proof of date of birth and proof of relationship with minor to be attached or else sign the declaration on the reverse (Refer instruction ‘f ’).
F I R S T M I D D L E L A S T
NAME IN FULL OF THE FATHER (OR) MOTHER / GUARDIAN (IN CASE OF MINOR)$ / Mr. Ms. Mrs.CONTACT PERSON FOR INSTITUTIONAL APPLICANTS
COMMON APPLICATION FORM FOR OPEN-ENDED EQUITY AND BALANCED SCHEMES
Account type (please ) Savings Current NRO NRE
Account No.
IFS Code
(this is a 11-digit number)
BANK PARTICULARS OF 1ST APPLICANT (Mandatory as per SEBI Guidelines)
Bank Name Branch
Address MICR Code
(this is a 9-digit number next to your cheque number)
City Pin*
79[D:<5D9<'>D<47R:'L6$#'GDIRECT PLANI'M.0-+0'&*(F',0#0' 'Q'&*(F':(,0)0K'M.-%'8'U!&*$%'=*30%'/0.$JN'LT0"0#'*%+&#?(&*$%'O\@N
OPTION (for all schemes) Growth Dividend Payout Dividend Reinvestment (Default is growth option)
UTI-Balanced Fund
UTI-Banking Sector Fund - Regular Plan
UTI-Contra Fund
UTI-Dividend Yield Fund
UTI-Energy Fund
UTI-Equity Fund
UTI-India Lifestyle Fund
UTI-Infrastructure Fund
UTI-Leadership Equity Fund
UTI-Master Plus Unit Scheme
UTI-Mastershare Unit Scheme
UTI-Master Value Fund
UTI-Mid Cap Fund
UTI-MNC Fund
UTI-Nifty Index Fund
UTI-Opportunities Fund
UTI-Pharma & Healthcare Fund
UTI-Services Industries Fund
UTI-Top 100 Fund
UTI-Transportation & Logistics Fund
UTI-Wealth Builder Fund Series II - Retail Plan
>0&-*.+'$"']0%0;(*-.'UJ%0#+,*!'LM.0-+0'-&&-(,'-'+0!-#-&0'+,00&'J*&,'&,*+'"$#)-&'*"'&,0'+!-(0'!#$3*101'*+'*%+?";(*0%&N
Sr. No.
Name Address>0&-*.+'$"'710%&*&2'
such as PAN / Passport
^'$"'$J%0#+,*!
1
2
3
4
5
6
[Please attach self attested copy of PAN/Passport (proof of photo identity) along with application form]
>0&-*.+'$"']0%0;(*-.'UJ%0#+,*!'LM.0-+0'&*(F'-!!.*(-/.0'(-&0=$#2NA'UJ%0#+,*!'10&-*.+'&$'/0'!#$3*101'*"'&,0'UJ%0#+,*!'!0#(0%&-=08*%&0#0+&'*%'
&,0'&#?+&'$"'-%2']0%0;(*-#2'*+'-+'!0#'&,0'&,#0+,$.1'.*)*&'!#$3*101'/0.$JA'>0&-*.+'&$'/0'!#$3*101'"$#'0-(,'+?(,'/0%0;(*-#2A'
LT0"0#'*%+&#?(&*$%'_N
Category Unlisted
company Partnership
Firm Unincorporated
4++$(*-&*$%8]$12'$"'
Individuals
Trust Foreign
Investor $$$
Ownership per cent
@@@ >25% >15% >15% >=15%
666 ,705$(8/9 95$4501:;5 #" (8:$5(<4:9/1:=<9$#31(<9$#95$1> #" ?2$/@/4:= 95$(#0</015$5(1 /0 185 A$2(1 :( #0 185 @:15 #" 185 :99=/4:1/#0 (8:== B5 "2$0/(85@ by the investor.
CCC '0 185 4:(5 #" D#$5/;0 /0E5(1#$(F 185 B50534/:= #705$(8/9 7/== B5 @515$G/05@ :( 95$ HI-' ;2/@5=/05(+ D#$ @51:/=( $5"5$ 1# HJ'<$5=5E:01 J@@50@2G+
'0 4:(5 #" :0> 48:0;5 /0 185 B50534/:= #705$(8/9F 185 /0E5(1#$ 7/== B5 $5(9#0(/B=5 1# /01/G:15 KA' JLM < /1( &5;/(1$:$ < N&J :( G:> B5 :99=/4:B=5 immediately about such change.
Unitholding Option Demat Mode Physical Mode (if Demat account details are provided below, units will be allotted by default in Electronic Mode only)
DEMAT ACCOUNT DETAILS - (Please ensure that the sequence of names as mentioned in the application form matches with that of the account held with any
one of the Depository Participant. Demat Account details are compulsory if demat mode is opted above
National
Securities
Depository
Limited
Depository Name _________________________________ Central
Depository
Services
(India)
Limited
Depository Name ___________________________________________________
DP ID No.
-50534/:$>
Account No.
Target ID No.
Enclosures : Client Master List (CMl) Transaction cum Holding Statement Delivery Instruction Slip (DIS)
FRIEND IN NEED DETAILS (refer instruction - k) In case UTI MF is unable to communicate with me/us at my / our registered address, I / we authorize
UTI MF to correspond with the following person to ascertain my/our updated contact details.
Name
Address:
Relationship with the applicant (optional) Mobile
F I R S T M I D D L E L A S T
ACKNOWLEDGEMENTL<$'/0';..01'*%'/2'&,0'4!!.*(-%&N
H1:G9 #" KA' JLM ,"345< Authorised Collection Centre
dated
(scheme name)
Sr. No. 2014/
T0(0*301'"#$)'5#'8'5+'8'58+
An application under
-.$%='J*&,'S,0_?0'8'>>'9$A$ /Cash
>#-J%'$%'L]-%FN
"$#'`'L*%';=?#0+N
$ M85O25( :0@ @$:"1( :$5 (2B?541 1# $5:=/(:1/#0+
GENERAL INFORMATION - Please ( N'J,0#030#'-!!.*(-/.0
OTHER DETAILS (For Individuals Only)
OTHER DETAILS (For Non-Individuals Only)
STATUS: Resident Individual Listed Company Unlisted Company Minor through guardian HUF
Partnership Trust Sole Proprietorship Society Body Corporate
AOP BOI FII NRI Foreign Nationals* Others (Please specify) ____________________________________________________________________________________
OCCUPATION: Business Student Agriculture Self-employed Professional
Housewife Retired Private Sector Service Public Sector Service Government Service
Forex Dealer Others (Please specify) __________________________________________________________________
MODE OF HOLDING: Single Anyone or survivor Joint
MARITAL STATUS: Unmarried Married Wedding Anniversary D D M M
*' US]+'Q' :'!0#+$%+'*%(.?1*%='`?-.*;01'6$#0*=%'7%30+&$#+'#0=*+&0#01'*%' :4'-%1'S-%-1-'-%1'#0+*10%&+'$"'S-%-1-'-#0'%$&'-..$J01'&$'*%30+&'*%'?%*&+'$"'-%2'$"'&,0'+(,0)0+'$"' <7'56A
1. Gross Annual Income Details Please tick ( ) Below 1 Lac 1-5 lacs 5-10 Lacs 10-25 Lacs >25 Lacs
[OR]
Net-worth in ` ________________________________________________________________________ as on (date) D D M M Y Y Y Y
XA' M.0-+0'&*(F'*"'-!!.*(-/.0a Politically Exposed Person (PEP) Related to a Politically Exposed Person (PEP)
(For definition of PEP, please refer instruction ‘w’).
YA' 4%2'$&,0#'*%"$#)-&*$%a ___________________________________________________________________________________________________________
1. Gross Annual Income Details Please tick ( ) Below 1 Lac 1-5 lacs 5-10 Lacs 10-25 Lacs >25 Lacs-1 Crore >1 Crore
XA' 90&HJ$#&,'*% ` ________________________________________________________________________ as on (date) D D M M Y Y Y Y
YA' 7+'&,0'0%&*&2'*%3$.301'*%'8'!#$3*1*%='-%2'$#'&,0'"$..$J*%='+0#3*(0+
– Foreign Exchange / Money Changer Services YES NO
– Gaming / Gambling / Lottery Services (e.g. casinos, betting syndicates) YES NO
– Money Lending / Pawning YES NO
bA' 4%2'$&,0#'*%"$#)-&*$%a ___________________________________________________________________________________________________________
(Net worth should not be older than 1 year)
(Net worth should not be older than 1 year)
Sign. here
Notes :
P+ '" 185 :99=/4:1/#0 /( /04#G9=515 :0@ :0> #185$ $5O2/$5G501 /( 0#1 "2=3==5@F 185 :99=/4:1/#0 /( =/:B=5 1# B5 $5?5415@+
2. Consolidated Account Statement (CAS) will be sent within 10 days of the following month of the transaction.
3. M.0-+0'0%+?#0'&,-&'-..'cdS'S$)!.*-%(0'M#$$"'-%1'M49''10&-*.+'-#0'=*30%K'"-*.*%='J,*(,'2$?#'-!!.*(-&*$%'J*..'/0'#0\0(&01A'M49'%$&'
-!!.*(-/.0'"$#'5*(#$':7MA
4. All communication relating to issue of Statement of Account, Change in name, Address or Bank particulars, Nomination, Redemption, Death
Claims etc., may please be addressed to the Registrar :
M/s. Karvy Computershare Private Limited, Narayani Mansion, H.No.1-90-2/10/E, Vittalrao Nagar, Madhapur, Hyderabad – 500 081.
Tel. 040-23312454, Fax: 040-23115503,
E-mail: [email protected]
NOMINATION DETAILS (Please N'L!.0-+0'+*=%'*"'2$?'1$'%$&'J*+,'&$'%$)*%-&0N
I/We hereby nominate the undermentioned Nominee to receive the amounts to my / our credit in the event of my / our death. I/We also understand
that all payments and settlements made to such Nominee and signature of the Nominee acknowledging receipt thereof, shall be a valid discharge by the
AMC / Mutual Fund / Trustee.
9-)0'-%1'411#0++'$"'9$)*%00 <$'/0'"?#%*+,01'*%'(-+0'%$)*%00'*+'-')*%$#
Name
Date of Birth d d m m y y y y
(in case of nominee is a minor)
Name of the guardian
Address of guardian
Address with pin code
Signature of Nominee / guardian
(for minor)
'0E5(1#$( 78# 7/(8 1# 0#G/0:15 17# #$ 18$55 95$(#0( G:> 3== /0 185 (59:$:15 "#$G 9$5(4$/B5@ "#$ 185 (:G5 :0@ :11:48 /1 7/18 18/( :99=/4:1/#0 "#$G+
I/We do not wish to nominate
:*=%-&?#0'$"'V+&'4!!.*(-%&'8'W?-#1*-%
:*=%-&?#0'$"'X%1'4!!.*(-%&
:*=%-&?#0'$"'Y#1'4!!.*(-%&
Sign. here
DECLARATION AND SIGNATURE OF APPLICANT/s
!"I/We have read and understood the contents of the Scheme Information Document, Statement of Additional Information and Key Information
Memorandum, addenda issued till date and apply to the Trustee of UTI Mutual Fund as indicated above. I/We agree to abide by the terms and
4#0@/1/#0(F $2=5( :0@ $5;2=:1/#0( #" 185 (485G5 :( #0 185 @:15 #" /0E5(1G501+ '<Q5 20@5$1:R5 1# 4#03$G 18:1 18/( /0E5(1G501 8:( B550 @2=> :218#$/(5@
by appropriate authorities in terms of all relevant documents and procedural requirements. ! I/We have not received nor been induced by any rebate
or gifts, directly or indirectly in making investments. ! The ARN holder has disclosed to me/us all the commissions (in the form of trail commission or
any other mode), payable to him for the different competing Schemes of various Mutual Funds from amongst which the Scheme is being recommended
to me/us. ! I/We hereby authorize UTI MF/UTI AMC to share my data furnished in the Form to my distributor and other service providers of the UTI
MF for the purpose of servicing, issue of account statement/consolidated statement of account etc and cross selling of products/schemes of the UTI
MF. ! '<Q5 4#03$G 18:1 75 :$5 %#0S&5(/@501( #" '0@/:0 %:1/#0:=/1><,$/;/0 :0@ 18:1 185 "20@( :$5 $5G/115@ "$#G :B$#:@ 18$#2;8 :99$#E5@ B:0R/0;
channels or from my / our NRE / NRO Account. I/We undertake to provide further details of source of funds and any such other relevant documents,
if called for by UTI Mutual Fund (Applicable to NRI’s). ! I hereby solemnly declare that I am the father/mother/guardian of the minor child in whose
name the application is made. The date of birth stated by me is true and correct. I do not have any documents in support of the date of birth and
relationship with minor child. (Strike out if this declaration is not applicable).
T *=5:(5 (50@ 185 J44#201 H1:15G501F JB$/@;5@ J002:= &59#$1F A$:0(:41/#0 4#03$G:1/#0F 4#GG20/4:1/#0 #" 48:0;5 #" :@@$5((F 48:0;5 #" B:0R @51:/=(
etc. through email only at the below email ID. (If you wish to receive in physical form please tick )
First
Applicant
Details
Mobile NumberTel. No.
(R) STD CODE
(O) STD CODE
*E mail ____________________________________
Alternate E-mail _____________________________
:*=%-&?#0'$"'V+&'4!!.*(-%&'8'W?-#1*-%
Name of 1st Authorised Signatory
_____________________________________
Designation ___________________________
:*=%-&?#0'$"'X%1'4!!.*(-%&
Name of 2nd Authorised Signatory
____________________________________
Designation __________________________
:*=%-&?#0'$"'Y#1'4!!.*(-%&
Name of 3rd Authorised Signatory
___________________________________
Designation _________________________
