Application No.
FORM 1 - FOR LUMP SUM / SIP INVESTMENTS
(PLEASE READ THE INSTRUCTIONS BEFORE FILLING UP THE FORM. All sections to be completed in ENGLISH in BLACK / BLUE COLOURED INK and in BLOCK LETTERS.)
TRANSACTION CHARGES FOR APPLICATIONS ROUTED THROUGH DISTRIBUTORS/AGENTS ONLY
(Refer Instruction No. 20)
In case the subscription (lumpsum) amount is ` 10,000/- or more and your Distributor has opted to receive Transaction Charges, 150/- (for first time mutual fund investor) or 100/- (for investor other than first
time mutual fund investor) will be deducted from the subscription amount and paid to the distributor. Units will be issued against the balance amount invested.
` `
I confirm that I am a first time investor across Mutual Funds.
I confirm that I am an existing investor in Mutual Funds.
OR
Received subject to realisation, verification and conditions, an application for purchase of Units as mentioned in the application form.
ACKNOWLEDGMENT SLIP
From
Application No.
Cheque no.
Date Amount
Scheme
Stamp & Signature
SECOND APPLICANT
Mr. Ms.
M/s.
GUARDIAN DETAILS (In case First / Sole Applicant is minor) / CONTACT PERSON - DESIGNATION / PoA HOLDER (In case of Non-individual Investors)
Relationship Of Guardian (Refer Instruction No. 11)
Proof of the Relationship with Minor
Date of Birth
D D M M Y Y Y Y
CKYC No.
14 digit CKYC Number
THIRD APPLICANT
Mr. Ms.
M/s.
Date of Birth
D D M M Y Y Y Y
CKYC No.
14 digit CKYC Number
Mr. Ms.
M/s.
Date of Birth
D D M M Y Y Y Y
CKYC No.
14 digit CKYC Number
Birth Certificate
School Certificate
Passport
Other
Specify
TAX STATUS (Applicable for First / Sole Applicant)
Resident Individual FIIs NRI - NRO HUF Club / Society PIO Body Corporate Minor Government Body Trust NRI - NRE Bank & FI
Sole Proprietor Partnership Firm QFI Provident Fund Others
Specify
PAN (Mandatory)
PAN (Mandatory)
PAN (Mandatory)
EXISTING INVESTOR'S FOLIO NUMBER
(Applicable details and Mode of holding will be as per the existing Folio No.)
(If you have an existing folio with KYC validated,
please mention here and skip to section 6/7.)
Anyone or Survivor
Joint (Default)
Single
MODE OF HOLDING
(in case of Demat Purchase Mode of Holding should be same as in Demat Account)
INVESTMENT TYPE
(Please tick any one)
LUMP SUM WITH STP
LUMP SUM WITH SIP
LUMP SUM
SINGLE CHEQUE MULTIPLE SCHEMES
Aadhaar No.
Aadhaar No.
Serial No., Date & Time Stamp
Sub-Distributor ARN
Distributor ARN
EUIN
Internal Sub-Broker / Sol ID
Employee Code
ARN ARN E
RIA CODE^
Upfront commission shall be paid directly by the investor to the AMFI registered distributor based on the investor's assessment of various factors including the service rendered by the distributor.
^I/We, have invested in the scheme(s) of Axis Mutual Fund under Direct Plan. I/We hereby give my/our consent to share/provide the transactions data feed/ portfolio holdings/ NAV etc. in respect of my/our investments under Direct Plan(s) of all
the below mentioned scheme(s) of Axis Mutual Fund, to the above mentioned SEBI Registered Investment Adviser.
First / Sole Applicant /
Guardian
Second Applicant
Third Applicant
“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 distributor/sub broker or notwithstanding the advice of in-
appropriateness, if any, provided by the employee/relationship manager/sales person of the
distributor/sub broker.”
Power of Attorney Holder
Aadhaar No.
APPLICANT INFORMATION (MANDATORY)
1
(In case of investment "On behalf of Minor", Please Refer Instruction no. 11.)
FIRST / SOLE APPLICANT
Mr. Ms.
M/s.
PAN (Mandatory)
Date of Birth
D D M M Y Y Y Y
CKYC No.
14 digit CKYC Number
Address
State City Pin Code
Aadhaar No. Mobile No.
Email ID
Mobile No.
Email ID
Optional
Optional
Optional
Optional
(words)
Amount
(figures)
TO BE DETACHED BY KARVY & PRESENTED TO AXIS BANK CMS
authorise you to debit my/our account no.
I/ We
Name of the account holder(s)
DEBIT MANDATE
Application No.
(For Axis Bank A/c only.) To be processed in CMS software under client code “AXISMF”
Signature of First Account Holder
D D M M Y Y
Date
6
Signature of Second Account Holder Signature of Third Account Holder
Savings
NRO
NRE
Current FCNR
Others
Specify
Account type
Axis Bluechip Fund, Axis Long Term Equity Fund, Axis Regular Saver Fund, Axis Triple Advantage Fund, Axis Midcap Fund, Axis Focused 25 Fund, Axis Arbitrage Fund,
Axis Equity Saver Fund, Axis Multicap Fund, Axis Dynamic Equity Fund OR Axis MF Multiple Schemes Axis Equity Hybrid Fund Axis Small Cap Fund Axis Growth Opportunities Fund
to pay for the purchase of
QFUND.IN
KYC DETAILS
2
(Refer Instruction No. 8. In case of investment "On behalf of Minor", Please Refer Instruction No. 11)
OCCUPATION [Please tick (P)]
FIRST APPLICANT
Private Sector Service Public Sector Service Government Service Business Professional Agriculturist Retired Housewife
Student Forex Dealer Others
SECOND APPLICANT
Private Sector Service Public Sector Service Government Service Business Professional Agriculturist Retired Housewife
Student Forex Dealer Others
THIRD APPLICANT
Private Sector Service Public Sector Service Government Service Business Professional Agriculturist Retired Housewife
Student Forex Dealer Others
GROSS ANNUAL INCOME [Please tick (P)]
as on
[Not older than 1 year]
FIRST APPLICANT
Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs > 25 Lacs - 1 Crore > 1 Crore
Net worth (Mandatory for Non - Individuals Rs.
D D M M Y Y Y Y
SECOND APPLICANT
Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs > 25 Lacs - 1 Crore > 1 Crore OR Net Worth
THIRD APPLICANT
Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs > 25 Lacs - 1 Crore > 1 Crore OR Net Worth
For Individuals
For Non-Individual Investors (Companies, Trust, Partnership etc.)
I am Politically Exposed Person
Is the company a Listed Company or Subsidiary of Listed Company or Controlled by a Listed Company:
(If No, please attach mandatory UBO Declaration)
Foreign Exchange / Money Charger Services
Gaming / Gambling / Lottery / Casino Services
Money Lending / Pawning
Yes No
Yes
No
Yes
No
Yes
No
I am Related to Politically Exposed Person
FATCA AND CRS DETAILS FOR INDIVIDUALS
3
(Including Sole Proprietor. )Refer Instruction No. 23
The below information is required for all applicants/guardian
Place/City of Birth Country of Birth
Country of Citizenship / Nationality
First Applicant / Guardian
Second applicant
Third applicant
Indian U.S. Others
Indian U.S. Others
Indian U.S. Others
Are you a tax resident (i.e., are you assessed for Tax) in any other country outside India?
Yes
No
[Please tick]
If ‘YES’ please fill for ALL countries (other than India) in which you are a Resident for tax purpose i.e. where you are a Citizen/Resident / Green Card Holder / Tax Resident in the respective countries.
Country of Tax Residency
Tax Identification Number or
Functional Equivalent
Identification Type
(TIN or other please specify)
Address Type
Residential Registered Office Business
Residential Registered Office Business
Residential Registered Office Business
First Applicant / Guardian
Second applicant
Third applicant
'FATCA and CRS Self Certification form' is available on the website of AMC i.e. www.axismf.com or at the Investor Service Centres (ISCs) of Axis Mutual Fund
DEMAT ACCOUNT DETAILS (OPTIONAL)
4
(Please ensure that the sequence of names as mentioned in the application form matches with that of the A/c. held with the depository participant.) Refer Instruction No. 19
DPID No.
Beneficiary A/c No.
CDSL: Depository Participant Name
NSDL: Depository Participant Name
I N
Beneficiary A/c No.
Enclosed
Client Master Transaction/ Statement Copy/ DIS Copy
QUICK CHECKLIST
KYC acknowledgement letter (Compulsory for MICRO Investments)
Self attested PAN card copy
Email id and mobile number provided for online transaction facility
Plan / Option / Sub Option name mentioned in addition to scheme name
SIP Registration Mandate - NACH for SIP investments
Multiple Bank Accounts Registration form (if you want to register multiple bank accounts so that future payments can be made
from any of the accounts)
Relationship proof between Guardian and Minor (if application is in the name of a Minor) attached
Additional documents attached for Third Party payments. Refer instruction No. 7.
FATCA Declaration.
I am not related to Politically Exposed Person
NOMINATION DETAILS
5
(Mandatory) (Refer Instruction No. 18)
I/We DO NOT wish to nominate and sign here
Nominee Name
Allocation
(%)
Guardian Signature
Guardian Name
(in case of Minor)
1
2
3
BANK ACCOUNT DETAILS FOR PAYOUT
8
(Please note that as per SEBI Regulations it is mandatory for investors to provide their bank account details. Refer Instruction No. 6)
Name of the Bank
Branch Address
Pin Code
Account No.
City
Account Type
Savings Current NRE NRO FCNR Others
IFSC Code (11 Digit) MICR Code (9 Digit)
Mode
Cheque
DD
Axis Bank Debit Mandate (Please fill section 6.)
Savings NRO
NRE
Current FCNR Others
Specify
Amount (figures)
D D M M Y Y
Dated
Pay-in A/c no.
Drawn on bank /
branch name &
address
Account type
(words)
Cheque / DD no.
Non-Third Party Payment
Third Party Payment (Refer instruction no. 7 and attach 'Third Party Payment Declaration Form')
PAYMENT TYPE
7A
Scheme Plan
Option
Amount
Total In words
In figures
Sr. No.
1.
2.
3.
Sr.
No.
Relationship with
Investor
PAN
IFSC Code (11 Digit) MICR Code (9 Digit)
Tick here and don't fill the section below, if the Bank account details for Pay-Out should be same as the bank account details mentioned in section 7C.
First / Sole Applicant Second Applicant
Third Applicant
INVESTMENT DETAILS Refer Instruction No. 22)
7B
4.
PAYMENT DETAILS
7C
Having read and understood the content of the SID / KIM of the scheme and SAI of the Axis Mutual Fund (The Fund), I/we hereby apply for units of the scheme. I have read and understood the terms, conditions, details, rules and
regulations governing the scheme. I/We hereby declare that the amount invested in the scheme is through legitimate source only and does not involve designed for the purpose of the contravention of any Act, Rules, Regulations,
Notifications or Directives of the provisions of the Income Tax Act, Anti Money Laundering Laws, Anti Corruption Laws or any other applicable laws enacted by the Government of India from time to time. I/we have not received
nor have been induced by any rebate or gifts, directly or indirectly in making this investment. I/We confirm that the funds invested in the Scheme, legally belongs to me/us. In event “Know Your Customer” process is not
completed by me/us to the satisfaction of the Mutual Fund, (I/we hereby authorize the Mutual Fund, to redeem the funds invested in the Scheme, in favour of the applicant, at the applicable NAV prevailing on the date of such
redemption and undertake such other action with such funds that may be required by the law.) The ARN holder 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 amongst which the Scheme is being recommended to me/ us. I / we give my / our consent to collect personal data or information as prescribed in the privacy policy which is available
on the website of the AMC / Fund. I /We give my consent to AMC and its agents to contact me over phone, SMS, email or any other mode to address my investment related queries and/or receive communication pertaining to
transactions/ non-commercial transactions/ promotions/ potential investments and other communication/ material irrespective of my blocking preferences with the Customer Preference Registration Facility .
I/We confirm that I/We do not have any existing Micro SIP/Lumpsum investments which together with the current application will result in aggregate investments exceeding ` 50,000 in a year (Applicable for Micro investment
only.) with your fund house. For NRIs 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 / Non Resident Ordinary / FCNR account. I/We confirm that details provided by me/us are true and correct.
CERTIFICATION: I / We have understood the information requirements of this Form (read along with the FATCA & CRS Instructions) and hereby confirm that the information provided by me/us on this Form is true, correct, and
complete. I / We also confirm that I / We have read and understood the FATCA & CRS Terms and Conditions below and hereby accept the same.
AADHAAR DECLARATION: I/ We hereby provide my/our consent in accordance with Aadhaar Act, 2016 and regulations made thereunder, for (i) collecting, storing and usage (ii) validating/authenticating and (ii) updating my/
our Aadhaar number(s) in accordance with the Aadhaar Act, 2016 (and regulations made thereunder) and PMLA. I/ We hereby provide my/our consent for sharing/disclosing of the Aadhaar number(s) including demographic
information with the asset management companies of SEBI registered mutual fund (s)and their Registrar and Transfer Agent (RTA) for the purpose of updating the same in my/our folios with my PAN.
First / Sole Applicant /
Guardian
Second Applicant
Third Applicant
Power of Attorney Holder
DECLARATION AND SIGNATURE
9
Date :
D D M M Y Y
Place :