End on Till Further Notice

UMRN

D D M M Y Y Y Y

Date

Sponsor Bank Code

C I T I 0 0 0 P I G W

Utility Code

(Please

)

CREATE

MODIFY

CANCEL

I/We hereby authorize

Religare Invesco Mutual Fund

to debit (Please

)

SB-NRE

SB-NRO

Others__________

Bank Account Number

Or MICRIFSCwith Bank

Name of customers bank

an amount

of Rupees

In Words

In Figures

Frequency :

Monthly

Quarterly

Half Yearly

Yearly

As & when presented Debit Type :

Fixed Amount

Maximum Amount

PhoneFolio No.

E-mailPAN

D D M M Y Y Y Y

From

D D M M Y Y Y Y

PERIOD

Until Cancelled

This is to conrm that the declaration has been carefully read, understood & made by me / us

Signature Primary Account Holder

1 Name as in bank records 3 Name as in bank records2 Name as in bank records

Signature of Account Holder

C I T I 0 0 0 0 2 0 0 0 0 0 0 0 3 7

✕ ✕ ✕ ✕

Form No : E

Frequency Monthly (Default) Quarterly (Jan, April, July, Oct)

(Default)

Each SIP Amount (Rs.)

SIP Date

SIP Period

PAN / KRN

The Trustees,

Religare Invesco Mutual Fund

I/We have read and understood the contents of the

Statement of Additional Information

/ Scheme Information Document of the respective Scheme and the terms and

conditions of SIP enrollment and ECS Debit Clearing.

Declaration : I/We hereby declare that the particulars given above are correct and express my/our willingness to make payments referred above though participation in ECS (Debit Clearing/NACH/Auto

Debit). If the transaction is delayed or not eected at all for reasons of incomplete or incorrect information, I/We would not hold the user institution responsible. I/We will also inform Religare Invesco

Mutual Fund / Religare Invesco Asset Management Company Private Limited, about any changes in my/ our bank account. I/We have read and agreed to the terms and conditions mentioned overleaf.

Key Partner / Agent Information

Upfront commission, if any, 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.

Sign Here

Sole/First Applicant/Guardian

Sign Here

Second Applicant

Sign Here

Third Applicant

For details on transaction charges payable to distributors, please refer to KIM.

I/We hereby conrm 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. (Refer Instruction no.1(f)).

Systematic Investment Plan (SIP) Registration cum mandate form for ECS/NACH/Auto Debit

First time investors subscribing to the Scheme through SIP-ECS to complete this form compulsorily along with

Application Form. (Please read terms and conditions overleaf)

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

? ?

(3) New SIP Micro SIP Change in ECS Bank Account

(Please provide a cancelled cheque)

M M Y Y Y YM M Y Y Y Y

Enclosed (3) KYC Proof

3. Authorisation of the Bank Account Holder (to be lled and signed by the Investor)

Bank A/c No.

This is to inform that I/We have registered for the RBI’s Electronic Clearing Service (Debit Clearing) and that my payment towards

my investment in Religare Invesco Mutual Fund shall be made from my/our below mentioned bank account with your bank. I/

We authorise the representative carrying this ECS (Debit Clearing/NACH/Auto Debit) Mandate Form to get it veried & executed.

First Account Holder Signature (As in Bank Records) Second Account Holder Signature (As in Bank Records) Third Account Holder Signature (As in Bank Records)

? ?

2. First SIP Transaction

Cheque No.

Bank

I/We hereby authorise Religare Invesco Mutual Fund / Religare Invesco Asset Management Company Private Limited and their authorised service providers, to debit my / our following bank account

by ECS (Debit Clearing) / Direct Debit for collection of SIP payments.

Bank City

Cheque Date Amount (Rs.)

PAN/KRN (Refer Instruction no. 3),

Not applicable in Growth option,

KYC (Refer Instruction no. 14)

Bank Name

1. Investment and SIP Details

First / Sole Investor

Name

Application No.

(New Investor)

Mr. / Ms. / M/s.

(Investors applying under the direct plan must mention “Direct” against Scheme name.)

Folio No.(Existing Unitholder)

Existing UMRN

Start From

Religare Invesco

Scheme Name Plan Dividend Frequency

Scheme

Option

(If UMRN is registered in the folio)

Sub-Broker Code

Distributor / Broker ARN

For Oce Use Only

ARN -

Employee Unique Identication No. (EUIN)

(Of Individual ARN holder or Of employee /

Relationship Manager / Sales Person of the Distributor)

Internal Sub-Broker/Employee Code

QFUND.IN

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