Please Read All Instructions as given in KIM, to help you complete the Application Form Correctly.
Declaration for “Execution Only” Transaction (where Employee Unique Identification Number-EUIN* box is left blank). Please refer instruction 12 of KIM for complete details on EUIN. 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.
st
Signature of 1 Applicant / Guardian /
Authorised Signatory /PoA/Karta
nd
Signature of 2 Applicant / Guardian /
Authorised Signatory /PoA
rd
Signature of 3 Applicant / Guardian /
Authorised Signatory /PoA
1. EXISTING UNIT HOLDER INFORMATION [Please ll in your Folio Number, KIN, Section 2 & proceed to Section 7 - Investment Details]
Please Lumpsum Investment
Micro Application
SIP Application
Applicable transaction charges will be deducted in case your distributor has opted for such charges. Upfront commission shall be paid directly by the investor to the ARN Holder (AMFI registered
Distributor) based on the investor’s assessment of various factors including the services rendered by the ARN Holder.
I AM A FIRST TIME INVESTOR IN MUTUAL FUNDS
OR
I AM AN EXISTING INVESTOR IN MUTUAL FUNDS
TRANSACTION CHARGES (Please any one of the below. Refer Instruction No. 11)
COMMON APPLICATION FORM
Application No.:
05-2017
4. BANK ACCOUNT DETAILS - Mandatory [Refer Instruction Nos. 3 & 4]
A/c. Type Pls. ( )
Core Banking A/c No.
NRE CURRENT SAVINGS NRO
Bank Branch City:
State: Pin Code
MICR Code
IFSC Code (Mandatory for
Credit via NEFT/RTGS)
Please attach a cancelled cheque
OR a clear photo copy of a cheque
* mandatory elds
Folio No. CKYC Identication No. (KIN)
Sub Agent Code
Sub Broker /
Agent ARN Code
Name & Broker Code /
ARN / RIA Code
ISC Date Time Stamp
Reference No.
EUIN*
st
2. APPLICANT(S) NAME AND INFORMATION [Refer Instruction 2] If the 1 / Sole Applicant is Minor, then please provide details of natural / legal guardian
st
1 SOLE APPLICANT Mr. / Ms. / M/s.
PAN
POA / Custodian Name: Proof Attached KYC (Please )
Pls indicate if US Person or a resident for tax purpose / Resident of Canada
Yes
$
No ($Default if not )
CKYC ID No. (KIN)
3. FIRST APPLICANT AND KYC DETAILS
a*. Occupation Details [Please tick ( )]
Business Retired
Agriculture Proprietorship
Others___________________
(Please specify)
StudentPrivate Sector Public Sector Government Service Professional Housewife
Place of Birth /
Incorporation:
Gender
Male Female Other
Nationality:
Country of Birth /
Incorporation:
e*. Non-Individual Investors involved/providing
any of the mentioned services
Foreign Exchange / Money Changer Services Gaming/Gambling/Lottery/Casino Services
Money Lending / Pawning None of the above
D D M M Y Y Y Y
*Date of Birth
(Individual)
Incorporation
(Non-individual)
Birth Certicate
Passport of the Minor
Others
School Leaving Certicate / Mark Sheet
(Please specify)
Proof of Date of Birth (Please )
(For minor applicant)
Relationship with Minor (Please )
Mother Father Legal Guardian
st
GUARDIAN (In case 1 Applicant is a Minor)
Mr. / Ms. / M/s.
Proof Attached
KYC (Please )
GUARDIAN CKYC
ID No. (KIN)
GUARDIAN
PAN
POA / Custodian
CKYC ID No. (KIN)
POA / Custodian
PAN
Contact Person for Corporate Investor: Designation:Name
st
1 SOLE APPLICANT Individual or Non-Individual [Please ll Ultimate Benecial Ownership (UBO) Declaration Form in section 11a & 11b - Refer Instruction No. 17]
Type:
Resident Individual
Sole Prop
NRI - NRE Trust
Bank / Fls
FIIs
PIO Society/AOP/BOI Minor thru Guardian
NRI - NRO
HUF LLP Listed Company Partnership Firm FOF - MF Schemes
(Please specify)
Others ____________________Private Company
Public Ltd. Company Articial Juridicial Person
10-25 Lakh
Below 1 Lakh 1-5 Lakh 5-10 Lakh
>25 Lakh
> 1 Crore
b*. Gross Annual Income (`) [Please tick ( )]
c*. Politically Exposed Person (PEP) Status (Also applicable for authorised signatories/Promoters/Karta/Trustee/Whole time Directors) I am PEP I am Related to PEP Not Applicable
d*. Net-worth (Mandatory for Non-Individuals) `_______________________________________________ as on (Not older than 1 year)
D D M M Y Y Y Y
Branch Name: Address:
Name of the Bank:
Internal Code for
Sub-Agent/Employee
QFUND.IN
9. NOMINATION DETAILS [Minor / HUF / POA Holder / Non Individuals cannot Nominate - Refer Instruction No. 9]
No. Nominee(s) Name
Date of Birth
(in case of Minor)
Name of the Guardian
(in case of Minor)
Relationship
% of Share
Signature of Nominee / Guardian
1
D D M M Y Y Y Y
2
D D M M Y Y Y Y
3
D D M M Y Y Y Y
PLEASE REGISTER MY/OUR NOMINEE AS PER BELOW DETAILS OR I/WE DO NOT WISH TO NOMINATE
8. DEMAT ACCOUNT DETAILS - Mandatory for units in Demat Mode - Please ensure that the sequence of names as mentioned under section 3 matches as per the Depository Details.
National Securities Depository Limited (NSDL) Central Depository Services (India) Limited (CDSL)
Benef. A/C No.
16 Digit A/C No.
DP ID
I N
Enclosures - Please
( ) Transaction cum Holding Statement Delivery Instruction Slip (DIS) Client Masters List (CML)
DP Name DP Name
6a. MAILING ADDRESS [Please provide your E-mail ID and Mobile Number to help us serve you better]
Tel. Off. Resi.
Mobile
City
State
Pin Code
E - Mail^^
^^Please Use Block Letters. Investors providing email ID would mandatorily receive all Communications, Statement of Accounts and Abridged Annual Report through e-mail only.
* mandatory elds
Payment Type [Please ( )]
Third Party Payment
(Please attach ‘Third Party Payment Declaration Form’)
Self (Non-Third Party Payment)
7. INVESTMENT AND PAYMENT DETAILS ( For complete information on Investment Details please refer to Instructions No. 6. )
Cheque / DD / UTR No. & Date
Amount of Cheque / DD /
RTGS / NEFT in gures (Rs.)
DD Charges,
if any
Net Purchase
Amount
Drawn on Bank /
Branch
Pay-In Bank A/c No.
(For Cheque Only)
Scheme
Growth (Default)
Dividend*
Payout
Reinvestment
Direct Plan
Regular Plan
Div frequency*
*Dividend frequency is applicable only for Mirae Asset Cash Management Fund & Mirae Asset Savings Fund.
5. JOINT APPLICANTS, IF ANY AND THEIR KYC DETAILS
nd
2 APPLICANT Mr. / Ms. / M/s. (Not Applicable in case of Minor Applicant)
Male Female Other
Gender
Proof Attached KYC Pls
D D M M Y Y Y Y
Date of Birth (Mandatory)
CKYC ID No. (KIN)
Place of Birth Country of Birth Nationality:
Pls indicate if US Person or a resident for tax purpose / Resident of Canada Yes
No* (*Default if not )
PAN Details
st
Local Address of 1 Applicant
Mode of Holding:
Anyone or Survivor
Single
Joint
(Please note that the Default option is Anyone or Survivor)
a*. Occupation Details [Please tick ( )]
Business Retired
Agriculture Proprietorship
Others___________________
(Please specify)
StudentPrivate Sector Public Sector Government Service Professional Housewife
10-25 Lakh
Below 1 Lakh 1-5 Lakh 5-10 Lakh
>25 Lakh
> 1 Crore
b*. Gross Annual Income (`) [Please tick ( )]
c*. Politically Exposed Person (PEP) Status I am PEP I am Related to PEP Not Applicable
d. Net-worth `_______________________________________________ as on (Not older than 1 year)
D D M M Y Y Y Y
rd
3 APPLICANT Mr. / Ms. / M/s. (Not Applicable in case of Minor Applicant)
Male Female Other
Gender
Proof Attached KYC Pls
D D M M Y Y Y Y
Date of Birth (Mandatory)
CKYC ID No. (KIN)
Place of Birth Country of Birth Nationality:
Pls indicate if US Person or a resident for tax purpose / Resident of Canada Yes
No* (*Default if not )
PAN Details
Mode of Holding:
Anyone or Survivor
Single
Joint
(Please note that the Default option is Anyone or Survivor)
a*. Occupation Details [Please tick ( )]
Business Retired
Agriculture Proprietorship
Others___________________
(Please specify)
StudentPrivate Sector Public Sector Government Service Professional Housewife
10-25 Lakh
Below 1 Lakh 1-5 Lakh 5-10 Lakh
>25 Lakh
> 1 Crore
b*. Gross Annual Income (`) [Please tick ( )]
c*. Politically Exposed Person (PEP) Status I am PEP I am Related to PEP Not Applicable
d. Net-worth `_______________________________________________ as on (Not older than 1 year)
D D M M Y Y Y Y
6b. Mandatory for NRI / Fll Applicant [Please provide Full Address. P. O. Box No. may not be sufcient. For Overseas Investors, Indian Address is preferred]
Overseas Correspondence Address
10. FATCA & CRS DETAILS (Please consult your professional tax advisor for further guidance on FATCA & CRS classication)
We are a,
Financial institution
or
Direct reporting NFE
[Please tick ( )]
PART A To be lled by Financial Institutions or Direct Reporting Non Finacial Entity (NFEs)
GIIN
Note: If you do not have a GIIN but you are sponsored by another entity, please provide your sponsor's GIIN above and indicate your sponsor's name below
Name of sponsoring entity:
GIIN not available [Please tick ( )]
Applied for Not obtained – Non-participating FINot required to apply for - please specify 2 digits sub-category
PART B (please ll any one as appropriate “to be lled by NFEs other than Direct Reporting NFEs”)
1
Is the Entity a publicly traded company
(that is, a company whose shares are regularly
traded on an established securities market)
Yes (If yes, please specify any one stock exchange on which the stock is regularly traded)
Name of stock exchange:
2
Is the Entity a related entity of a publicly
traded company (a company whose shares are
regularly traded on an established securities market)
Yes (If yes, please specify name of the listed company and one stock exchange on which the stock is regularly traded)
Name of listed company:
Nature of relation
Subsidiary of the Listed Company or Controlled by a Listed Company
Name of stock exchange:
3
Is the Entity an active NFE
Yes (If yes, please ll UBO declaration in the next section.)
Nature of Business:
Please specify the sub-category of Active NFE Mention code: Refer instruction 16(c)
4
Is the Entity a passive NFE
Yes (If yes, please ll UBO declaration in the next section.)
Nature of Business:
For details refer instruction No. 16.
Date & Stamp of Collection Centre / ISC
Payment Details
Scheme Name and Plan
Received Application from Mr. / Ms. / M/s. _____________________________________________________________________________ as per details below:
For Lumpsum ‘OR’ SIP
ACKNOWLEDGMENT SLIP
Amount (Rs.) ____________________________________
Cheque / DD No.: ________________________________
Dated _________________________________________
Bank & Branch __________________________________
Cheque / DD is subject to realisation
*This declaration is not needed for Companies that are listed on any recognized stock exchange or is a Subsidiary of such Listed Company or is Controlled by such Listed Company. Please list below the details of controlling
person(s), confirming ALL countries of tax residency / permanent residency / citizenship and ALL Tax Identification Numbers for EACH controlling person(s). Owner-documented FFI's should provide FFI Owner Reporting
Statement and Auditor's Letter with required details as mentioned in Form W8 BEN E.
11a. DECLARATION FOR ULTIMATE BENEFICIAL OWNERSHIP [UBO] (Refer instruction No. 17)*
The detail of this page should be lled by Non-Individual investors only.
FOR NON-INDIVIDUALS ONLY
# Additional details to be lled by controlling persons with tax residency / permanent residency / citizenship / Green Card in any country other than India.
* To include US, where controlling person is a US citizen or green card holder
%In case Tax Identication Number is not available, kindly provide functional equivalent
1. PAN:
City of Birth:
Country of Birth:
Occupation Type:
Nationality:
Father's Name:
Date Of Birth:
Gender
Male Female Other
2. PAN:
City of Birth:
Country of Birth:
Occupation Type:
Nationality:
Father's Name:
Date Of Birth:
Gender
Male Female Other
3. PAN:
City of Birth:
Country of Birth:
Occupation Type:
Nationality:
Father's Name:
Date Of Birth:
Gender
Male Female Other
$$ Address Type: Residential or Business (default)/Residential/Business/Registered Office. Attached documents should be self certi ed by the UBO and certi ed by the applicant or Authorised signatory. In case the above
information is not provided, it will be presumed that applicant is the UBO, with no declaration to submit. In such case, MAMF/AMC reserves the right to reject the application or reverse the allotment of units, if subsequently it is found
that applicant has concealed the facts of bene cial ownership. I/We also undertake to keep you informed in writing about any changes/modi cation to the above information in future and also undertake to provide any other additional
information as may be required at your end.
# If passive NFE, please provide below additional details. (Please attach additional sheets if necessary). Also provide below mandatory details if the UBO does not have a PAN. (Refer Instruction No. 16)
11b. [Mandatory] DETAILS OF ULTIMATE BENEFICIAL OWNERS (If the given space below is not adequate, please attach multiple declaration forms)
Name of UBO & Address
$$
Address Type
PAN/Tax Payer
Identification No./
%
Equivalent ID No.
Document Type
Refer instruction
No. 16(d)
Country of tax
Residency/
permanent
residency*
Country of
citizenship
UBO Code
(Mandatory)
KYC (Yes / NO)
[please attach
the KYC
acknowledgement
copy]
% of beneficial
interest
PAN / Any other Identication Number (PAN, Aadhar, Passport,
Election ID, Govt. ID, Driving Licence NREGA Job Card, Others)
City of Birth - Country of Birth
Occupation Type: Service, Business, Others
Nationality:
Father's Name: Mandatory if PAN is not available
DOB: Date of Birth
Gender: Male, Female, Other
13. DECLARATION AND SIGNATURES / THUMB IMPRESSION OF APPLICANT(s) [Refer Instructions 2(e)]
st
Signature of 1 Applicant / Guardian /
Authorised Signatory /PoA/Karta
nd
Signature of 2 Applicant / Guardian /
Authorised Signatory /PoA
rd
Signature of 3 Applicant / Guardian /
Authorised Signatory /PoA
12. FATCA AND CRS DETAILS (Self Certication) (Refer instruction No. 16) (FOR INDIVIDUALS & NON-INDIVIDUALS)
FOR INDIVIDUALS: Please indicate all countries in which you are resident for tax purposes and the associated Tax Reference Numbers below.
FOR NON-INDIVIDUALS: Is the “Entity” a tax resident of any country other than India?
(If Yes, please provide country/ies in which the entity is a resident for tax purpose and the associated Tax Identication No. below)
Yes No
In case of applications with POA, the POA holder should ll separate form to provide the above details mandatorily.
st
1 Applicant (Sole / Guardian / Non-Individual)
Tax Residency
Status: 1
Do you have any non-Indian
Country(ies) of Birth /
Citizenship / Nationality
and Tax Residency
Yes No
Country of Birth /
Incorporation
Country Citizenship /
Nationality
Are you a US specied
person?
Yes No
Please provide Tax Payer Id.
Address Type
nd
2 Applicant
Do you have any non-Indian
Country(ies) of Birth /
Citizenship / Nationality
and Tax Residency
Yes No
Country of Birth
Country Citizenship /
Nationality
Are you a US specied
person?
Yes No
Please provide Tax Payer Id.
Address Type
rd
3 Applicant
Do you have any non-Indian
Country(ies) of Birth /
Citizenship / Nationality
and Tax Residency
Yes No
Country of Birth
Country Citizenship /
Nationality
Are you a US specied
person?
Yes No
Please provide Tax Payer Id.
Address Type
Individual or Non-Individual investors ll this section
if ticked Yes above.
Country:
Type:
No.:
Tax Residency
Status: 2
Country:
Type:
No.:
Tax Residency
Status: 3
Country:
Type:
No.:
Tax Residency
Status: 1
Country:
Type:
No.:
Tax Residency
Status: 2
Country:
Type:
No.:
Tax Residency
Status: 3
Country:
Type:
No.:
Tax Residency
Status: 1
Country:
Type:
No.:
Tax Residency
Status: 2
Country:
Type:
No.:
Tax Residency
Status: 3
Country:
Type:
No.:
(Address Type: Residential or Business (default) / Residential / Business / Registered Ofce) (For address mentioned in form / existing address appearing in folio)
To The Trustees, Mirae Asset Mutual Fund (The Fund) – (A) Having read and understood the contents of the SID of the Scheme(s), I/We hereby apply for units of the scheme(s) and agree to abide by the terms, conditions, rules and regulations governing the scheme.
(B) I/We hereby declare that the amount invested in the scheme(s) is through legitimate sources only and does not involve and is not designed for the purpose of the contravention of any provisions of the Income Tax Act, Anti Money Laundering Laws or any other
applicable laws enacted by the Government of India from time to time. (C) Signature of the nominee acknowledging receipts of my/our credit will constitute full discharge of liabilities of Mirae Asset Mutual Fund. (D) The information given in / with this application form is
true and correct and further agrees to furnish additional information sought by Mirae Asset Global Investments (India) Limited (AMC)/ Fund and undertake to update the information/details with the AMC / Fund/Registrars and Transfer Agent (RTA) from time to time. I/We
hereby confirm that the AMC/Fund shall have the right to share my information and other details with the regulatory and government authorities as and when needed. I/We will indemnify the Fund, AMC, Trustee, RTA and other intermediaries in case of any dispute
regarding the eligibility, validity and authorization of my/our transactions. (E) I/We further declare that "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. (F) I/We hereby confirm that I/We have not been offered/ communicated any indicative portfolio and/ or any indicative yield by the
Fund/AMC/its distributor for this investment. I/We have not received nor have been induced by any rebate or gifts, directly or indirectly in making this investment. (G) Applicable to Investors availing the online facility:- I/We have read, understood and shall be
bound by the terms & conditions of the PIN agreement available on the AMC website for transacting online. (H) RIA:- I/We hereby permit the AMC to share my/our current & historic transaction details to the Registered Investment Advisor (RIA), if any transactions are
carried out using the RIA code. (I) Applicable to Foreign Resident's Residing in India:- I/ We confirm that I/We satisfy the Residency test as prescribed under FEMA provisions. I/We further declare that I/We am/are "Person Resident in India" and are allowed to invest
into the Scheme as per the said FEMA regulations and other applicable laws and regulations. (J) I / We confirm that I am / We are not United States person(s) under the laws of United States or resident(s) of Canada. In case of change to this status, I / We shall
notify the AMC, in which event the AMC reserves the right to redeem my / our investments in the Scheme(s). (K) FATCA /CRS 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 and hereby accept the same. In case the above information is not
provided, it will be presumed that applicant is the ultimate beneficial owner, with no declaration to submit. In such case, the concerned SEBI registered intermediary reserves the right to reject the application or reverse the allotment of units, if subsequently it is found that
applicant has concealed the facts of beneficial ownership. I/We also undertake to keep you informed in writing about any changes/modification to the above information in future & also undertake to provide any other additional information as may be required at your end.
(H) RIA: I/We hereby agree to consent the AMC to share my transaction details to the registered investment advisor (RIA) through the registrar or otherwise.
Application No.:
Mirae Asset India Opportunities Fund
Mirae Asset Prudence Fund
Mirae Asset Savings Fund
Mirae Asset Emerging Bluechip Fund
Mirae Asset Tax Saver Fund
Mirae Asset China Advantage Fund
Mirae Asset Great Consumer Fund
Mirae Asset Cash Management Fund
Mirae Asset Dynamic Bond Fund
Mutual Fund investments are subject to market risks, read all scheme related documents carefully.
Cheque/DD should be Drawn in favour of the Scheme Name
Individual investor have to ll in below details in case of joint applicants
For non-Individual investor in case, if you country of incorporation / Tax resistance in US, but you are not a specied US person then please mention exemption code____________(Refer instruction 16(e))
