Received subject to realisation, verification and conditions, an application for purchase of Units as mentioned in the application form.
ACKNOWLEDGMENT SLIP
Application No.
From
Cheque no.
Date Amount
Scheme
Stamp & Signature
TRANSACTION CHARGES FOR APPLICATIONS THROUGH DISTRIBUTORS ONLY(Refer Instruction 11) In case the subscription amount is `10,000
or more and your Distributor has opted to receive Transaction Charges, the same are deductible as applicable from the purchase/ subscription amount and payable to the Distributor.
Units will be issued against the balance amount invested.
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.
First / Sole Applicant /
Guardian
Second Applicant
Third Applicant
Power of Attorney
Holder
EXISTING INVESTOR'S DETAILS
(Please fill your Folio No., Name, Section 2,7,10 &12)
1
Mr. Ms. M/s
FIRST APPLICANT'S DETAILS
2
(Non-individual investor please fill in FATCA, CRS & UBO Declaration in Section 10B, 11 & 12 )
Transaction Charges for
per subscription ` 10,000
and above
Investors applying under Direct Plan must mention “Direct” in ARN Column
Guardian named below is
MotherFather
Court Appointed
For Investments "On behalf of Minor"
Birth Certificate
School Certificate
Passport
Others
Specify
Name
F I R S T M I D D L E L A S T
Father’s Name
F I R S T M I D D L E L A S T
Name of the Guardian (In case of minor) / Contact person for non individuals / PoA holder name
Guardian / PoA PAN
Tel.
Email ID
Mobile
Tax Residence Address (for KYC Address)
Pin Code
City
State
Overseas address
Email ID & Mobile No. are essential to enable us to communicate better with you
F I R S T M I D D L E L A S T
(Refer Instruction 1d)
INDIVIDUALS
NON-INDIVIDUALS
Partnership Firm
HUF
Private Limited Company
Society
Artificial Juridical Person
Public Limited Company
Status
Others
Specify
Gross Annual
Income OR
Net-worth*
in `
*
Not older
than one year
Is the entity involved in any of the following:
Foreign Exchange/ Money Changer
Yes No
1
Gaming / Gambling / Lottery
Yes No
(casinos, betting syndicates)
2
Money Lending/ Pawning
Yes No
3
as on
D D M M Y Y
25L-1CR >1CR
<1L
1-5L 5-10L 10-25L
networth
25L-1CR >1CR
<1L
1-5L 5-10L 10-25L
as on
D D M M Y Y
networth
(Networth is mandatory for Non-individuals)
Pvt. Sector Service
Housewife Defence Professional
Retired Business
Agriculture
Others
Occupation
Public Sector Gov. Service Student
Forex Dealer
Specify
AOP/BOI
Trust H Liquidator
Limited Liability Partnership
Resident Individual
Proprietor
PIO
Trust
Minor
FII/ FPI NRI
Listed Company
Body Corporate
NGO
FI Govt. Body
Bank
Defence Establishments
NPO
Any other information
Any other information
I am PEP I am Related to PEP Not Applicable
(Mandatory)
3
Folio No. Name
F I R S T M I D D L E L A S T
Date of Birth / Incorporation
D D M M Y Y Y Y
Country of Birth / IncorporationPlace of Birth / Incorporation
Mandatory incase of NRI’s
Sub-Distributor ARN/RIA#
Distributor ARN / RIA#
EUIN
Internal Sub-Broker/Employee Code
Distributor Name
ARN/RIA ARN
#By mentioning RIA code, I/We authorize you to share with the SEBI Registered Investment Advisor the details of my/our transactions in the scheme(s) of Motilal Oswal Mutual Fund.
Residential Registered office Business Residential or Business
** Please mention PAN/PEKRN(PAN Exempted KYC Reference Number) as it is mandatory
Correspondence Address
JOINT APPLICANT'S DETAILS
4
Mr. Ms. M/s
SECOND APPLICANT'S DETAILS
Mode of Holding
Joint
Anyone or Survivor (Default)
Name
F I R S T M I D D L E L A S T
Existing Investor - `100
New Investor - `150
CIN
PAN /PEKRN**
City of Incorporation
Nationality
Indian US Others ( )Pl e a s e S p e c i f y
Application No.
Continuous Offer of Units at Applicable NAV
Key Information Memorandum and Common Application Form
Form - 1
KIN (KYC identification number)
KIN of Guardian/ PoA (KYC identification number)
Aadhar No.
Aadhar No. of Guardian
QFUND.IN
DEMAT ACCOUNT DETAILS
5
(Mandatory, only if you require units in the demat form. Please fill in all details, else the application is liable to be rejected).
Nomination provided in demat account shall be considered.
NSDL CDSL
Depository Participant (DP) Name
DP ID
Beneficiary A/c No.
EMAIL COMMUNICATION
6
All communications will be sent by default to the registered E-mail id / Mobile No. In case you wish to receive physical communication please
**Please mention PAN/PEKRN (PAN Exempted KYC Reference Number) as it is mandatory
Father’s Name
F I R S T M I D D L E L A S T
INDIVIDUALS
Gross Annual
Income OR Net-
worth* in `
*
Not older than
one year
as on
D D M M Y Y
25L-1CR >1CR
<1L
1-5L 5-10L 10-25L
networth
Any other information
Politically Exposed Person (PEP) Status
I am PEP I am Related to PEP
Not Applicable
Pvt. Sector Service
Housewife Defence Professional
Retired Business
Agriculture
Others
Occupation
Public Sector Gov. Service Student
Forex Dealer
Specify
Mr. Ms. M/s
THIRD APPLICANT'S DETAILS
Name
F I R S T M I D D L E L A S T
Father’s Name
F I R S T M I D D L E L A S T
INDIVIDUALS
Gross Annual
Income OR Net-
worth* in `
*
Not older than
one year
as on
D D M M Y Y
25L-1CR >1CR
<1L
1-5L 5-10L 10-25L
networth
Any other information
Politically Exposed Person (PEP) Status
I am PEP I am Related to PEP
Not Applicable
Pvt. Sector Service
Housewife Defence Professional
Retired Business
Agriculture
Others
Occupation
Public Sector Gov. Service Student
Forex Dealer
Specify
Email ID & Mobile No. are essential to enable us to communicate better with you
Email ID & Mobile No. are essential to enable us to communicate better with you
PAN /PEKRN**
Email ID
Mobile
PAN /PEKRN**
Email ID
Mobile
INVESTMENT & PAYMENT DETAILS
7
Date of Birth
D D M M Y Y Y Y
Country of Birth
Place of Birth
Nationality
Indian US Others ( )Pl e a s e S p e c i f y
Date of Birth
D D M M Y Y Y Y
Country of Birth
Place of Birth
Nationality
Indian US Others ( )Pl e a s e S p e c i f y
LUMPSUM INVESTMENT
ORZERO BALANCEOR
SYSTEMATIC INVESTMENT PLAN / MICRO SIP-ECS
LUMPSUM INVESTMENT
SYSTEMATIC INVESTMENT PLAN
Payment Mode:
Cheque
DD RTGS NEFT
Funds Transfer
Amount (`) (i)
DD charges (`) (ii)
Total Amt. (`) (i)+(ii)
Date
Instrument No.
D D M M Y Y
Bank Name
Bank A/c No.
Branch Name & City
Account Type:
Current
Savings
NRO NRE FCNR
Weekly
Fortnightly
Monthly
Quartely
st th th st th
(1 , 7 , 14 , 21 , 28 )
st th
1 -14
st
1
st
1
th st
7 -21
th
7 (Default)
th
7 (Default)
th th
14 -28
th
14
th
14
st
21
st
21
th
28
th
28
Amount (`)
Date
D D M M Y Y
Cheque /DD No.
st
1 SIP Instalment
Drawn on Bank
Bank & Branch
Subsequent SIP Instalment Amount (`)
In words
Payment Type (Please ) Non - Third party payment Third party payment (Please fill the Third Party Payment Declaration Form)
Plan and Option
Direct (Default Plan)
Regular
Option
Growth (Default Option)
Div - Payout
Div - Reinvest (Default Option)
(N/A for MOSt Focused Long Term)
Daily Weekly
Fortnightly
Monthly
Quartely
Applicable for Motilal Oswal MOSt Ultra Short Term Bond Fund
(Not Applicable for Di vidend Pa y out O p tion)
Motilal Oswal MOSt Ultra Short Term Bond Fund
Scheme
Motilal Oswal MOSt Focused Dynamic Equity Fund Motilal Oswal MOSt Focused Multicap 35 Fund Motilal Oswal MOSt Focused 25 Fund
Motilal Oswal MOSt Focused Long Term Fund Motilal Oswal MOSt Focused Midcap 30 Fund
Motilal Oswal Asset Management Company Limited
10th Floor, Motilal Oswal Tower, Rahimtullah Sayani Road,
Opposite Parel ST Depot, Prabhadevi, Mumbai - 400025
Email: mfservice@motilaloswal.com. Toll Free No.: 1800-200-6626
website: www.motilaloswalmf.com
Quartely Annually (Default Option)
Applicable for Motilal Oswal MOSt Focused Dynamic Equity Fund
KIN (KYC identification number)
KIN (KYC identification number)
D D M M Y Y Y Y
Annual SIP
Aadhar No.
Aadhar No.
M Y Y
End
date
Perpetual
To
SIP Period
From
M M Y Y
M
Weekly - Any Day of Transfer________________(Monday to Friday)
Monthly SIP- Any date of the month except (29th, 30th and 31st)
Quarterly SIP- Any date of the month for each quarter (i.e. January, April,
July, October) except (29th, 30th and 31st)
D D
D D
Any Day/
Date SIP
Y Y
Or
(please fill OTM Debit Mandate form NACH/
ECS/ Direct Debit Form-2)
Name
(Date of Birth if nominee is minor)
Address
Guardian Name
(in case Nominee is a Minor)
Signature
(Guardian in case
Nominee is a Minor)
Allocation
%
100%
If you do not wish to nominate sign here.
NOMINATION DETAILS
9
(Refer Instruction 9)
First / Sole Applicant /
Guardian
Second Applicant
Third Applicant
Power of Attorney Holder
Unit Holder's Signature
Current
Savings
NRO
NRE
FCNR
Others
Bank Name
Bank A/c No.
IFSC Code (11 digit)*
Branch Name
City
Pin
Type
Specify
8
(Mandatory) Redemption / Dividend /Refund payouts will be credited into this bank account in case it is in the current list of banks with whom Motilal Oswal Mutual Fund has Direct Credit facility.
MICR Code (9 digit)*
*Mentioned on your cheque leaf
BANK DETAILS
I / We understand that the instructions to the bank for Direct Credit / NEFT /ECS will be given by the Mutual Fund, and such instructions will be adequate discharge of the Mutual Fund towards redemption / dividend / refund proceeds. In case the bank does not credit my / our bank
account with / without assigning any reason thereof, or if the transaction is delayed or not effected at all or credited into the wrong account for reasons of incomplete or incorrect information. I / We would not hold Motilal Oswal Mutual Fund responsible. Further the Mutual Fund
reserves the right to issue a demand draft / payable at par cheque in case it is not possible to make payment by Direct Cash/NEFT/ECS.
If however the unit holders wish to receive a cheque (instead of a direct credit into their bank account) Please tick the box alongside
10
FATCA- CRS Declaration and Supplementary Information
Reason A: The country where the Account Holder is liable to pay tax does not issue Tax Identification Numbers to its residents. Reason B: No TIN required. (Select this reason Only if the authorities of
the respective country of tax residence do not require the TIN to be collected). Reason C: Others; please state the reason thereof.
#
Please attach additional sheets if necessary
%
In case Tax Identification Number is not available, kindly provide its functional equivalent .
In case TIN or its functional equivalent is not available, please provide Company Identification number or Global Entity Identification Number or GIIN, etc.
In case the Entity's Country of Incorporation / Tax residence is U.S. but Entity is not a Specified U.S. Person, mention Entity's exemption code here
Please refer to para 3(vii) Exemption code for U.S. persons of FATCA instructions & Definitions Non-Individual.
10A Declaration for Individual
1. Is “Entity” a tax resident of any country other than India Yes No (If yes, please provide country/ies in which the entity is a resident for tax purposes and the associated Tax ID number below.)
10B Declaration for Non-Individual / Legal Entity
Part B (please fill any one as appropriate “to be filled by NFEs other than Direct Reporting NFEs”)
Yes
(If yes, please fill UBO declaration in the next section.)
Nature of Business
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
Yes
Nature of Business
Please specify the sub-category of Active NFE
(Mention code –refer 2 FATCA instruction and definition
for non-individual)
3. Is the Entity an active Non Financial Entity (NFE)
No
No
No
No
Are you a tax resident (i.e., are you assessed for Tax) in any other country outside India? Yes No
If ‘No’ please proceed for the signature of declaration
#
If'YES', please fill for ALL countries (other than India) in which you are a Resident for tax purposes i.e., where you are a Citizen / Resident / Green Card Holder / Tax Resident in the respective countries
Tax Identification Number or
Functional Equivalent
Identification Type
(TIN or other, please specify)
If TIN is not available, please tick (P)
the reason A, B, & C (as defired below)
First Applicant
Second Applicant
Third Applicant
Country of Tax Residency
Reason
A B C
Reason
A B C
Reason
A B C
Part A (to be filled by Financial Institutions or Direct Reporting NFEs)
1. We are a,
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 as applicable)
Applied for
If the entity is a financial institution,
Not required to apply for - please specify 2 digits sub-category
Global Intermediary Identification Number (GIIN)
Not obtained – Non-participating FI
Country
%
Tax Identification Number
Identification Type (TIN or Other, please specify)
Having read and understood the contents of the Scheme Information Document of the Scheme(s), I/We hereby apply for the units of the scheme(s) and agree to abide by the terms, conditions, rules and regulation governing
the scheme(s). 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 Act, Rules, Regulations,
Notifications or Directions 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 understood
the details of the scheme (s) & 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 (s), legally belong to
me/us. In the 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(s), 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 (in the form of trail commission or any other mode), payable to him for the different competing Scheme of various Mutual Funds from amongst which the Scheme
is being recommended to me/us. 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 the details provided by me/us are true and correct. I declare that the information is to the best of my Knowledge, belief, accurate and
complete. I agree to notify MOMF/AMC immediately in the event of information changes.
FATCA / CRS Certification:
Declaration for Individual: I hereby confirm that the information provided hereinabove is true, correct, and complete to the best of my knowledge and belief and that I shall be solely liable and responsible for the information
submitted above.I also confirm that I have read and understood the FATCA & CRS Terms and Conditions below and hereby accept the same. I also undertake to keep you informed in writing about any changes / modification to
the above information in future within 30 days of the same being effective and also undertake to provide any other additional information as may be required any intermediary or by domestic or overseas regulators/ tax
authorities
Declaration for Non-Individual: 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.
DECLARATION AND SIGNATURE
12
11
*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.
Name of UBO
Address Type
interest
PAN/Tax Payer
%
Equivalent ID No.
No.:
Type:
Country of tax
Residency*
Controlling
1
Person Type
(Mandatory)
Residential
Business
Residential
Business
Residential
Business
Address
(Include State, Country,
PIN/ZIP Code & Contact Details)
No.:
Type:
No.:
Type:
#
Additional details to be filled 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 Identification Number is not available, kindly provide functional equivalent
Election ID, Govt. ID, Driving Licence NREGA Job Card, Others)
City of Birth -CountryofBirth
Occupation Type: Service, Business, Others
Nationality:
Father's Name: Mandatory if PAN is not available
Gender:Male, Female, Other
Gender
Male Female Other
Date Of Birth:
D D M M Y Y Y Y
PAN:
City of Birth:
Country of Birth:
3.Name:
PAN:
City of Birth:
Country of Birth:
2.Name:
PAN:
City of Birth:
Country of Birth:
1.Name:
Occupation Type:
Nationality:
Father's Name:
Occupation Type:
Nationality:
Father's Name:
Occupation Type:
Nationality:
Father's Name:
Gender
Male Female Other
Date Of Birth:
D D M M Y Y Y Y
Gender
Male Female Other
Date Of Birth:
D D M M Y Y Y Y
UBO
Second Applicant
Third Applicant
Power of Attorney Holder
First / Sole Applicant /
Guardian
Date: Place:
# If passive NFE, please provide below additional details for each controlling person. (Please attach additional sheets if necessary.)
Name/ PAN/ Any other Identification Number (PAN, Aadhar, Passport
