APP No.:
APPLICATION FORM
(To be filled in CAPITAL letters)
Name of the Investor Mr/Ms/M/s :
Scheme /Plan/ Option:
Payment Details:
Amount ` Instrument No/Cash Deposit Slip No. Date : Drawn on Bank
Time Stamp & Date
of receiving office
APP No.:
Corporate Office Address: Reliance Centre, 7th Floor, South Wing, Off Western Express Highway, Santacruz (East), Mumbai - 400 055.
Equity & Sector Specific CAF / 24th Oct 2019 / Ver 4.2
NAME^
Mr. Ms. M/s.
5. SECOND APPLICANT DETAILS
PAN / PEKRN^**
CKYC Id^**
^
STATUS : Resident Individual NRI
8. BANK ACCOUNT DETAILS MANDATORY for Redemption/Dividend/Refunds, if any (Refer Instruction No. III)
Please ensure the name in this application form and in your bank account are the same. Please update your IFSC and MICR Code in order to get payouts via electronic mode in to your bank account.
M a n d a t o r y
Name & Branch
of Bank
M a n d a t o r y
Account No.
MICR Code
9 Digit For Credit via NEFT
IFSC Code
PIN
F o r C r e d i t v i a R T G S
Branch City
A/c. Type ( ) SB Current NRO NRE FCNR
Guardian’s Relationship With Minor
Father Mother Court Appointed Guardian
Proof of Date of Birth and Guardian’s Relationship with Minor
Are you involved / providing any of the mentioned services :
(Applicable only for Non Individuals)
Foreign Exchange / Money Changer Services Gaming / Gambling / Lottery / Casino Services
Money Lending / Pawning None of the above
Date of Birth
of 1st Applicant
D D
M M
Y Y Y Y
(Mandatory in
case of Minor)
4. FIRST APPLICANT DETAILS
NAME^
Mr. Ms. M/s.
Name of Guardian if first applicant is minor /
Contact Person for non individuals
Mr. Ms.
Note: In case First Applicant is Non Individual please attach FATCA, CRS & UBO Self Certification Form (Ref Ins No. XIV) **In case First Applicant is Minor then details of Guardian will be required.
^Mandatory for all type of Investors. It is mandatory for investors to be KYC compliant prior to investing in Nippon India Mutual Fund. Refer instruction no.II. 5, 6 & X
FI NRI
Company/Body Corporate Sole Proprietor Defence Establishment
PIO
Bank
^^^
FPI
Government Body Partnership Firm
Others
STATUS^ :
(^^^as and when applicable)
Resident Individual
PSU
AOP/BOI
Minor through Guardian
HUF
Trust /Charities / NGOs
Society
PAN / PEKRN^**
CKYC Id^**
Birth Certificate Passport Others
NAME^
Mr. Ms. M/s.
6. THIRD APPLICANT DETAILS
PAN / PEKRN^**
CKYC Id^**
^
STATUS : Resident Individual NRI
House /Flat No.
Street Address
##
Please note that your address details will be updated as per your KYC records with CKYC / KRA
##
Correspondence Address (P.O. Box is not sufficient)
Overseas Address (Mandatory for NRI / FPI Applicants)
Email ID
( C o u n t r y C o d e )
Tel. (Res.)
STD Code
Tel. (Off.) Mobile No.
7. CONTACT DETAILS OF SOLE / FIRST APPLICANT (Refer Instruction No. VII & IX)
Email ID provided pertains to Self Family Member
Spouse Dependent Parents Dependent Children
Investors providing Email Id would mandatorily receive E - Statement of Accounts in lieu of physical Statement of Accounts and the annual report or abridged summary on email. Please register your Mobile No
& Email Id with us to get instant transaction alerts via SMS & Email. I hereby authorize RNAM to send important information and regular updates to me on WhatsApp. (Refer instruction no. XVI for Terms
and Conditions.) I wish to receive scheme wise annual report or abridged summary through Physical mode (Applicable only for investors who have not specified the email id)
House /Flat No.
Street Address
Country
Pin Code
City/ Town
State
Country
Pin Code
City/ Town
State
(If you have an existing folio number with KYC validated, please mention the number here, enter your name in section 4 & proceed to section 9 & 10 to provide FATCA / Additional KYC details. If these details are
already provided please proceed to Section 11. Mode of holding will be as per existing folio number.)
SIGN
HERE
*Please sign alongside in case the EUIN is left blank/not provided. 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.
Second Applicant /
Authorised Signatory
Third Applicant /
Authorised Signatory
First / Sole Applicant / Guardian /
Authorised Signatory
Name & Broker Code / ARN
Sub Agent Code
Sub Agent ARN Code
*Employee Unique Identification Number
++
RIA Code
ARN-
(ARN stamp here)
ARN-
DISTRIBUTOR / BROKER INFORMATION
(Refer Instruction No. I.9 & 10)
[Please tick(P)] Single Joint (Default) Any one or Survivor
^MODE OF HOLDING :
APPLICATION FOR Zero Balance Folio Investment
3. GENERAL INFORMATION
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.
Enclosures (Please tick any one box) : Client Master List (CML) Transaction cum Holding Statement Cancelled Delivery Instruction Slip (DIS)
Target ID No.
DP ID No. Beneficiary Account No.
I N
National Securities Depository Limited (NSDL) Central Depository Securities Limited (CDSL)
2. UNITHOLDING OPTION - Demat Mode Physical Mode These details are compulsory if the investor wishes to hold the units in DEMAT mode. Ref. Instruction No. XI.
1. INVESTOR'S FOLIO NUMBER
[Please tick (P) any one]
I am a First time investor across Mutual Funds
I am an existing investor in Mutual Funds
OR
(Note: If Email pertains to Family Member please select any one)
ACKNOWLEDGMENT SLIP ( Please retain this slip)
To be filled in by the investor. Subject to realization of cheque and finishing of Mandatory Information.
QFUND.IN
SMS
Add convenience to your life with our value added service
Simply send **SMS to 966 400 1111 to avail below facilities
Types of Facilities
NAV
Balance
Last 3 Transaction
Statement thru mail
Single Folio
SMS mynav
SMS Balance
SMS Transaction
SMS ESOA
Multiple Folio
SMS mynav <space> last 6 digits of folio
SMS balance <space> last 6 digits of folio
SMS txn <space> last 6 digits of folio
SMS ESOA <space> last 6 digits of folio
**SMS charges apply
Investor Service. A NIMF Virtual Branch Experience.
For more details : Visit : www.nipponindiamf.com
You can also follow us on
I/We would like to invest in Nippon India_____________________________ subject to terms of the Statement of Additional Information (SAI), Scheme Information Document (SID), Key Information Memorandum (KIM)
and subsequent amendments thereto. I/We have read, understood (before filling application form) and is/are bound by the details of the SAI, SID & KIM including details relating to various services including but not
limited to Nippon India Any Time Money Card. I/We have not received nor been induced by any rebate or gifts, directly or indirectly, in making this investment. I / We declare that the amount invested in the Scheme is
through legitimate sources only and is not designed for the purpose of contravention or evasion of any Act / Regulations / Rules / Notifications / Directions or any other Applicable Laws enacted by the Government of
India or any Statutory Authority. I accept and agree to be bound by the said Terms and Conditions including those excluding/ limiting the Reliance Nippon Life Asset Management Limited (RNAM) liability. I understand
that the RNAM may, at its absolute discretion, discontinue any of the services completely or partially without any prior notice to me. I agree RNAM can debit from my folio for the service charges as applicable from time
to time. 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 hereby declare that the above information is given by the undersigned and particulars given by me/us are correct and complete. Further, I agree that the transaction charge
(if applicable) shall be deducted from the subscription amount and the said charges shall be paid to the distributors.
I confirm that I am resident of India. I/We confirm that I am/We are Non-Resident of Indian Nationality/Origin and I/We hereby confirm that the funds for subscription have been remitted from abroad through
normal banking channels or from funds in my/our Non-Resident External /Ordinary Account/FCNR Account. I/We undertake that all additional purchases made under this folio will also be from funds received from
abroad through approved banking channels or from funds in my/ our NRE/FCNR Account. I hereby declare that the information provided in the Form is in accordance with section 285BA of the Income Tax Act, 1961
read with Rules 114F to 114H of the Income Tax Rules, 1962 and the information provided by
me /us in the Form, its supporting Annexures as well as in the documentary evidence provided by me/us are, to the best of our
knowledge and belief, true, correct and complete.
++ I/We, have invested in the Scheme(s) of your Mutual Fund under Direct Plan. I/We hereby give you my/our consent to share/provide the transactions data feed/ portfolio holdings/ NAV etc. in respect of my/our
investments under Direct Plan of all Schemes Managed by you, to the above mentioned Mutual Fund Distributor / SEBI-Registered Investment Adviser. I hereby authorize the representatives of Reliance Nippon Life
Asset Management Ltd and its Associates to contact me through any mode of communication. This will override registry on DND / DNDC , as the case may be.
Mr./Ms./M/s
13. POWER OF ATTORNEY (POA) HOLDER DETAILS
(Refer Instruction No. II. 1)
PAN^
Mr./Ms./M/s
Mr./Ms./M/s
14. DECLARATION AND SIGNATURE
First Applicant POA Name
Second Applicant POA Name
Third Applicant POA Name
Nominee Name & Address
Guardian Name
(in case Nominee is Minor)
Guardian Relation
with Nominee
Allocation
(%)
Sign of
Nominee
Sign of
Guardian
Signature of Applicants
1st Applicant
2nd Applicant
3rd Applicant
Date of Birth
of Nominee
Nominee Relation
With Investor
PAN of Nominee
(Optional)
(Mandatory if mode of holding is single) (Refer Instruction No. VI) In case of existing investor, nomination details mentioned in
the below table will replace the existing details registered in the folio. Signature of applicants is mandatory if you do not wise to nominate.
12. NOMINATION - I wish to Nominate
Yes No
%
In case Country of Tax Residence is only India then details of Country of Birth & Nationality need not be provided. In case Tax Identification Number is not available, kindly provide its functional equivalent
^**
Country of Nationality
^**
Country of Nationality
^**
Country of Nationality
Sole/First Applicant/Guardian
^**
Country of Birth
Second Applicant
^**
Country of Birth
Third Applicant
^**
Country of Birth
# Please indicate all Countries in which you are a resident for tax purpose, associated Taxpayer Identification Number and it's Identification type eg. TIN etc.
9. FATCA and CRS DETAILS For Individuals (Mandatory) Non Individual Investors should mandatory fill separate FATCA/CRS details form
Sole/First Applicant/Guardian Second Applicant Third Applicant
Identification
Type
Tax Payer
%
Ref. ID No
# ^**
Country
1
2
3
Identification
Type
Tax Payer
%
Ref. ID No
#
Country
1
2
3
Identification
Type
Tax Payer
%
Ref. ID No
#
Country
1
2
3
Equity & Sector Specific CAF / 24th Oct 2019 / Ver 4.2
Are you a Politically Exposed Person (PEP)^**
Are you related to a Politically Exposed Person (PEP)^**
^**
PEP DETAILS
1st Applicant
Yes No
Yes No
(Net worth should
not be older
than 1 year)
GROSS ANNUAL INCOME DETAILS^**
1st Applicant
2nd Applicant
3rd Applicant
Guardian
Below 1 Lac
1-5 Lacs 5-10 Lacs 10-25 Lacs 25 Lacs-1 Crore >1 Crore
^**
NET-WORTH in `
Date
D D M M Y Y Y Y
D D M M Y Y Y Y
D D M M Y Y Y Y
D D M M Y Y Y Y
10. ADDITIONAL KYC DETAILS
^**
OCCUPATION
st
1 Applicant
nd
2 Applicant
rd
3 Applicant
Guardian
Professional Agriculturist Housewife Retired
Government Service/PublicSector
Business
Forex Dealer Student
Private Sector Service
Others
SIGN
HERE
Second Applicant /
Authorised Signatory
Third Applicant /
Authorised Signatory
First / Sole Applicant / Guardian /
Authorised Signatory
2 nd Applicant 3 rd Applicant Guardian
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Option Growth^^ Dividend Payout Dividend Reinvestment
Dividend Frequency
11. INVESTMENT & PAYMENT DETAILS (Separate Application Form is required for investment in each Plan/Option. Multiple cheques not permitted with single application form
(Refer instruction no. IV) OTBM facility is available to investors who have Invest Easy facility registered with NIMF.
Scheme
(Refer Instruction No. I-10) (For Product Labeling please refer last page of application form) (If you wish to invest in Direct Plan please mention Direct Plan against the scheme name)
[Please tick (
P
) the appropriate boxes only if applicable
to the scheme in which you plan to invest]
Investment
Amount ( ` )
DD Charges
(if applicable) ( ` )
Net Amount~
( ` )
Instrument No/Cash
Deposit Slip No/UTR No.
Date
Drawn on Bank Bank Branch
City
^^ $
( Default option if not selected) ~Units will be allotted for the net amount minus the transaction charges if applicable. Investors are requested to collect the cash deposit slip from the DISC
Reason for Investment:
House
Children’s education
Children’s Marriage
Car
Retirement
Others
$
Mode of Payment Cheque DD Funds Transfer OTBM Facility (One Time Bank Mandate) RTGS / NEFT Cash (Refer Instruction No. XV)
D D M M Y Y Y Y
I
I minus II
I
I