Have you invested in UTI MF earlier. Yes No
If yes, please provide : Scheme Name ..................................................................................................................................... Folio ................................................................... (Optional)
CR / CA Code For Chief Representative
DD Amount
DD Charges
Total
DD No.: Dated: Drawn on:
DISTRIBUTOR INFORMATION
(only empanelled Distributors/Brokers will be permitted to distribute Units)
ARN Broker Name Sub-Broker Code/ M O Code UTI RM No.
Bank Branch Code
Upfront commission 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.
PAYMENT DETAILS
Cheque / DD* No. Amt. of investment (i)
Date DD Charges if any (ii)
Bank Net amount paid (i-ii)
Branch Amt in words
Account Type Please () Current Savings NRE NRO DD issued from abroad
*Please mention the application No. on the
reverse of the cheque/DD. Cheque/DD must
be drawn in favour of "The Name of the
Scheme" & crossed "A/c Payee Only"
*PAN of 2nd Applicant
Enclosed PAN Card Copy Please ()
Name of 2nd Applicant Mr. Ms. Mrs.
Date of Birth of 2nd Applicant
d d m m y y y y
Name of 3rd Applicant Mr. Ms. Mrs.
*PAN of 3rd Applicant
Know Your Customer (KYC)
KYC Mandatory for Investment of Rs.50,000 & above
Copy of KYC acknowledgement enclosed
Yes No
F I R S T M I D D L E L A S T
F I R S T M I D D L E L A S T
Enclosed PAN Card Copy Please ()
Know Your Customer (KYC)
KYC Mandatory for Investment of Rs.50,000 & above
Copy of KYC acknowledgement enclosed
Yes No
Date of Birth of 3rd Applicant
d d m m y y y y
Applicant’s address / (for NRIs) At my Overseas address as mentioned above
(for NRIs) To be despatched to my resident relative’s address in India as given above
NAME IN FULL OF THE FATHER/MOTHER OR GUARDIAN (IN CASE OF MINOR)/ CONTACT PERSON FOR INSTITUTIONAL APPLICANTS Mr. Ms. Mrs.
F I R S T M I D D L E L A S T
OVERSEAS ADDRESS (Overseas address is mandatory for NRI / FII applicants in addition to mailing address in India)
City*
State
Country*
Zip/Pin*
PLEASE USE SEPARATE FORM FOR EACH SCHEME
(PLEASE READ INSTRUCTIONS CAREFULLY TO HELP US SERVE YOU BETTER)
COMMON APPLICATION FORM FOR OPEN-END
EQUITY AND BALANCED SCHEMES
Sr.No. 2010/
Registrar Sr. No.
ACKNOWLEDGEMENT
(To be lled in by the Applicant)
Stamp of UTI AMC Ofce/
Authorised Collection Centre
dated
* Cheques and drafts are subject to realisation.
(scheme name)
Sr. No. 2010/
Received from Mr / Ms / M/s
An application under
along with Cheque / DD No.*
Drawn on (Bank)
for Rs. (in gures)
APPLICANT'S PERSONAL DETAILS (Please ll in Block Letters) Mr. Ms. Mrs.
Name of First Applicant
First Applicant’s Address (Do not repeat the name) Name & Address of resident relative in India (for NRIs) (P.O. Box No. is not sufcient)
F I R S T M I D D L E
L A S T
Date of Birth Mandatory for minors
d d m m y y y y
Village/Flat/Bldg./Plot*
Street/Road/Area
City* State Pin*
Tel. No. (R)
S T D C O D E
(0) Mobile
e-mail
Alternate e-mail
S T D C O D E
*PAN OF 1ST APPLICANT/FATHER/MOTHER/GUARDIAN (whose particulars are furnished in the form)
Enclosed PAN Card Copy Please ()
Know Your Customer (KYC)
KYC Mandatory for Investment of Rs.50,000 & above
Copy of KYC acknowledgement enclosed
Yes No
ONLINE ACCESS
I/We wish to access the account online through ‘invest@uti’ at www.utimf.com.
I/We have read and understood terms & conditions available at www.utimf.com and agree to abide by the same concerning all my/our folios.
DETAILS OF OTHER APPLICANTS
OPTION FOR DESPATCH OF STATEMENT OF ACCOUNT
I wish to opt for Consolidated Account Statement (CAS) across schemes of all fund houses at the periodicity stipulated by Association of Mutual Funds of India. Please ()
If you wish to receive the following via e-mail (Refer instruction k)
Please ()
Account Statement Annual Report Transaction Conrmation Communication of change of address, bank details etc. CAS
QFUND.IN
* Applicable to NRI’s
Notes:
1. If the application is incomplete and any other requirement is not fullled, the application is liable to be rejected.
2. In case the applicant does not receive the Statement of Account within 30 days from the date of acceptance of the application, he/she may please write to the Registrar
quoting serial number, date of acknowledgement and the name of the accepting authority.
3. Please ensure that all PAN details are given, failing which your application will be rejected (PAN not applicable for Micro SIP).
4. All communications relating to issue of Statement of Account, Change in Name, Address or Bank Particulars, Nomination, Redemption, Death Claims, etc., may
please be addressed to the Registrar :
M/s. Karvy Computershare Pvt. Ltd.
Narayani Mansion, H. No. 1-90-2/10/E, Vittalrao Nagar, Madhapur, Hyderabad - 500 081
Tel.: 040-23421944 to 47 • Fax: 040-23115503 • Email: uti@karvy.com
DECLARATION AND SIGNATURES OF APPLICANT/s
I/We have read and understood the contents of the Scheme Information Document, Statement of Additional Information and Key Information Memorandum, addenda issued till date and
apply to the Trustee of UTI Mutual Fund as indicated above. I/We agree to abide by the terms and conditions, rules and regulations of the scheme as on the date of investment. I/We
undertake to conrm that this investment has been duly authorised by appropriate authorities in terms of all relevant documents and procedural requirements.
I/We have not received nor been induced by any rebate or gifts, directly or indirectly in making investments.
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/We conrm that we are Non-Residents of Indian Nationality/Origin and that the funds are remitted from abroad through approved banking channels or from my / our NRE / NRO Account.
I/We undertake to provide further details of source of funds and any such other relevant documents, if called for by UTI Mutual Fund.
NOMINATION DETAILS
I/We hereby nominate the undermentioned Nominee to receive the amounts to my / our credit in the event of my / our death. I/We also understand that all payments
and settlements made to such Nominee and signature of the Nominee acknowledging receipt thereof, shall be a valid discharge by the AMC / Mutual Fund / Trustee.
Investors who wish to nominate two or three persons may ll in the separate form prescribed for the same and attach it with this application form.
Name
Date of Birth
(in case nominee is a minor)
Address
Name of the guardian:
Address of guardian
Signature of nominee/guardian
(For minor)
Name and address of Nominee To be furnished in case nominee is a minor
Signature of 3rd Applicant
Name of the 3rd Authorised Signatory
Designation
Signature of 2nd Applicant
Name of the 2nd Authorised Signatory
Designation
Signature of 1st Applicant / Guardian
Name of the 1st Authorised Signatory
Designation
GENERAL INFORMATION - Please () wherever applicable
Status
Resident Individual Minor through guardian HUF Partnership Trust
Company Sole Proprietorship Society Body Corporate AOP
BOI FII NRI Others
Mode of Holding Single Anyone or survivor Joint
Occupation Business Student Agriculture Self-employed Professional
Housewife Retired Service Others
Marital Status Unmarried Married Wedding Anniversary
D
BANK PARTICULARS OF 1ST APPLICANT (Mandatory as per SEBI Guidelines)
Annual Income of First Individual Applicant (Please () < 5 Lacs > 5 Lacs - < 15 Lacs > 15 Lacs - < 25 Lacs > 25 Lacs * Denotes Mandatory Fields
Bank Name Branch
Address MICR Code
(this is a 9-digit number next to your cheque number)
City Pin*
IFS Code
Account type (please ) Savings Current NRO NRE
Account No.
INVESTMENT DETAILS (Please )
UTI-Balanced Fund
UTI-Banking Sector Fund
UTI-Contra Fund
UTI-Dividend Yield Fund
UTI-Energy Fund
UTI-Equity Fund
UTI-Infrastructure Fund
UTI-Leadership Equity Fund
UTI-Master Index Fund
UTI-Master Plus Unit Scheme
UTI-Mastershare Unit Scheme
UTI-Master Value Fund
UTI-Mid Cap Fund
Plan available only under UTI-Banking Sector Fund and UTI-Wealth Builder Fund Series II.
Regular/Retail Plan Institutional Plan (Minimum is Rs.5 crore under UTI-Banking Sector Fund and Rs.1 crore under UTI-Wealth Builder Fund Series II). (Default is Regular/Retail
Plan. However, if the application is for amounts of Rs.5 crore / Rs.1 crore and above the default Plan is the Institutional Plan.)
OPTION (for all schemes)
Growth Dividend Payout Dividend Reinvestment (Default is growth option)
I wish to Opt for Systematic Investment Plan (SIP). I wish to Opt for Automatic Trigger Facility.
(Investor opting for Systematic Investment Plan (SIP) & / or Automatic Trigger Facility may ll in separate form/s prescribed for the same & attach with this application form.
UTI-MNC Fund
UTI-Nifty Index Fund
UTI-Opportunities Fund
UTI-Pharma & Healthcare Fund
S&P CNX NIFTY UTI NOTIONAL
DEpository Receipts Scheme
(SUNDER)
UTI-Services Industries
Fund
UTI-Top 100 Fund
UTI-Transportation &
Logistics Fund
UTI-Wealth Builder Fund
Series II
D M M
Systematic Withdrawal Plan (available under Growth Option of all schemes except SUNDER, UTI-Banking Sector Fund - Institutional Plan & UTI-Wealth
Builder Fund – Series II – Institutional Plan) - Please ll separate form.