Non-Individual Investors involved/ providing any of the mentioned services
Foreign Exchange / Money Changer Services
Money Lending / Pawning
None of the above
Gaming / Gambling / Lottery / Casino Services
... continued overleaf
ACKNOWLEDGEMENT SLIP
(To be flled in by the Investor) [For any queries please contact our nearest Investor Service Centre or call us at our Customer Service Number 1800 3010 6767 / 1800 419 7676 (Toll Free)]
Date :
Received from Mr. / Ms. / M/s.
________________________________________________________________________________________________
ISC Stamp & Signature
HDFC MUTUAL FUND
Investors must read the Key Information Memorandum, the instructions and Product Labeling on cover page before completing this Form.
The Application Form should be completed in English and in BLOCK LETTERS only.
Application Form (Except for ETFs, HDFC Retirement Savings Fund and HDFC Children’s Gift Fund)
FOR OFFICE USE ONLY
(TIME STAMP)
TRANSACTION CHARGES FOR APPLICATIONS THROUGH DISTRIBUTORS ONLY
(Refer Instruction 2)
In case the purchase/ subscription amount is Rs. 10,000 or more and your Distributor has opted in 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 ARN Holder (AMFI
registered Distributor) based on the investors’ assessment of various factors including the service rendered by the ARN Holder.
1. EXISTING UNIT HOLDER INFORMATION
(IF YOU HAVE EXISTING FOLIO, PLEASE FILL IN SECTIONS viz. 1, 5, 6, 10 AND 13 ONLY. Refer instruction 3).
The details in our records under the folio number mentioned alongside will apply for this application.
Folio No.
ARN/RIA NameARN/RIA Code
ARN-
Sub Agent’s ARN
Employee Unique
Identification Number
(EUIN)
Internal Code
for Sub-Agent/
Employee
an application for Purchase of Units of the Scheme(s) alongwith Cheque / DD / Payment Instrument as detailed overleaf.
Resident Individual
HUF
AOP
NRI-Repatriation NRI-Non Repatriation
PIO
Partnership
Trust
Minor through guardian
BOI
Body CorporateCompany
FIIs
OCI
_________________________
Others
(please specify)
Society / Club
LLP
Foreign National Resident in India
Sole Proprietorship
FPI
Status of First/ Sole Applicant [Please tick (P)]
Individual Non - Individual [Please attach FATCA, CRS & Ultimate Beneficial Ownership (UBO) Self Certification Form and
Aadhaar Updation Form ] (Refer Instruction 4, 19 & 18 c) (Mandatory)
Non Profit Organisation
Anyone or Survivor
Joint
Single
2. MODE OF HOLDING [Please tick (P)]
3. UNIT HOLDER INFORMATION (Refer instruction 4)
D
DATE OF BIRTH@
Proof of date of birth@
Please (P)
Attached
NAME OF FIRST / SOLE APPLICANT (In case of Minor, there shall be no joint holders) Ensure that name is as per Aadhaar Card
Mr.
Ms.
M/s.
Nationality
Head Office : HDFC House, 2nd Floor, H.T. Parekh Marg,
165-166, Backbay Reclamation, Churchgate, Mumbai - 400 020.
Bank Branch Code
KEY PARTNER / AGENT INFORMATION (Investors applying under Direct Plan must mention “Direct” in ARN column.) (Refer Instruction 1)
4. JOINT APPLICANT DETAILS, If any (Refer instruction 4) (In case of Minor, there shall be no joint holders)
1.1. NAME OF SECOND APPLICANT
Mr.
Ms.
M/s.
Nationality
^ On providing email-id investors shall receive the physical copy of scheme wise annual report or an abridged summary thereof/ account statements/ statutory and other documents by email.
However, if the investors wish to receive the scheme wise annual report or an abridged summary thereof [Please tick (P)] Opt-in (Refer Instruction 10 & 12)
eAlerts Mobile
eDocs Email^
Telephone : Off.
Res.
Fax
CONTACT DETAILS OF FIRST / SOLE APPLICANT
Country Code
I/ We would like to register for online access to transact on HDFCMFOnline Investors as per the terms & conditions displayed on website: www.hdfcfund.com (Email id mandatory)
Relationship with Minor@ Please (P)
Father Mother
Court appointed Legal Guardian
Proof of relationship with minor@ Please (P)
Attached
@ Mandatory
Nationality
Contact No.
Designation
NAME OF GUARDIAN (in case of First / Sole Applicant is a Minor) / NAME OF CONTACT PERSON – DESIGNATION (in case of non-individual Investors)
Mr.
Ms.
MAILING ADDRESS OF FIRST / SOLE APPLICANT (Mandatory) (Refer Instruction 4a)
CITY
STATE
PIN CODE
STD Code
2. NAME OF THIRD APPLICANT
Mr.
Ms.
M/s.
Nationality
5. ADDITIONAL KYC DETAILS (Refer instruction 4b)
st nd rd
Occupation details for 1 Applicant 2 Applicant 3 Applicant Guardian
Private Sector Service
Public Sector Service
Government Service
Business
Professional
Agriculturist
Retired
Housewife
Student
Proprietorship
Others (Please specify)
Politically Exposed Person (PEP) details: Is a PEP Related to PEP Not Applicable
st
1 Applicant
nd
2 Applicant
rd
3 Applicant
Guardian
Authorised Signatories
Promoters
Partners
Karta
Whole-time Directors
Trustee
# Please attach Proof. Refer instruction No 16 for PAN/PEKRN and No 18a for KYC (KRA). Refer instruction No 18b for KYC Identification Number issued by CKYCR.
July 2018
EUIN Declaration (only where EUIN box is left blank) (Refer Instruction 1)
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.
First/ Sole Applicant/ Guardian
Third Applicant
Second Applicant
SIGN
Proof Attached
[Please tick (P)] (Mandatory)
KYC Number KYC #
KYC Number
Proof Attached
[Please tick (P)] (Mandatory)
KYC #
Proof Attached
[Please tick (P)] (Mandatory)
KYC Number KYC #
Proof Attached
[Please tick (P)] (Mandatory)
KYC Number KYC #
Mandatory
PAN#/ PEKRN#
PAN#/ PEKRN#
PAN#/ PEKRN#
PAN#/ PEKRN#
D M M Y Y Y Y
Qfund India
Mutul Fund
Mutual Fund
India
Mutual Fund
Mutual Fund
India
PAN#/ PEKRN#
Particulars
Scheme Name / Plan / Option / Sub-option /
Payout Option
Drawn on (Name of Bank and Branch)
Amount in figures (Rs.)
Please Note: All Purchases are subject to realisation of cheques / demand drafts / Payment Instrument.
Cheque / DD / Payment Instrument /
UTR No. / Date
For unit holders opting to hold units in demat form, please ensure that the bank account linked with the demat account is mentioned here.
Bank Name
Branch Name
Bank City
Account Number
Account Type (Please )P
Savings
Current NRO NRE FCNR
Others (please specify) _______________________
(The 9 digit code appears on your cheque next to the cheque number)
MICR Code
IFSC Code***
*** Refer Instruction 5C (Mandatory for Credit via NEFT / RTGS) (11 Character code appearing on your
cheque leaf. If you do not find this on your cheque leaf, please check for the same with your bank)
8. BANK ACCOUNT DETAILS OF THE FIRST / SOLE APPLICANT (For redemption/ dividend if any) (refer instruction 5)
(Mandatory to attach proof, in case the pay-out bank account is different from the bank account mentioned under Section 10 below.)
7. POWER OF ATTORNEY (PoA) HOLDER DETAILS
Mr.
Ms.
M/s.
Name of PoA
# Please attach Proof. Refer instruction No 16 for PAN/PEKRN and No 18a for KYC (KRA). Refer instruction No 18b for KYC Identification Number issued by CKYCR.
6. FATCA AND CRS INFORMATION (for Individual including Sole Proprietor) (Self Certification) (Refer instruction 4)
If Yes, please provide the following information [mandatory]
Category
Country of Birth
Country of Tax Residency#
Tax Payer Ref. ID No^
First Applicant (including Minor) Second Applicant/ Guardian
Third Applicant
Please indicate all countries in which you are resident for tax purposes and the associated Tax Reference Numbers below.
The below information is required for all applicant(s)/ guardian
Place/ City of Birth
Is the applicant(s)/ guardian's Country of Birth / Citizenship / Nationality / Tax Residency other than India? Yes No
Address Type: Residential or Business Residential Business Registered Office (for address mentioned in form/existing address appearing in Folio)
Identification Type
[TIN or other, please specify]
Country of Tax Residency 2
Tax Payer Ref. ID No. 2
Identification Type
[TIN or other, please specify]
Country of Tax Residency 3
Tax Payer Ref. ID No. 3
Identification Type
[TIN or other, please specify]
#To also include USA, where the individual is a citizen/ green card holder of USA. ^In case Tax Identification Number is not available, kindly provide its functional equivalent.
5. ADDITIONAL KYC DETAILS, If any (Refer instruction 4b) Contd.
Gross Annual Income Range (in Rs.)
Below 1 lac
1-5 lac
5-10 lac
OR Networth in Rs. (Mandatory
for Non Individual) (not older
than 1 year)
st
1 Applicant
nd
2 Applicant
rd
3 Applicant
Guardian
Gross Annual Income Range (in Rs.)
10-25 lac
25 lac- 1 cr
> 1 cr
st
1 Applicant
nd
2 Applicant
rd
3 Applicant
Guardian
as on
DD MM YYYY
Proof Attached
[Please tick (P)] (Mandatory)
KYC Number KYC #
July 2018
Mandatory
Mandatory
AADHAAR DETAILS (Ensure all details are as per Aadhaar Card) (for Individual including Sole Proprietor) Not mandatory for NRIs (Refer instruction 18c)
Particulars Aadhaar Number*
(Please enclose copy of front & back side)
Date of Birth
D D M M Y Y Y Y
1st Applicant
2nd Applicant
3rd Applicant
Guardian
POA
Mandatory
* All the applicants whose Aadhaar Number is mentioned are required to sign the form.
# If Aadhaar number is applied for, please enclose proof of enrolment.
PIN Code Mobile No.
Enrolment
Proof#
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
Mutual Fund
India
Mutual Fund
India
Mutual Funds
Mutual Fund India
Mutual Funds India
Mutual Fund India
Mutual Fund Bandra
Mutual Fund BKC
Unitholders will receive redemption/ dividend proceeds directly into their bank account (as furnished in Section 8) via Direct credit/ NEFT/ECS facility
I/We want to receive the redemption / dividend proceeds (if any) by way of a demand draft instead of direct credit / credit through NEFT system / credit through ECS into my / our bank account
9. MODE OF PAYMENT OF REDEMPTION / DIVIDEND PROCEEDS (refer instruction 11)
*Investor opting to hold units in demat form, may provide a copy of the DP statement enable us to match the demat details as stated in the application form.
11. UNIT HOLDING OPTION
NSDL
CDSL
DP Name
DP ID
Beneficiary
Account No.
I N
DP Name
12. NOMINATION (refer instruction 15) (Mandatory for new folios of Individuals where mode of holding is single) (For Units in Non-Demat Form)
[Please (P) and sign]
I/We do not wish to Nominate
First / Sole Applicant Second Applicant Third Applicant
Name and Address of Nominee(s)
Date of Birth
Name and Address of Guardian
Signature of Nominee
(Optional)/ Guardian of
Nominee (Mandatory)
Proportion (%) in which
the units will be shared by
each Nominee
(should aggregate to 100%)
(to be furnished in case the Nominee is a minor)
Nominee 1
Nominee 2
Nominee 3
I/We wish to nominate as under:
OR
Beneficiary
Account No.
DEMAT MODE* PHYSICAL MODE (Default)
*Demat Account details are mandatory if the investor wishes to hold the units in Demat Mode
( refer instruction 13)
Relationship
with
Applicant
13. DECLARATION & SIGNATURE/S (refer instruction 14)
I/We confirm that my application is in compliance with applicable Indian and foreign laws.
Please (P) If Yes, (P)
Yes
No
Repatriation basis Non-repatriation basis
I / We have read, understood the terms and conditions of the scheme related documents and agree to comply with the same
as an Unitholder. I /We hereby apply to the Trustees for allotment of Units of the Scheme(s) of HDFC Mutual Fund (‘Fund’)
and confirm and declare as under:
(a) I/We am/are eligible Investor(s) as per the scheme related documents and not prohibited by any order/ruling
/judgement passed by SEBI/ Statutory Authority or Courts in India and Foreign laws. I am/We are authorised to make
this investment as per the Constitutive documents/ authorization(s). The amount invested in the Scheme(s) is through
legitimate sources only and is not for the purpose of contravention and/or evasion of any act, rules, regulations,
notifications or directions issued by any regulatory authority in India.
(b) The information given by me /us in or along with this application form is true and correct and shall furnish such other
further/additional information as may be required by the HDFC Asset Management Company Limited (AMC)/ Fund
.I/We undertake to promptly inform the AMC / Fund/Registrars and Transfer Agent (RTA) in writing about any change in
the information furnished by me/us from time to time.
(c) I/We hereby authorize you to disclose, share, remit in any form/manner/mode the above information and/or any part of
it including the changes/updates that may be provided by me/us to the Fund, its Sponsor/s, Trustees, Asset
Management Company, its employees, agents and third party service providers, SEBI registered intermediaries for
single updation/ submission, any Indian or foreign statutory, regulatory, judicial, quasi- judicial authorities/agencies
including but not limited to Financial Intelligence Unit-India (FIU-IND) etc without any intimation/advice to me/us.
(d) I/We shall be liable and responsible for any loss, claims suffered, directly or indirectly by AMC/ Fund/ RTA/ SEBI
Intermediaries, arising out of any false, misleading, inaccurate and incomplete information furnished by me/us at the
time or investing/redeeming the units. I/We hereby unconditionally and irrevocably indemnify and at all time keep
indemnified, save and harmless AMC/Fund/Trustee and their officers, directors and employees against all actions,
proceedings, claims, losses, damages, charges and expenses incurred or suffered /paid by AMC/Fund in this regard
and in case of any dispute regarding the eligibility, validity and authorization of my/our transactions.
(e) The ARN holder (AMFI registered Distributor) has disclosed to me/us all the commissions (in the form of trail
commission or any other mode), payable to him/them 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 will redeem my/our entire investment/s before I/We change my/our Indian residency status. I/We shall be fully liable for
all consequences (including taxation) arising out of the failure to redeem on account of change in residential status.
(Please write Application Form No. / Folio No.
on the reverse of the Cheque / Demand Draft /
Payment Instrument.)
SIGN HERE
SIGNATURE(S)
For Foreign Nationals Resident in India only:
First / Sole
Applicant /
Guardian
SIGN
Second
Applicant
SIGN
Third
Applicant
SIGN
July 2018
For NRIs/ PIO/OCIs only:
I/We hereby accord my/our consent to HDFC AMC for receiving the promotional information/ material via email, SMS,
telemarketing calls etc. on the mobile number and email provided by me/us in this Application Form.
Consent for Telemarketing (Refer Instruction 20):
I/We hereby provide my consent in accordance with Aadhaar Act, 2016 and regulations made thereunder, for (i) collecting,
storing and usage (ii) validating/authenticating and (ii) updating my/our Aadhaar number(s) in accordance with the Aadhaar
Act, 2016 (and regulations made thereunder) and PMLA. I/We hereby provide my/our consent for sharing/ disclose of the
Aadhaar number(s) including demographic information with the asset management companies of SEBI registered mutual
fund and their Registrar and Transfer Agent (RTA) for the purpose of updating the same in my/our folios with my PAN.
Consent for authentication and sharing of Aadhaar data:
Scheme/Plan/Sub Option
10. INVESTMENTS & PAYMENT DETAILS [Please (P)]
Pay-In Bank Account No.
(For Cheque Only)
Third Party Payment (Please attach ‘Third Party Payment Declaration Form’)
Non-Third Party Payment
Payment Type [Please (P)]
Cheque/ DD/
Payment Instrument/
UTR No.
Amount of Cheque / DD /
Payment Instrument /
RTGS/ NEFT in figures (Rs.)
Net Cheque/ DD
Amount
DD Charges,
if any
Cheque/ DD/
Payment Instrument/
UTR Date
Regular Plan (Purchase/ Subscription routed through Distributor)
Mention valid ARN in Key Partner/ Agent Information
Direct Plan (Purchase/ Subscription made directly with the Fund)
Mention DIRECT in Key Partner/ Agent Information
(refer instruction 6 & 7 for Scheme details and instruction 8 & 9 for Payment Details) The name of the first/ sole applicant must be pre-printed on the cheque.
Drawn on Bank / Branch
Please note that OTM can be selected as mode of payment provided OTM is already registered. In case OTM is not registered please fill in the attached OTM Debit Mandate to make future
transactions via OTM
Mode of Payment
Cheque
Demand Draft
NEFT/ RTGS/ Fund Transfer One Time Mandate (OTM)
Growth Option if Growth or Dividend Option is not selected
Mumbai
India
Mutual Fund
India
Mutual Fund
India
Mutual Fund
India
Mutual Fund
Mumbai
Mutual Fund
Versova
MutualfundIndia
