Transaction Charges for Applications routed through Distributors/agents only (Refer Instruction 1 (viii))
Employee Unique ID. No. (EUIN)
Sub Broker Code
Sub Broker Name & ARN/ RIA No.Distributor Name & ARN/ RIA No.
MUTUAL FUNDS
Aditya Birla Sun Life Mutual Fund
Common Application Form
For Resident Indians and NRIs/FIIs/FPIs
(Please read the instructions before filling up the form. All sections to be completed in english in black / blue coloured ink and in block letters.)
Application No.
First Applicant / Authorised Signatory
Second Applicant
Third Applicant
In case the subscription (lumpsum) amount is ` 10,000/- or more and your Distributor has opted to receive Transaction Charges, 150/- (for first time mutual fund investor) or 100/- (for investor other than
first time mutual fund investor) will be deducted from the subscription amount and paid to the distributor. Units will be issued against the balance amount invested.
` `
Existing Unitholder please fill in your Folio No., Name & Email ID and then proceed to Section 5 (Applicable details and Mode of holding will be as per the existing Folio No.)
Existing Folio No.
1.
FIRST / SOLE APPLICANT INFORMATION (MANDATORY) (Refer Instruction No. 2,3,4) Fresh / New Investors fill in all the blocks. (1 to 8) In case of investment "On behalf of Minor", Please Refer Instruction no. 2(ii)
Name of First/Sole Applicant
(as per PAN/ Aadhaar Card)#
Mr. Ms.
M/s.
PAN / PEKRN (Mandatory)
Date of Birth**
D D
M M Y Y Y Y
AADHAR
Card Number
CKYC
Number
(Prefix
if any)
14 digit CKYC Number
Name of the Second Applicant
(as per PAN/ Aadhaar Card)#
Mr. Ms.
M/s.
PAN / PEKRN (Mandatory)
Date of Birth**
D D
M M Y Y Y Y
AADHAR
Card Number
CKYC
Number
(Prefix
if any)
14 digit CKYC Number
Name of the Third Applicant
(as per PAN/ Aadhaar Card)#
Mr. Ms.
M/s.
PAN / PEKRN (Mandatory)
Date of Birth**
D D
M M Y Y Y Y
AADHAR
Card Number
CKYC
Number
(Prefix
if any)
14 digit CKYC Number
Name of the Guardian (In case First / Sole Applicant is minor) / Contact Person - Designation - Poa Holder (In case of Non-individual Investors)(as per PAN/ Aadhaar Card)#
Mr. Ms.
M/s.
PAN / PEKRN (Mandatory)
Date of Birth**
D D M M Y Y Y Y
AADHAR
Card Number
CKYC
Number
(Prefix
if any)
14 digit CKYC Number
Relationship of Guardian (Refer Instrcution No. 2(ii))
ISD CODE
TEL: OFF.
S
T D
-
TEL: RESI
S
T
D
-
Proof of the Relationship with Minor**
** Mandatory in case the First / Sole Applicant is Minor
Tax Status [Please tick (3)] (Applicable for First / Sole Applicant)
Resident Individual FIIs NRI - NRO HUF Club / Society PIO Body Corporate Minor Government Body
Trust NRI - NRE Bank and FI Sole Proprietor Partnership Firm QFI Provident Fund Others
(Please Specify)
Acknowledgement Slip (To be filled in by the Investor)
Common Application Form
Application No.
Received from Mr. / Ms. __________________________________________________________ Date : _____/_____/___________
Collection Centre /
ABSLAMC Stamp & Signature
PAN/PEKRN Proof
KYC Complied
Yes
No
[Please Tick (3)] Enclosed
NECS Form
Aditya Birla Sun Life AMC Limited
(Formerly known as Birla Sun Life Asset Management Company Limited)
Regn. No.: 109. Regd Office: One Indiabulls Centre, Tower 1, 17th Floor, Jupiter Mill Compound,
841, Senapati Bapat Marg, Elphinstone Road, Mumbai - 400013
+91 22 4356 7000 | care.mutualfunds@adityabirlacapital.com | www.adityabirlasunlifemf.com | CIN: U65991MH1994PLC080811
Contact Us:
1800-270-7000
adityabirlacapital.com
#The application is liable to get rejected if
does not match with PAN card/ Aadhar card
EUIN is mandatory for “Execution Only” transactions. Ref. Instruction No. 9
I/we hereby confirm that the EUIN box has been intentionally left blank my 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.
Distributor Mobile No. Distributor Email Id
Qfund Mutual Fund India
Mutual Fund India
Mutual Fund India
Mutual Fund India
Mutual Fund India
Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs > 25 Lacs - 1 Crore > 1 Crore
Below 1 Lac
1-5 Lacs 5-10 Lacs 10-25 Lacs
> 25 Lacs - 1 Crore
> 1 Crore OR Net Worth ______________________________________
S.
No.
Scheme Name
Plan / Option
Net Amount Paid (`)
Payment Details
Cheque/DD No./UTR No.
(in case of NEFT/RTGS)
Bank and Branch
1.
ABSL
2.
GO GREEN [Please tick (3)] (Refer Instruction No. 10)
3.
BANK ACCOUNT DETAILS (Please note that as per SEBI Regulations it is mandatory for investors to provide their bank account details) Refer Instruction No. 3(A)
4.
INVESTMENT DETAILS [Please tick (3)] (Refer Instruction No. 5, 9 & 14) (If this section is left blank, only folio will be created)
Joint Single Anyone or Survivor (Default option is Anyone or survivor)
MODE OF HOLDING [Please tick (3)] (Please Refer Instruction No. 2(v))
MAILING ADDRESS OF FIRST / SOLE APPLICANT (P. O. Box Address is not sufficient. Please provide full address.)
CITY
STATE PINCODE
SMS Transact Online Access
Mobile No.
+91
I/ We would like to register for my/our SMS Transact and/
or Online Access
Email Id
Facebook Id
Twitter Id
Default Communication mode is E-mail only, if you wish to receive following document(s) via physical mode: [Please tick (3)]
Account Statement
Annual Report
Other Statutory Information
Name of the Bank
Branch Address
Pin Code
City
Account No.
Account Type [Please tick (3)]
11 Digit IFSC Code 9 Digit MICR Code
SAVINGS CURRENT NRE NRO FCNR OTHERS
(Please Specify)
Seperate cheque/ demand draft must be issued for each investment drawn in favour of respective scheme name and the instrument should be crossed “A/c Payee Only”.
Please write appropriate scheme name as well as the Plan/Option/Sub Option
S.
No.
Cheque / DD Favouring
Scheme Name* (refer Instruction 5)
Plan/Option
Cheque
Date
Amount
Invested (`)
DD
Charges^
Net Amount
Paid (`)
Cheque/DD No./UTR No.
(in case of NEFT/RTGS)
1.
ABSL
OCCUPATION [Please tick (3)]
FIRST APPLICANT
Private Sector Service Public Sector Service
Government Service
Business
Professional
Agriculturist
Retired
Housewife
Student Forex Dealer
Others .............................................................................................. (please specify)
GROSS ANNUAL INCOME [Please tick (3)]
FIRST APPLICANT
[Not older than 1 year]
D D M M Y Y Y Y
SECOND APPLICANT
THIRD APPLICANT
# (Type of Account : Saving / Current / NRE / NRO / FCNR / NRSR) *All purchases are subject to realization of funds ^Refer to Instruction No. 5 (vi)
Net worth (Mandatory for Non - Individuals) Rs. ______________________________________ as on
KYC DETAILS (Mandatory)
SECOND APPLICANT
Private Sector Service Public Sector Service
Government Service
Business
Professional
Agriculturist
Retired
Housewife
Student Forex Dealer
Others .............................................................................................. (please specify)
THIRD APPLICANT
Private Sector Service Public Sector Service
Government Service
Business
Professional
Agriculturist
Retired
Housewife
Student Forex Dealer
Others .............................................................................................. (please specify)
Below 1 Lac
1-5 Lacs 5-10 Lacs 10-25 Lacs
> 25 Lacs - 1 Crore
> 1 Crore OR Net Worth ______________________________________
OVERSEAS ADDRESS (Mandatory for NRI/FII Applicant.)
CITY
ZIP CODECOUNTRY
Drawn on Bank/Branch: ______________________________________________________________ A/c no._____________________________________ A/c Type: ______________
2.
ABSL
Drawn on Bank/Branch: ______________________________________________________________ A/c no._____________________________________ A/c Type: ______________
3.
ABSL
Drawn on Bank/Branch: ______________________________________________________________ A/c no._____________________________________ A/c Type: ______________
Mutual Fund India
Mutual Fund in India
Mutual Fund India
Mutual Fund India
Mutual Fund India
Mutual Fund India
I am
Politically
Exposed
Person
For Individuals
I am
Related to
Politically
Exposed
Person
Not
Applicable
For Non-Individual Investors (Companies, Trust, Partnership etc.)
Is the company a Listed Company or Subsidiary of Listed Company or Controlled by a Listed Company:
(If No, please attach mandatory UBO Declaration)
Yes No
Foreign Exchange / Money Charger Services
Yes No
Gaming / Gambling / Lottery / Casino Services
Yes No
Money Lending / Pawning
Yes No
5.
DEMAT ACCOUNT DETAILS (OPTIONAL) (Please ensure that the sequence of names as mentioned in the application form matches with that of the A/c. held with the depository participant.) Refer Instruction No. 3(B)
Depository Participant Name: _______________________________
Depository Participant Name: ______________________________________
Beneficiary A/c No.
DPID No.:
Beneficiary A/c No.
I N
NSDL:
CDSL:
Enclosed:
Client Master
Transaction/ Statement Copy/ DIS Copy
6.
NOMINATION DETAILS (Mandatory) (Refer Instruction No. 7)
I/We wish to nominate I/We DO NOT wish to nominate and sign here ................................................................................................. 1st Applicant Signature (Mandatory)
Nominee Name and Address
Guardian Name (in case of Minor)
Allocation %
Nominee/ Guardian Signature
Nominee 1
Nominee 2
Nominee 3
7.
FATCA & CRS INFORMATION [Please tick (3)] For Individuals & HUF (Mandatory) Non Individual investors should mandatorily fill separate FATCA detail form
The below information is required for all applicant(s)/ guardian
Address Type:
Is the applicant(s)/ guardian's Country of Birth / Citizenship / Nationality / Tax Residency other than India?
If Yes, please provide the following information [mandatory]
Please indicate all countries in which you are resident for tax purposes and the associated Tax Reference Numbers below.
Residential or Business Residential
Business Registered Office (for address mentioned in form/existing address appearing in Folio)
Yes No
Category
First Applicant (including Minor)
Second Applicant/ Guardian
Third Applicant
Name of Applicant
Place/ City of Birth
Country of Birth
Country of Tax Residency#
Tax Payer Ref. ID No^
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.
Sole/First Applicant
Second Applicant
Third Applicant
Applicant’s Relationship
with the Nominee
Mutual Fund India
Mutual Funds India
Mutual Fund India
Mutual Fund India
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