APPLICATION FORM (Please ll in BLOCK Letters)
Broker Name / ARN Sub Broker Code / ARN Employee Unique Identication Number Bank Serial No. / Branch Stamp / Receipt Date
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.
Declaration for “execution-only” transaction (only where EUIN box is
left blank) (Refer Instruction 28): I/We hereby conrm 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.
Signature of 1st Applicant / Guardian Signature of 2nd Applicant Signature of 3rd Applicant
TRANSACTION CHARGES FOR APPLICATIONS THROUGH DISTRIBUTORS / AGENTS ONLY (Refer Instruction 25)
I conrm that I am a First time investor across Mutual Funds.
(` 150 deductible as Transaction Charge and payable to the Distributor)
I conrm that I am an existing investor in Mutual Funds.
(` 100 deductible as Transaction Charge and payable to the Distributor)
In case the purchase / 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.
EXISTING UNIT HOLDER INFORMATION [Please ll in your Folio Number and proceed to Investment Details and Payment Details]
Folio No. Name of 1st Unit Holder
The details in our records under the folio number mentioned will apply for this application.
AADHAAR / PAN / PEKRN AND CKYC COMPLIANCE STATUS DETAILS - Mandatory [Refer Instruction Nos. 12 & 26]
PAN/PEKRN # (refer instruction) CKYC Compliance Status
**
(if yes, attach proof) KIN (CKYC Identication No.)
First / Sole Applicant
@
Yes
Second Applicant Yes
Third Applicant Yes
AADHAAR
Number
First / Sole Applicant
@
Second Applicant Third Applicant
@ If the rst/sole applicant is a Minor, then please provide details of Natural / Legal Guardian. **Refer instruction 12
APPLICANT(S) INFORMATION [Refer Instruction 1]
NAME OF FIRST / SOLE APPLICANT / MINOR (incase of minor their shall be no joint holder)
DATE OF BIRTH
(Mandatory in case of Minor)
D D / M M / Y Y Y Y
Mr. | Ms. | M/s.
Father / Husband's Name
Occupation Please ()
Private Sector Service
Public Sector
Government Service
Agriculturist
Professional
Business
Retired
Forex Dealer
Student
Housewife
Others
Please specify
Status Please()
Resident Individual
Minor thru Guardian
NRI - NRO Trust
Company/Body Corporate
HUF
Flls/FIPs
Bank / Fls
Partnership Firm
NRI-NRE
Society
OTHER DETAILS Please tick () Individual Non-Individual (Mandatory)
1. Gross Annual Income Details Please tick () Below 1 Lac 1 - 5 Lacs 5 - 10 Lacs 10 - 25 Lacs 25 Lacs - 1 Crore 1 Crore & above
[OR]
Net-worth in ` ________________________________________________________________________ as on (date)
D D / M M / Y Y Y Y
2. Please tick if applicable:
Politically Exposed Person (PEP) Related to a Politically Exposed Person (PEP) Not Applicable
3. Is the entity involved in / providing any or the following services
– Foreign Exchange / Money Changer Services
YES NO
– Gaming / Gambling / Lottery Services (e.g. casinos, betting syndicates) YES NO
– Money Lending / Pawning YES NO
4. Any other information ________________________________________________________________________________________________________________________________
I declare that the information is to the best of my knowledge and belief, accurate and complete. I agree to notify Canara Robeco Mutual Fund / Canara Robeco Asset Management company limited
immediately in case there is any change in the above information.
NAME OF SECOND APPLICANT
Mr. | Ms. | M/s.
Occupation Please ()
Private Sector Service
Public Sector
Government Service
Agriculturist
Professional
Business
Retired
Forex Dealer
Student
Housewife
Others
Please specify
Status Please()
Resident Individual
Minor thru Guardian
NRI - NRO Trust
Company/Body Corporate
HUF
Flls/FIPs
Bank / Fls
Partnership Firm
NRI-NRE
Society
OTHER DETAILS Please tick () Individual Non-Individual (Mandatory)
1. Gross Annual Income Details Please tick ()
Below 1 Lac 1 - 5 Lacs 5 - 10 Lacs 10 - 25 Lacs 25 Lacs - 1 Crore 1 Crore & above
[OR]
Net-worth in ` ________________________________________________________________________ as on (date)
D D / M M / Y Y Y Y
2. Please tick if applicable:
Politically Exposed Person (PEP) Related to a Politically Exposed Person (PEP) Not Applicable
3. Is the entity involved in / providing any or the following services
– Foreign Exchange / Money Changer Services
YES NO
– Gaming / Gambling / Lottery Services (e.g. casinos, betting syndicates)
YES NO
– Money Lending / Pawning
YES NO
4. Any other information ________________________________________________________________________________________________________________________________
I declare that the information is to the best of my knowledge and belief, accurate and complete. I agree to notify Canara Robeco Mutual Fund / Canara Robeco Asset Management company limited
immediately in case there is any change in the above information.
Canara Robeco Mutual Fund
Investment Manager : Canara Robeco Asset Management Co. Ltd. CIN No : U65990MH1993PLC071003
Construction House, 4th Floor, 5, Walchand Hirachand Marg, Ballard Estate, Mumbai 400 001.
Tel.: 6658 5000, Fax: 6658 5012 / 13, www.canararobeco.com Application No.
Qfund.in Mutual Fund India
Mutual Fund India
Mutual Fund India
Mutual Fund India
Mutual Fund India
Mutual Fund India
Mutual Fund India
Mutual Fund India
Mutual Fund India
Mutual Fund India
Mutual Fund India
NAME OF THIRD APPLICANT
Mr. | Ms. | M/s.
Occupation Please ()
Private Sector Service
Public Sector
Government Service
Agriculturist
Professional
Business
Retired
Forex Dealer
Student
Housewife
Others
Please specify
Status Please()
Resident Individual
Minor thru Guardian
NRI - NRO Trust
Company/Body Corporate
HUF
Flls/FIPs
Bank / Fls
Partnership Firm
NRI-NRE
Society
OTHER DETAILS Please tick () Individual Non-Individual (Mandatory)
1. Gross Annual Income Details Please tick () Below 1 Lac 1 - 5 Lacs 5 - 10 Lacs 10 - 25 Lacs 25 Lacs - 1 Crore 1 Crore & above
[OR]
Net-worth in ` ________________________________________________________________________ as on (date)
D D / M M / Y Y Y Y
2. Please tick if applicable:
Politically Exposed Person (PEP) Related to a Politically Exposed Person (PEP) Not Applicable
3. Is the entity involved in / providing any or the following services
– Foreign Exchange / Money Changer Services
YES NO
– Gaming / Gambling / Lottery Services (e.g. casinos, betting syndicates) YES NO
– Money Lending / Pawning
YES NO
4. Any other information ________________________________________________________________________________________________________________________________
I declare that the information is to the best of my knowledge and belief, accurate and complete. I agree to notify Canara Robeco Mutual Fund / Canara Robeco Asset Management company limited
immediately in case there is any change in the above information.
Relation with Minor Please ()
Mother
Father Legal Guardian
NAME OF THE GUARDIAN (In case of rst Applicant is a Minor)
Mr. | Ms. | M/s.
Proof of DOB ( Any one Mandatory)
Birth Certicates School Certicates / Mark Sheet Pass Port Others _____________________________
Occupation Please ()
Private Sector Service
Public Sector
Government Service
Agriculturist
Professional
Business
Retired
Forex Dealer
Student
Housewife
Others
Please specify
Status Please()
Resident Individual
Minor thru Guardian
NRI - NRO Trust
Company/Body Corporate
HUF
Flls/FIPs
Bank / Fls
Partnership Firm
NRI-NRE
Society
OTHER DETAILS Please tick () Individual Non-Individual (Mandatory)
1. Gross Annual Income Details Please tick ()
Below 1 Lac 1 - 5 Lacs 5 - 10 Lacs 10 - 25 Lacs 25 Lacs - 1 Crore 1 Crore & above
[OR]
Net-worth in ` ________________________________________________________________________ as on (date)
D D / M M / Y Y Y Y
2. Please tick if applicable:
Politically Exposed Person (PEP) Related to a Politically Exposed Person (PEP) Not Applicable
3. Is the entity involved in / providing any or the following services
– Foreign Exchange / Money Changer Services YES NO
– Gaming / Gambling / Lottery Services (e.g. casinos, betting syndicates)
YES NO
– Money Lending / Pawning YES NO
4. Any other information ________________________________________________________________________________________________________________________________
I declare that the information is to the best of my knowledge and belief, accurate and complete. I agree to notify Canara Robeco Mutual Fund / Canara Robeco Asset Management company limited
immediately in case there is any change in the above information.
Mode of Holding Please ()
Anyone or Survivor Joint (Default option is Anyone or Survivor)
POWER OF ATTORNEY (PoA) HOLDER DETAILS
Name of POA Mr. | Ms. | M/s.
PAN
KYC [Please () (Mandatory)] Proof Attached
Occupation Please ()
Private Sector Service
Public Sector
Government Service
Agriculturist
Professional
Business
Retired
Forex Dealer
Student
Housewife
Others
Please specify
Status Please()
Resident Individual
Minor thru Guardian
NRI - NRO Trust
Company/Body Corporate
HUF
Flls/FIPs
Bank / Fls
Partnership Firm
NRI-NRE
Society
OTHER DETAILS Please tick () Individual Non-Individual (Mandatory)
1. Gross Annual Income Details Please tick () Below 1 Lac 1 - 5 Lacs 5 - 10 Lacs 10 - 25 Lacs 25 Lacs - 1 Crore 1 Crore & above
[OR]
Net-worth in ` ________________________________________________________________________ as on (date)
D D / M M / Y Y Y Y
2. Please tick if applicable:
Politically Exposed Person (PEP) Related to a Politically Exposed Person (PEP) Not Applicable
3. Is the entity involved in / providing any or the following services
– Foreign Exchange / Money Changer Services
YES NO
– Gaming / Gambling / Lottery Services (e.g. casinos, betting syndicates) YES NO
– Money Lending / Pawning YES NO
4. Any other information ________________________________________________________________________________________________________________________________
I declare that the information is to the best of my knowledge and belief, accurate and complete. I agree to notify Canara Robeco Mutual Fund / Canara Robeco Asset Management company limited
immediately in case there is any change in the above information.
DEMAT ACCOUNT DETAILS (This section to be lled only if investor wish to hold units in demat form) (Client Master List (CML) to be enclosed) (Refer instructions No. 23)
National Securities Depository Limited (NSDL) Central Depository Services (India) Limited (CDSL)
Depository Participant Name Depository Participant Name
DP ID No. I N
Target ID No.
Mutual Fund India
Mutual Fund India
Mutual Fund India
Mutual Fund India
Mutual Fund India
Mutual Fund India
Mutual Fund India
Mutual Fund India
FATCA/CRS DETAILS For individuals & HUF (Mandatory) (Refer instruction no. 29)
The below information is required for all applicant(s) / guardian
Address Type: Residential Business Registered Oce (for address mentioned in form / existing address appearing in Folio)
Do you have non-Indian Country[ies] of Birth / Citizenship / Nationality and Tax Residency? Yes No Please tick as applicable and if yes, provide the below mentioned information (mandatory)
Sole / First Applicant / Guardian
Yes No Second Applicant Yes No Third Applicant Yes No or POA Yes No
Date of Birth Date of Birth Date of Birth
Place of Birth Place of Birth Place of Birth
Country of Birth Country of Birth Country of Birth
Country of Citizenship/
Nationality
Country of Citizenship/
Nationality
Country of Citizenship/
Nationality
Are you a US Specied Person?
Yes No
please provide Tax Payer Id
Are you a US Specied Person?
Yes No
please provide Tax Payer Id
Are you a US Specied Person?
Yes No
please provide Tax Payer Id
Country of Tax Residency
#
[other than India]
Taxpayer Identication No
Country of Tax Residency
#
[other than India]
Taxpayer Identication No
Country of Tax Residency
#
[other than India]
Taxpayer Identication No
1 1 1
2 2 2
# Please indicate all countries in which you are a resident for tax purpose and associated Taxpayer Identication number.
In case of applications with PoA, the PoA holder should ll separate form to provide the above details mandatorily.
MAILING ADDRESS [Please provide Full Address. P.O. Box No. may not be sucient. Overseas Investors will have to provide Indian Address]
Local Address of 1st Applicant
City State Pin Code
Tel Oce Residence Mobile
E-mail P L E A S E U S E B L O C K L E T T E R S
Overseas Correspondence address (Mandatory for NRI / FII Applicant)
City State Pin Code
COMMUNICATION (Please )
I/We wish to receive Account Statements/Annual Reports/Quarterly Statements/Newsletter/Updates or any other Statutory/Regulatory Information via Physical Mode.
BANK ACCOUNT DETAILS - Mandatory
Name of the Bank
Account No. A/c Type (please ) SAVINGS NRE CURRENT NRO FCNR
Branch Address
Bank Branch City State Pin Code MICR Code
(Please enter the 9 digit number that appears after your cheque number)
IFSC CODE (RTGS/NEFT) (Mandatory for Credit via NEFT/RTGS) Please attach a cancelled cheque OR a clear photo copy of a cheque
(11 Character code appearing on your cheque leaf. If you do not nd this on your cheque leaf, please check for the same with your Bank)
REDEMPTION / DIVIDEND REMITTANCE [Refer Instruction 20]
Electronic Payment
It is the responsibility of the Investor to ensure the correctness of the IFSC code/ MICR code for Electronic Payout at recipient/
destination branch corresponding to the Bank details.
Cheque Payment
If MICR and IFSC code for Redemption/Dividend Payout is available all payouts will be automatically processed as Electronic Payout-RTGS/NEFT/Direct Credit/NECS.
SIP ENROLLMENT DETAILS
SIP Amount
(Rs.)
Enrollment Period
REGULAR SIP : Start Month
M M - Y Y Y Y
End Month
M M - Y Y Y Y
Frequency Please ( )
Monthly Quarterly
PERPETUAL SIP : Start Month
Year
until further instruction (or) End on Month
1 2 Year 2 0 9 9
SIP Top Up : Rs. (in multiplies of Rs. 500/-) ________________________________________________________ Frequency Please ( )
Half Yearly Yearly
PAYMENT MECHANISM : Debit through ECS / Auto Debit facility (Fill up SIP Registration cum mandate form for NACH/ECS/Direct Debit)
ACKNOWLEDGMENT SLIP (TO BE FILLED IN BY THE SOLE/FIRST APPLICANT)
Canara Robeco Mutual Fund
Investment Manager : Canara Robeco Asset Management Co. Ltd. Application No.
Construction House, 4th Floor, 5, Walchand Hirachand Marg, Ballard Estate, Mumbai 400 001.
Received from Mr. / Ms. /M/s.
An application for purchase of________ units of ___________________________________
along with cheque / DD as detailed overleaf. Cheques / Drafts are subject to realisation.
Date _____/_____/___________
Stamp, Signature & Date
Mutual Fund India
Mutual Fund India
Mutual Fund India
Mutual Fund Mumbai
Mutual Fund India
Mutual Fund India
INVESTMENT DETAILS AND PAYMENT DETAILS (Payment through Cash/Outstation Cheques not accepted)
Separate cheque / demand draft must be issued for each investment, drawn in favour of respective scheme name. Please write appropriate scheme name as well as the Plan/Option/Sub Option.
Sr.
No.
Scheme Name Plan Option
Amount
Invested (`)
Cheque/DD No./UTR No.
(incase of NEFT/RTGS)
Bank and Branch and Account Number
1.
2.
3
# (Type of Account / Saving / Current / NRE / NRO / FCNR / NRSR) * All purchases are subject to realization of cheque/DD.
Details of Benecial Ownership (Please tick applicable category). Ownership details to be provided if the Ownership percentage/interest in the trust of any Beneciary is as per
the threshold limit provided below. Details to be provided for each such beneciary. (Mandatory for Non-Individual)
Category Unlisted company Partnership Firm Unincorporated Association/ Body of Individuals Trust Foreign Investor $$$
Ownership per cent @@@ >25% >15% >15% >=15%
@@@ Ownership percentage of shares/capital/prots/property of juridical person/interest in the Trust as on the date of the application shall be furnished by the investor.
$$$ In the case of Foreign investors, the benecial ownership will be determined as per SEBI guidelines. For details refer to SAI/relevant Addendum. In case of any change in the benecial ownership, the investor will be responsible to
intimate CRAMC / its Registrar / KRA as may be applicable immediately about such change.
Details of Benecial Ownership (Please attach a separate sheet with this format if the space provided is insucient)
Sr. Name Address Details of Identity such as
PAN / Passport
% of ownership
[Please attach self attested copy of PAN/Passport (proof of photo identity) along with application form]
NOMINATION DETAILS for Individuals [Minor / HUF / POA Holder / Non Individuals cannot Nominate – Refer Instruction No. 13]
I/We ___________________________________________________________________ do here by nominate the undermentioned Nominee(s) to receive the units to my / our credit in this folio no. in
the event of my / our death. I/We also understand that all payments and settlements made to such Nominee(s) and Signature of the Nominee(s) acknowledging receipt thereof, shall be a valid discharge by the
AMC / Mutual Fund / Trustees. I/We_____________________________________________________ do not wish to nominate
No. Nominee(s) Name Date of Birth (in case of Minor) Name of the Guardian
(in case of Minor)
Relationship with
Unit Holder
@
% of Share
1 D D - M M - Y Y Y Y
2 D D - M M - Y Y Y Y
3 D D - M M - Y Y Y Y
First / Sole Applicant / Guardian Second Applicant Third Applicant
@
If the percentage of share is not mentioned then the claim will be settled equally amongst all the indicated nominee(s)
DECLARATION
To the trustees Canara Robeco Mutual Fund. I / We have read and understood the contents of the SAI, SID and Key Information Memorandum of the Scheme. I/We hereby apply to the Trustees of Canara Robeco Mutual Fund
for allotment of units of the Scheme, as indicated above and agree to abide by the terms, conditions, rules and regulations of the Scheme. I/We hereby declare that I/ We are authorised to make this investment in the above
mentioned Scheme (s) and 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 any contravention or evasion of any Act, Rules, Regulations,
Notications or Directions of the provisions of Income Tax Act, Anti Money Laundering Act, Anti Corruption Act or any other applicable laws enacted by the government of India from time to time and we undertake to provide all
necessary proof / documentation, if any, required to substantiate the facts of this undertaking. I have not received nor been induced by any rebate or gifts, directly or indirectly in making this investment. I / We authorize the Fund
to disclose details of my/our account and all my/our transactions to the intermediately whose stamp appears on the application form. I also authorize the Fund to disclose details as necessary, to the Registrar & Transfer agent(s),
call centers, banks, custodians, depositories and/or authorised external third parties who are involved in transaction processing, despatches, etc. for the purpose of eecting payments to me/us. 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 dierent competing Schemes of various Mutual Funds from amongst which the Scheme is being recommended to me/us.
I/We hereby declare that currently there is no subsisting order/ruling/judgment etc., in force which has been passed by of any court, tribunal, statutory authority or regulator, including SEBI prohibiting or restraining me/us
from dealing in securities.
That in the event, the above information and/or any part of it is/are found to be false/untrue/misleading. I/We will be liable for the consequences arising therefrom. I/We will indemnify the fund, AMC, Trustee, RTA and other
intermediaries in case of any dispute regarding the eligibility, validity, and authorization of my/our transaction.
I / We hereby provide my / our consent in accordance with Aadhaar Act, 2016 and regulations made there under, 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 there under) 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 / our PAN.
Applicable to NRIs only : I/We conrm that I am/we are Non Resident of Indian Nationality/Origin and I/We hereby conrm that the funds for subscription have been remitted from abroad through approved banking channels
or from funds in my/our Non Resident External / Ordinary Account / FCNR / NRSR Account. Investment in the scheme is made by me / us on:
Repatriation basis Non Repatriation basis.
I / We have understood the information requirements of this Form (read along with the FATCA & CRS Instructions) and hereby conrm that the information provided by me/us on this Form is true, correct, and complete. I / We
also conrm that I / We have read and understood the FATCA & CRS Terms and Conditions below and hereby accept the same.
First / Sole Applicant / Guardian Second Applicant Third Applicant
To be furnished by partnership rms
To, The Trustees of Canara Robeco Mutual Fund, Sub : Our Subscription to the Schemes of
We, the undersigned, being the partner of M/s. ___________________________________________________ a Partnership rm formed under Indian Partnership Act, 1932 do hereby jointly and
severally authorise Mr. ____________________________________________________ to subscribe an amount of `_____________ for allotment of units of ____________________ Scheme on
behalf of and in the name of our rm. He is / They are also authorised to encash / disinvest the above units. We undertake to intimate you in writing about any change in the constitution or composition
of our rm and upon such change, also arrange to lodge the specimen signatures of the partners authorised to deal with the above units. We enclose the copy of the Partnership Deed alongwith this
application for subscription.
Name of the partners Signatures
________________________________________________________________ ________________________________________________________________
Sr.
No.
Scheme Name Plan Option
Amount
Invested (`)
Payment Details
Cheque/DD No./UTR No.
(incase of NEFT/RTGS)
Bank and Branch
1.
2.
3
M/s. Karvy Computershare Pvt. Limited “Karvy Plaza”
Karvy Selenium, Tower B, Plot No 31 & 32, Gachibowli, Financial District, Nanakramguda, Serilingampally, Hyderabad 500 032
Tel No. : 040 33215262/ 5269 E-mail : crmf@karvy.com
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