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 Benecial Ownership (Please tick applicable category). Ownership details to be provided if the Ownership percentage/interest in the trust of any Beneciary is as per
the threshold limit provided below. Details to be provided for each such beneciary. (Mandatory for Non-Individual)
Category Unlisted company Partnership Firm Unincorporated Association/ Body of Individuals Trust Foreign Investor $$$
Ownership per cent @@@ >25% >15% >15% >=15%
@@@ Ownership percentage of shares/capital/prots/property of juridical person/interest in the Trust as on the date of the application shall be furnished by the investor.
$$$ In the case of Foreign investors, the benecial ownership will be determined as per SEBI guidelines. For details refer to SAI/relevant Addendum. In case of any change in the benecial ownership, the investor will be responsible to
intimate CRAMC / its Registrar / KRA as may be applicable immediately about such change.
Details of Benecial Ownership (Please attach a separate sheet with this format if the space provided is insucient)
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,
Notications 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 eecting 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 dierent 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 conrm that I am/we are Non Resident of Indian Nationality/Origin and I/We hereby conrm 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 conrm that the information provided by me/us on this Form is true, correct, and complete. I / We
also conrm 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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