ACKNOWLEDGEMENT SLIP
(To be filled in by the Applicant)
Received from __________________________________________________________________________________________________________
Cheque / DD / RTGS / NEFT No. ___________________________________________________________ Dated: ______/______/______________
Drawn on Bank & Branch _________________________________________________________________________________________________
Scheme / Plan / Option / Sub-Option _____________________________________________________ Amount ` _________________________
Please Note : All purchases are subject to realisation of payment instrument
D D M M Y Y Y Y
Exchange Plaza, ‘B’ Wing, Ground Floor, NSE Building,
Bandra Kurla Complex, Bandra (East), Mumbai-400 051.
Toll Free - 1800 425 5600 • Fax: 022-6772 0512.
Website:
www.principalindia.com • E-mail: customer@principalindia.com
Application No.
TRANSACTION CHARGES FOR APPLICATIONS THROUGH DISTRIBUTORS/AGENTS ONLY [Refer Instruction No. B(14) for Details]
Investors are advised to confirm if he/she is a First Time Mutual Fund Investor by selecting [please one of the options:- First time Mutual Fund Investor Existing Investor]
Application No.
ARN No: Sub-Broker ARN: EUIN:
Signature, Stamp & Date
... continued overleaf
2 NEW APPLICANT'S DETAILS
(Please fill in Block Letters with black/blue ink, use one box for one alphabet leaving one box blank between two words)
Please read the instructions before filling the Application Form
DISTRIBUTOR INFORMATION & APPLICATION RECEIPT DATE
I/We hereby confirm that the EUIN box has been intentionally left blank by me/us as this is an "execution-only" transaction without
any interaction or advice by the employee/relationship manager/sales person of the above distributor or notwithstanding the advice
of in-appropriateness, if any, provided by the employee/relationship manager/sales person of the distributor and the distributor has
not charged any advisory fees on this transaction. (Refer Instruction No. G)
Upfront commission shall be paid directly by the investor to the AMFI registered Distributors based on the investor’s assessment of various factors
including the service rendered by the distributor.
Broker ARN Code
Sub-Broker ARN Code EUIN
Principal Group Employee CodeSub-Broker Code
Signature of Sole/ First Applicant/ Holder
Application Form
(Please read Product Labelling details and Instructions
before filling the Form)
All details are mandatory. The application is liable to get rejected if details not filled.
NAME OF FIRST / SOLE APPLICANT
Mr. Ms. M/s.
Enclose Proof of DOB (Mandatory for minor) - Birth Certificate Passport Other ______________
[Note: • No Joint holding permitted in case of minor applicant - Refer Instruction no. B(11). • Guardian: Mandatory for Minor Applicant. • POA Holder/Contact Person: Mandatory for Non-Individual Investors]
GUARDIAN / POA HOLDER / CONTACT PERSON
F I R S T N AME M I DD LE NAME LAS T NAME
F I R S T N AME M I DD LE NAME LAS T NAME
FATHER’S NAME
FATHER’S NAME
Gender - Male Female
NAME OF THE SECOND APPLICANT
Mr. Ms
F I R S T N AME M I DD LE NAME LAS T NAME
FATHER’S NAME
NAME OF THE THIRD APPLICANT
Mr. Ms
F I R S T N AME M I DD LE NAME LAS T NAME
FATHER’S NAME
PAN
Place / City of Birth /
Incorporation
Country of Birth /
Incorporation
Nationality
Date of Birth/Incorporation
DDMMYY YY
Gender - Male Female
Date of Birth
DDMMYY YY
Gender - Male Female
Date of Birth
DDMMYY YY
PAN
Place / City of Birth Country of Birth
Nationality
PAN
Place / City of Birth Country of Birth
Nationality
PAN
Place / City of Birth Country of Birth
Nationality
Relationship with Minor Applicant - Father Mother Legal Guardian
ADDRESS OF FIRST / SOLE APPLICANT [P.O. Box Address is not sufficient]
Zip Code
OVERSEAS ADDRESS
(in case the First Applicant is NRI/FII/PIO) [P.O. Box Address is not sufficient] {Refer Instruction No. B(5)}
Pin Code
Gender - Male Female
Date of Birth
DDMMYY YY
Dividend Sweep into Scheme
Plan
(In case of Dividend Sweep Facility,
please ensure to fulfill the minimum
investment criteria in the new Scheme)
Option
Scheme / Plan /
Option /
Sub-Option /
Frequency
Principal -
Scheme Name
Plan: Direct Plan
Regular Plan
Option:
Dividend Growth AEP Sub-Option: Payout Reinvest Sweep
Frequency:
Daily Weekly Monthly Quarterly Annual
3 INVESTMENT DETAILS (Cheque/DD should be in favour of “Scheme Name”)
Note: Please refer KIM of the schemes before selecting appropriate ‘Option’, ‘Sub-Option’ and ‘Frequency’ as availability/applicability of these options may differ for various schemes.
In case the choice of option is not indicated, default option shall be Growth Option. Under Dividend Option, the default sub-option shall be Dividend reinvestment option.
Where e-mail ID is provided all communications like Account Statement, Newsletter, Annual Report etc. will be done electronically. Physical, if required, will be mailed to your registered address on request.
CONTACT DETAILS OF FIRST / SOLE APPLICANT
(Please ensure that you fill in the contact details for us to serve you better)
Phone O R Fax
Mobile
I / We wish to receive updates via SMS on my mobile (Please )
e-mail
IN B LOCK L ETT ERS
1 EXISTING UNITHOLDERS DETAILS
(Please note that the applicant details and mode of holding will be as per the existing Folio Number) [Refer Instruction No. B(1)]
Please fill your Folio No. and Name and then proceed to Section (3)
Common Account / Folio No.
Name of Sole / First Unit Holder
Qfund.in Mutual fund India
Mutual fund India
Mutual fund India
Mutual fund India
Mutual fund India
Mutual fund India
Mutual fund India
CHECK LIST : Please ensure the following : • Application form is complete in all respects and signed by all Applicants • Bank Account details are filled • Copy of PAN card • Copy of Know Your Customer (KYC)
Acknowledgement letter issued KYC Registration Agency (KRA) / printout of KYC compliance status downloaded from website of KRA, as applicable • Appropriate options are filled • To prevent fraudulent practices investor
are urged to make the Payment Instruments favouring “Name of the Scheme A/c. First Investor Name” OR “Name of the Scheme A/c. Permanent Account Number” OR “Name of the Scheme A/c. Folio Number”
and the same should be crossed “Account Payee Only”. • If you are investing for the first time, please ensure that you fill in the contact details for us to serve you better.
For investment related enquiries, Investor Grievance please contact:
Principal Mutual Fund
Exchange Plaza, ‘B’ Wing, Ground Floor, NSE Building, Bandra Kurla Complex, Bandra (East), Mumbai - 400 051.
TOLL FREE: 1800 425 5600. • Fax: 022-6772 0512 • E-mail:
customer@principalindia.com • Website: www.principalindia.com
4 KYC / FATCA DETAILS FOR ALL APPLICANTS
(Mandatory, Please
. The application is liable to get rejected if details not filled)
Status details for First Applicant Second Applicant Third Applicant Guardian
Resident Individual
NRI / PIO
Sole Proprietorship –––
Minor through Guardian
#
–––
Non Individual
Company/Body
Corporate
Partnership
Trust
Society
–––
HUF
Bank
AOP
FI / FII / FPI
Others (Please specify) _____________ _____________ _____________ _____________
Gross Annual Income Range (in
``
``
`)
Occupation details for First Applicant Second Applicant Third Applicant Guardian
Below 1 lac
1 - 5 lac
5 - 10 lac
10 - 25 lac
25 lac- 1 crore
above 1 crore
OR Networth in `
(Mandatory for _____________ ____________ ____________ ____________
Non Individual) as on as on as on as on
(Not older than 1 year
Politically Exposed Person (PEP) Details: Is a PEP Related to PEP Not Applicable
First / Sole Applicant
Second Applicant
Third Applicant
Guardian
Authorised Signatories
Promoters
Partners
Karta
Whole-time Directors
“Address of tax residence would be taken as available in KRA database. In case of any change. Please
approach KRA & notify the changes.”
Type of Address given at KRA Residential Business Registered Office
First / Sole Applicant
Second Applicant
Third Applicant
Guardian
Occupation details for First Applicant Second Applicant Third Applicant Guardian
Private Sector
Public Sector
Government Service
Business
Professional
Agriculturist
Retired
Housewife
Student
Others (Please specify) _____________ _____________ _____________ _____________
5 MODE OF HOLDING (Please
)
Single Jointly Either / Anyone or Survivor (If no choice mode, default option : Jointly)
7 PAYMENT DETAILS (Mandatory) The name of the First/Sole Applicant must be preprinted on the cheque [Refer Instruction No. C]
(i) Investment Amount (`)
Mode of Payment (Please )
(ii) DD Charges (`)
Net Amount (`) (i)+(ii)
Cheque DD RTGS NEFT ECS Funds Transfer
Details of the Payer (In case, the First Unitholder is not one of the Bank A/c. holder as mentioned above)
Parent/Grand Parent/related person (Not to exceed ` 50,000):
Employer: Custodian:
Please enclose any one of the relevant documents as indicated below as per the Mode of Payment: RTGS / NEFT / ECS / Bank Transfer - Instruction to the Bank from the Unitholder to Debit the Account.
• DD / Pay order / Banker’s Cheque and the like -
Declaration / Acknowledgement from Bank Copy of Passbook / Bank Statement Bank confirmation of Non-Resident Account Type / FIRC
* Please mention the Application No., PAN and Name of the First Unitholder on the reverse of the Payment Instrument.
Mandatory Enclosure
KYC Acknowledgement Letter &
Third Party Declaration Form
Name
Name Name
Branch & City
Drawn on Bank
*Cheque / DD / RTGS / NEFT No.
Dated
DDMMYY YY
Payment from
Bank A/c. No.
6 BANK ACCOUNT DETAILS (Mandatory) [Refer Instruction No. C]
[* indicates - Mandatory]
Account No.
Bank Name
(Do not abbreviate)
Branch Address
MICR Code*
This is a 9 digit number next to your Cheque No.
Branch / City
(Please provide the full account number)
Pin Code
Essential Enclosures : (For Direct Credit):
Blank cancelled cheque Copy of cheque
Only for
RTGS*
IFSC*
Code
NEFT*
Code
Note: It is mandatory to enclose Proof of Bank (personalised cancelled cheque leaf) where the Payment Bank Account is different from the above mentioned Bank Account details.
Account Type (Please )
Savings Current NRE NRO FCNR NRSR
Mutual fund India
Mutual fund in India
Mutual fund Mumbai
Mutual fund Andheri
Mutual Fund Versova
10 PRIVACY POLICY CONFIRMATION [Refer instruction No. ‘H’]
I/We consent to and authorize the AMC to share all information (including without limitation personal information or sensitive personal data or information) provided by me/us for transacting in Principal Mutual
Fund with any of its Associates/Group Companies, for offering their services and products. I/We confirm that I/we have read and understood "Privacy Policy" of PMF/AMC hosted on www.principalindia.com and
hereby consent to and authorize AMC to collect personal information or sensitive personal data or information as defined in the "Privacy Policy" and to use all such information including without limitation personal
information /sensitive personal data or information provided by me/us for extending and offering services and support requested and to share with and disclose the same to PMF/AMC's Associates/Group
Companies (Affiliates), for offering their services and products. I/We also consent to disclose all such information including without limitation personal information /sensitive personal data or information provided
by me/us to non-affiliated third parties such as, but not limited to, attorneys, accountants, auditors and persons or entities that are assessing our compliance with industry standards.
[Applicants can make multiple nomination (to the maximum of three) by filing nomination form available at our Investor Service Centres / www.principalindia.com]
I/We do hereby nominate the undermentioned Nominee to receive the Units allotted to my/our credit in my/our folio 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 valid discharge by the AMC/Mutual Fund/ Trustees.
NOMINEE’S NAME
Mr. Ms
NAME OF PARENT / LEGAL GUARDIAN (in case of nominee being a minor)
Mr. Ms
ADDRESS OF NOMINEE / GUARDIAN (in case of nominee being a minor)
City Pin Code
Specimen Signature of Nominee / Guardian
OR
I/We do not wish to nominate a nominee in my / our folio.
Signature of 1st Unit Holder Signature of 2nd Unit Holder
Signature of 3rd Unit Holder
9 NOMINATION
(Please
and confirm the option selected) - Please Refer Instruction No. ‘E’
Date of Birth
(in case of nominee being a minor)
DDMMYY YY
8 DEMAT ACCOUNT DETAILS (OPTIONAL) [Refer instruction No. ‘B (13)’]
(Please ensure that the sequence of names as mentioned in the application form matches with that of the account held with the Depository Participant).
In case Unit holders do not provide their Demat Account details, Units will be allotted in physical form.
NSDL DP Name ___________________________________________ DP ID Beneficiary Account No.
CSDL DP Name ___________________________________________ Beneficiary Account No.
FATCA & CRS – TERMS & CONDITIONS
Details under FATCA & CRS: The Central Board of Direct Taxes has notified Rules 114F to 114H, as part of the Income-Tax Rules, 1962, which Rules require Indian financial institutions such as the
Bank to seek additional personal, tax and beneficial owner information and certain certifications and documentation from all our account holders. In relevant cases, information will have to be
reported to tax authorities/appointed agencies. Towards compliance, we may also be required to provide information to any institutions such as with holding agents for the purpose of ensuring
appropriate with holding from the account or any proceeds in relations thereto.
Should there by any change in any information provided by you, please ensure you advise us promptly, i.e., within 30 days.
Please note that you may receive more than one request for information if you have multiple relationships with (Insert FI’s name) or its group entities. Therefore, it is important that you respond to
our request, even if you believe you have already supplied any previously requested information.
Ultimate Beneficiary Owner (UBO) Details
(Refer Instruction No. F) (For Non-individual Only: UBO Declaration attached)
Applicant is the UBO(s) of this investment (Default) Applicant is NOT the UBO(s) of this investment
Non Individual Investors involved / providing any of the mentioned services
i. 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
ii. Foreign Exchange / Money Changer Services YES NO
iii. Gaming / Gambling / Lottery / Casino Services YES NO
iv. Money Lending / Pawning
YES NO
11 US / NON-US PERSON DECLARATION FOR INDIVIDUAL (FATCA)
#
I/We hereby declare and agree that I am/we are not a “U.S. person” for U.S. federal income tax purposes and that I am/we are not acting for, or on behalf of a U.S. person. I/We understand that Principal Pnb Asset
Management Company Pvt. Ltd., believing this statement to be true, will rely on it and act on it. In the event this statement is false, Principal Pnb Asset Management Company Pvt. Ltd. reserves the right and shall
be entitled to reject the application or terminate the folio.
I/We agree to notify Principal Pnb Asset Management Company Pvt. Ltd. within 30 days of any change in my/our status as a U.S. person for the purposes of U.S. federal income tax. I/We agree to indemnify Principal
Pnb Asset Management Company Pvt. Ltd. in respect of any false, misleading, inaccurate and incomplete information regarding my/our “U.S. person” status for U.S. federal income tax purposes.
I am a US Person I am not a US Person
The below information is required for all applicant(s)/Guardian:
12 FATCA INFORMATION / FOREIGN TAX LAWS [Refer instruction No. ‘I’]
Category First Applicant Second Applicant/Guardian Third Applicant
Are you a tax resident of any country other than India? Yes No Yes No Yes No
If yes, Please indicate all countries in which you are resident for tax purpose and the associated Tax Reference Numbers below:
Country
#
Tax Identification Number
##
Identification Type (TIN or Other, please specify)
#
To also include USA, where the individual is a citizen / green card holder of The USA
##
In case Tax Identification Number is not available, kindly provide its functional equivalent.
$
In case TIN or its functional equivalent is not available, please provide Company Identification Number or Global Entity Identification Number or GIN, etc.
Non individuals: Please fill FATCA & CRS Declaration also
In case the entities country of Incorporation / Tax residence is U.S. but Entity is not a Specified U.S. Person, mention Entitys exemption code here:
Mutual Funds Nariman point
Mutual funds Worli
Mutual Fund
Mutual fund India
Mutual fund
Mutual fund India
Mutual fund India
III. INDIVIDUAL / NON-INDIVIDUAL DECLARATION:
I/We have read and understood the contents of the Scheme Information Document/s to the Scheme(s) including the sections on “Prevention of Money Laundering and Know Your Customers”. I / We hereby apply to the Trustees
of the Principal Mutual Fund (the Mutual Fund) for units of the Scheme as indicated above [“the Scheme”] and agree to abide by the terms and conditions, of the Scheme and such other scheme(s) of the Mutual Fund [Scheme(s)]
into which my/our investment may be moved pursuant to any instruction received from me/us to sweep/switch the units as applicable to my / our investment including any further transaction under the Scheme(s). I / We have not
received nor have been induced by any rebate or gifts, directly or indirectly, in making this investment. I/We further declare that the amount invested by me/us in the Scheme(s) is derived through legitimate sources and is not held
or designed for the purpose of contravention of any act, rules, and regulations or any statute or legislation or any other applicable laws or any notifications, directions issued by any governmental or statutory authority from time
to time. I/We further confirm that I/we have the express authority from the relevant constitution to invest in the units of the Scheme and the Principal Pnb Asset Management Company Pvt. Ltd. [AMC], its Trustee and the Mutual
Fund would not be responsible if the investment is ultra vires the relevant constitution. I/We further confirm that the ARN holder (Broker/Sub-Broker) 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(s) has been recommended to me/us. I / We authorize AMC to reject the application, reverse the
units credited, restrain me/us from making any further investment in any of the Scheme/s of Principal Mutual Fund, recover / debit my/our folio(s) with the penal interest and take any appropriate action against me/us in case the
cheque(s) / payment instrument is /are returned unpaid by my/our bank for any reason whatsoever. I/We hereby further agree that AMC can directly credit all the dividend payouts and redemption amount to my / our bank account,
where AMC has such arrangement with my / our Bank. I/We hereby agree for the AMC/Trustees to compulsorily redeem any Units held directly or beneficially by me/us if I/we fail to provide the information called for by the AMC
/ Principal Mutual Fund or if the units are found to be held in contravention of any regulatory requirements / prohibitions issued from time to time.
Applicable to NRIs only: I / We confirm that I am / we are Non- Residents of Indian Nationality / Origin and I / We hereby confirm that the funds for subscription have been remitted from abroad through approved banking
channels or from funds in my/our Non-Residents External / Ordinary Account /FCNR Account.
13 FATCA & CRS DECLARATION AND CERTIFICATION (Please consult your professional tax advisor for further guidance on FATCA & CRS classification)
PART A (to be filled by Financial Institutions or Direct Reporting NFEs)
1. We are a, Financial institution
6
or
Direct reporting NFE
7
(please tick as appropriate)
GIIN
Note: If you do not have a GIIN but you are sponsored by another entity, please provide your sponsor's GIIN above and indicate your
sponsor's name below:
Name of sponsoring entity
GIIN not available (please tick as applicable) Applied for
If the entity is a financial institution, Not required to apply for - please specify 2 digits sub-category
10
Not obtained – Non-participating FI
PART B (Please fill any one as appropriate “to be filled by NFEs other than Direct Reporting NFEs”)
1. Is the Entity a publicly traded company
1
(that is, a company whose shares are regularly traded on an established securities market)
Yes
(If yes, please specify any one stock exchange on which the stock is regularly traded)
Name of stock exchange _______________________________________________________________________
2. Is the Entity a related entity
2
of a publicly traded company
(a company whose shares are regularly traded on an established securities market)
Yes
(If yes, please specify name of the listed company and one stock exchange on which the stock is regularly traded)
Name of listed company ________________________________________________________________________
Nature of relation:
Subsidiary of the Listed Company or Controlled by a Listed Company
Name of stock exchange ________________________________________________________________________
3. Is the Entity an active
3
NFE
Yes
(If yes, please fill UBO declaration in the next section.)
Nature of Business ______________________________________________________________________________
Please specify the sub-category of Active NFE (Mention code - refer 2c of Part D)
4. Is the Entity a passive
4
NFE
Yes
(If yes, please ?ll UBO declaration in the next section.)
Nature of Business ______________________________________________________________________________
1
Refer 2a of Part D |
2
Refer 2b of Part D |
3
Refer 2c of Part D |
4
Refer 3(ii) of Part D |
6
Refer 1 of Part D |
Refer 3(vii) of Part D |
10
Refer 1A of Part D
I. FOR NON-INDIVIDUAL / ENTITY:
II. ALL APPLICANTS:
I / We have understood the information requirements of this Form (read along with the FATCA & CRS Instructions) and hereby confirm that the information provided by me/us on this Form is true, correct, and
complete. I / We also confirm that I / We have read and understood the FATCA & CRS Terms and Conditions below and hereby accept the same.
Signature of
1st Applicant /
POA Holder / Guardian
APPLICANT SIGNATURE POA HOLDER SIGNATURE
Enclosed (please ) PAN KYC
Attach copy of PAN & KYC^)
POA Details - Enclosed Notarised Power of Attorney
Name
Signature of
2nd Applicant /
POA Holder
APPLICANT SIGNATURE POA HOLDER SIGNATURE
Enclosed (please ) PAN KYC
Attach copy of PAN & KYC^)
POA Details - Enclosed Notarised Power of Attorney
Name
PAN
Signature of
3rd Applicant /
POA Holder
APPLICANT SIGNATURE POA HOLDER SIGNATURE
Enclosed (please ) PAN KYC
Attach copy of PAN & KYC^)
POA Details - Enclosed Notarised Power of Attorney
Name
PAN
^ Refer Instruction No. D
IV. SIGNATURE:
PAN
14 CHECKLIST
Please ensure that:
All relevant particulars are filled in / ticked in the form
PAN details are furnished [Refer Instruction No. D]
KYC acknowledgement letter is enclosed [Refer Instruction No. D].
Your investment is not less than the minimum investment amount.
Your application is completed and signed by all applicants.
To prevent fraudulent practices, Investors are urged to make the payment instruments (cheque / Demand draft / Pay Order etc.) favouring "Name of the Scheme A/c. First Investor
Name" OR "Name of the Scheme A/c. Permanent Account Number" OR "Name of the Scheme A/c. Folio Number".
On the reverse of the payment instrument submitted please mention the Application Number, PAN and Name of the First Applicant.
Mutual fund India
Mutual fund Indiia
Mutual fund India
Mutual fund India
Mutual fund Bandra