Acknowledgement Slip

Received from Mr./Ms./M/s. ______________________________________________________________________ PAN _________________________________ ` _________________________________

for purchase in _______________________________________________________________________________________________________________________Subject to verification and realisation.

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TATA MUTUAL FUND

Mafatlal Centre 9th Floor Nariman Point Mumbai - 400 021

Application Form For Tata Mutual Fund

ALL THE DETAILS REQUESTED IN THE FORM ARE MANDATORY FOR EACH OF THE APPLICANTS

1. Advisor / Distributor Information Refer Sec. B

ARN / RIA

Code Sub-Broker ARN Code Sub-Broker / Bank Branch Code EUIN Code

Internal Code

OR Declaration for “execution-only” transaction – 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.

In case the subscription 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. 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.

^ By mentioning RIA code, I / we authorize you to share with the SEBI Registered Investment Adviser (RIA) the details of my / our transactions in the schemes(s) of Tata Mutual Fund

Sole / 1

Applicant Signature /

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Applicant Signature /

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Applicant Signature /

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2. Applicant’s Information Refer Sec. A, C & F

The Name of the Applicants should be as mentioned in the PAN , Aadhaar and the KYC acknowledgement. There can be upto 3 holders. No joint holders allowed with 1

applicant as a minor. Any applicants should not be a resident of Canada or a person who falls within the definition of the term “U.S. Person” under the US Securities Act of 1933

and corporations or other entities organised under the laws of the U.S. For Investors New to Tata Mutual Fund, mention the C-KYC No. Incase C-KYC No. is not available kindly

complete the Know Your Client (KYC) form attached herewith.

Applicant’s Details

The first applicant

will be the primary

holder and all

correspondence will be

sent to him/her.

Only the first holder

can be a minor.

Existing Investors may

mention the Folio no.

and proceed to Sec. 4

> >

Mr. Ms. M/s.

PAN / PEKRN Folio No.

Name

Date of Birth (DOB)

DD/ MM/ YYYY

In case of Minor: Proof of DOB:

Birth certificate School leaving certificate

Passport Others ………….............

Aadhaar No.

C-KYC

Power Of Attorney (POA) / Proprietor / Guardian details (minor applicant)

POA / Proprietor /

Guardian Details

Mr. Ms.

PAN / PEKRN

Name

To be filled by

Guardian

> >

Relationship with the Minor Applicant

Mother Father Legal Guardian

Proof of Relationship

Birth certificate School leaving certificate Passport Others ……….............

Aadhaar No.

Date of Birth

DD/MM/YYYY

C-KYC

Tax Status

Resident Individual

NRI-Repatriation

NRI-Non-Repatriation

Minor - Resident Individual

Minor - NRI

Person of Indian Origin

Sole Proprietorship

Hindu Undivided Family

Partnership

Company

Trust

Others (please specify) ..

Body Corporate

Limited Liability Partnership

Body of Individuals

Society / Club

Non Profit Organization

..............................................

Overseas Citizen of India

Foreign National Resident in India

Qualified Foreign Investor

Foreign Portfolio Investor

Foreign Institutional Investor

3. Contact Details Refer Sec. D

Mailing address is

required for initial

communication. We

will overwrite this

address with the 1

Applicants address

as per the KRA

records

> >

City

PIN State Country

Residence Phone (prefix STD Code) Office Phone (prefix STD Code)

Extn

Mobile Email

Sr. No.:

QFund.in Mutual Fund India

Mutual fund India

Mutual fund in Bandra

Mutual fund Mumbai

Mutual fund Bandra

Mutual fund Mumbai

Overseas address

Mandatory for Non-

Resident Individuals

and Overseas

Investors in addition

to the mailing

address.

City

State ZIP Code Country

4. Investment Instrument Details Refer Sec. E

The name of the

first applicant

should be available

on the investment

Cheque.

Cheque/ DD to be

drawn in favour

of ‘Name of the

Scheme’

> >

Gross Amount (`) (A) DD Charges (`) (if any)

(B)

Net Amount (`) (Cheque / DD Amount)

(A - B)

Account Number A/c Type Dated

DD/ MM/ YYYY

Drawn on Bank Cheque / DD No.

Branch Branch City

5. Investment Scheme Details Refer Sec. F & Product Labels

Scheme Name

> >

Plan

(select any one)

> >

Regular Direct

Option

> >

Sub Option

> >

Div. Payout Option

(select any one)

> >

Dividend Reinvestment Dividend Payout

6. Bank Account Details Refer Sec. G

This must be an

Indian account. The

applicant should

be a holder in this

account.

The bank account details provided below will be held on record and considered as default bank mandate to pay redemption proceeds and dividend

payouts (if applicable).

Bank Name Branch

Account number

A/C type Savings Current NRO

NRNR NRE

MICR IFSC for RTGS IFSC for NEFT

Address

City PIN State

Cheque Details Acknowledgement Slip

Cheque/DD No. _______________________ dated ______________________ A/c. No. __________________________________ Bank ______________________________

Call 1800 209 0101 (On all days between 9 am and 9.30 pm)

Subject to realisation.

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Mutual fund India

mutual fund

Mutual fund mumbai

Mutual fund

Mutual fund India

7. Joint Applicant’s Details Refer Sec. E & F

Mode of Holding

Single

Joint Any one or Survivor (Default)

Applicant’s Details

Mr. Ms.

PAN / PEKRN Status

Resident Individual

NRI

Name

Aadhaar No.

Date of Birth

DD/MM/YYYY

C-KYC

III

Applicant’s Details

Mr. Ms.

PAN / PEKRN Status

Resident Individual

NRI

Name

Aadhaar No.

Date of Birth

DD/MM/YYYY

C-KYC

8. Know Your Customer (KYC) Details Refer Sec. G

CATEGORIES

FIRST APPLICANT (Including Minor) SECOND APPLICANT / GUARDIAN THIRD APPLICANT

Occupation

> >

Private Sector Service Retired

Public Sector Service Business

Government Sector Agriculturist

Professional Forex Dealer

Housewife Student

Others (please specify) .......................

Private Sector Service Retired

Public Sector Service Business

Government Sector Agriculturist

Professional Forex Dealer

Housewife Student

Others (please specify) ...........................

Private Sector Service Retired

Public Sector Service Business

Government Sector Agriculturist

Professional Forex Dealer

Housewife Student

Others (please specify)

........................

Gross Annual Income

> >

Below 1 Lac 1-5 Lacs

5-10 Lacs 10-25 Lacs

>25 Lacs-1 crore >1 crore

Networth in (Mandatory for Non-individual)

` ..................................................... as on

DD/ MM/ YYYY

(not older than 1 year)

Below 1 Lac 1-5 Lacs

5-10 Lacs 10-25 Lacs

>25 Lacs-1 crore >1 crore

Networth in

` ........................................................... as

DD/ MM/ YYYY

(not older than 1 year)

Below 1 Lac 1-5 Lacs

5-10 Lacs 10-25 Lacs

>25 Lacs-1 crore >1 crore

Networth in

` ................................................... as on

DD/ MM/ YYYY

(not older than 1 year)

Others

> >

Not Applicable

Politically Exposed Person

Related to Politically Exposed Person

Not Applicable

Politically Exposed Person

Related to Politically Exposed Person

Not Applicable

Politically Exposed Person

Related to Politically Exposed Person

Additional KYC Details for Non - Individuals

For Non Individuals

only

(Companies,

Trust, Partnership

etc.)

> >

Is the company a Listed Company or Subsidiary of Listed Company or Controlled by a Listed Company: Yes No

(if No, mandatory to attach the UBO declaration)

Non Individual investors involved/providing any of the mentioned services

Foreign Exchange / Money Changer Services Gaming / Gambling / Lottery / Casino Services

Money Lending / Pawning None of the above

9. Foreign Account Tax Compliance Act (FATCA) & CRS Details Refer Sec. H

For Individuals

FIRST APPLICANT (including Minor) SECOND APPLICANT / GUARDIAN THIRD APPLICANT

Country of Birth

> >

Place of Birth

> >

Nationality

> >

Indian U. S.

Others (Please specify) _________________

Indian U. S.

Others (Please specify) _________________

Indian U. S.

Others (Please specify) _________________

Type of address given at KRA

> >

Residential or Business Residential

Registered Office Business

Residential or Business Residential

Registered Office Business

Residential or Business Residential

Registered Office Business

Are you also a resident in

any other country(ies) for tax

purposes?

> >

No Yes No Yes No Yes

If yes, complete section below.

Country of Tax Residency 1

> >

Tax Identification Number 1

> >

Identification Type 1

> >

If TIN is not available please

tick the reason A, B or C *

> >

Reason A B C Reason A B C Reason A B C

Country of Tax Residency 2

> >

Tax Identification Number 2

> >

Identification Type 2

> >

If TIN is not available please

tick the reason A, B or C *

> >

Reason A B C Reason A B C Reason A B C

* Reason A: The country where the Account Holder is liable to pay tax does not issue Tax Identification Numbers to its residents; Reason B: No TIN required (Select this reason

only if the authorities of the respective country of tax residence do not require the TIN to be collected); Reason C: Others- Please state the reasons thereof

FATCA & CRS Related Details for Non Individuals: Please submit Form W8 BEN-E / Specified declaration (Enclosed)

Mutual fund india

Mutual fund India

Bandra

Mutual fund Mumbai

Mutual fund bandra

10. Nomination Details Refer Sec. L

Mandatory for

Individual(s) applying

singly or jointly.

Select any one

> >

You can nominate up to 3 persons to receive the Units allotted to you in your folio in the unfortunate event of death of all unit holders. 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.

Nominee Nominee Name Date of Birth

DD/ MM/ YYYY

Address

City

State

PIN Country

Guardian Name in case of Minor Nominee Allocation (%) Signature of Nominee / Guardian

Nominee Nominee Name Date of Birth

DD/ MM/ YYYY

Address

City

State

PIN Country

Guardian Name in case of Minor Nominee Allocation (%) Signature of Nominee / Guardian

Nominee Nominee Name Date of Birth

DD/ MM/ YYYY

Address

City

State

PIN Country

Guardian Name in case of Minor Nominee Allocation (%) Signature of Nominee / Guardian

Applicant Signature /

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Applicant Signature /

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Applicant Signature /

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11. Demat Account Details Refer Sec. M

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 the details are

found to be incorrect,

Units will be allotted in

physical mode.

Fill these details only if you wish to have your units in Demat mode.

Depository participant Name

Central Depository Securities Limited

Target ID No.

National Securities Depository Limited

DP ID No.

Beneficiary Account No.

12. Declaration and Signatures Refer Sec. N

I/We am/are not prohibited from accessing capital markets under any order/ruling/judgment etc., of any regulation, including SEBI. I/We confirm that my application is in compliance with applicable Indian and foreign laws. I / We hereby confirm and declare as under:-

(1) I / We have read, understood and hereby agree to comply with the terms and conditions of the scheme related documents and apply for allotment of Units of the Scheme(s) of Tata Mutual Fund (‘Fund’) indicated in this application form.

(2) I/We am/are eligible Investor(s) as per the scheme related documents and am/are authorised to make this investment. 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.

(3) The information given in / with this application form is true and correct and further agree to furnish such other further/additional information as may be required by the Tata Asset Management Limited (TAML)/ Fund and undertake to inform the AMC /

Fund/Registrars and Transfer Agent (RTA) in writing about any change in the information furnished from time to time.

(4) 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.

(5) 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 Mutual 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.

(6) 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 transactions.

(7) 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.

(8) 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.

(9) For Foreign Nationals Resident in India only: 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.

(10) For NRIs/ PIO/OCIs only: I/We confirm that my application is in compliance with applicable Indian and Foreign laws.

(11) I/We, the holder of the above stated Aadhaar number, hereby give my consent to Tata Mutual Fund(TMF), to obtain my Aadhaar number, Name and Fingerprint/Iris for authentication with UIDAI, use my mobile number mentioned in my account for sending

SMS alerts to me. 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.

Date: _____________________

Applicant Signature /

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Applicant Signature /

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Applicant Signature /

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