Sr. No. 2009/
ACKNOWLEDGEMENT SLIP
(To be filled in by the Applicant)
Received from Mr./Ms./M/s.
An application under
alongwith Cheque / DD No.* Dated
Drawn on (Bank)
for Rs. (in figures)
* Cheque and drafts are subject to realisation
Stamp of UTI AMC Office /
Authorised Collection Centre
If you wish to receive the following via e-mail Please (
) [Refer Instruction (k)]
Account Statement Annual Report Transaction Confirmation Communication of change of address, bank details etc.
(Application Form continued on the reverse)
Overseas Addresss (Overseas address is mandatory for NRI / FII applicants in addition to mailing address in India)
*City
State
*Country
ZIP/Pin*
PAYMENT DETAILS
Cheque / DD# No.
Amt. of investment (i)
Date DD Charges if any (ii)
Bank
Net amount paid (i-ii)
Branch
Amt. in words
Account type (please )
Savings Current NRE
NRO DD issued from abroad
Scheme Name
# Please mention the application No. on the reverse of the cheque / DD. Cheque / DD must be drawn in favour of “The Name of the Scheme” & crossed “A/c Payee Only”
* Denotes Mandatory Fields
OPTION FOR DESPATCH OF STATEMENT OF ACCOUNT
Applicant’s address / (for NRIs) At my Overseas address as mentioned above (for NRIs) To be despatched to my resident relative’s address in India as given above.
(PLEASE READ INSTRUCTIONS CAREFULLY TO HELP US SERVE YOU BETTER)
COMMON APPLICATION FORM FOR
INCOME SCHEMES
Sr. No. 2009/
Registrar Sr. No.
PLEASE USE SEPARATE FORM FOR EACH SCHEME
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.
DISTRIBUTOR INFORMATION
(only empanelled Distributors / Brokers will be permitted to distribute Units)
ARN Broker Name
Sub-Broker Code /
Bank Branch Code
M O Code UTI RM No.
CR / CA Code For Chief Representative
DD Amount
DD Charges
Total
DD No.: Dated: Drawn on:
APPLICANT’S PERSONAL DETAILS (PLEASE FILL IN BLOCK LETTERS) Mr. Ms. Mrs. M/s.
Name of First Applicant / Other Mentally Handicapped Persons (for UBF / MIS) and Adult Female Persons (For MUS)
Guardian Name (if Minor) / Contact Person and Designation - for institutional applicants) / Alternate applicant ( incase of UBF / MIS / MUS)
Have you invested in UTI MF earlier, Yes No
If yes, please provide:Scheme Name:
Folio No. (Optional)
F I R S T M I D D L E L A S T
Mr. Ms. Mrs.
*PAN OF 1st APPLICANT (whose particulars are furnished in the form)
Enclosed PAN Card Copy Please ( )
Know Your Customer (KYC)
KYC Mandatory for Investment of Rs.50,000 & above
Copy of KYC acknowledgement enclosed
Yes No
First Applicant’s Address (Do not repeat the name) Name & Address of resident relative in India (for NRIs) (P.O. Box No. is not sufficient)
Alternate e-mail
City* Pin*
(O)
Mobile
State
Street/Road/Area
Village/Flat/Bldg./Plot*
--
e-mail
S T D CO D E
S T D CO D E
Tel. No. (R)
Status
Resident Individual
Minor through guardian
HUF
Partnership
Trust
Company
Sole Proprietorship
Society
Body Corporate
AOP
BOI
FII
NRI
Others (specify) _________________________
Mode of Holding
Single
Anyone or Survivor
Joint
First holder or Survivor (for UTI MUS)
Occupation
Business
Student
Agriculture
Self employed
Professional
Housewife
Retired
Service
Others (specify) ________________________
Marital Status
Unmarried
Married
Wedding Anniversary
D D M M
Annual Income of First Individual Applicant < 5 Lacs > 5 Lacs - < 15 Lacs > 15 Lacs - < 25 Lacs > 25 Lacs
BANK PARTICULARS (Mandatory as per SEBI guidelines)]
Bank Name Branch
Address MICR Code
City *Pin
(this is a 9-digit number next to your cheque number)
Account type (please
) Savings Current NRO NRE
IFS Code
Account No.
d d m m y y y y
Date of Birth
F I R S T M I D D L E L A S T
DETAILS OF OTHER APPLICANTS
Name of 2nd Applicant Mr. Ms. Mrs. M/s.
d d m m y y y y
Date of Birth
F I R S T M I D D L E L A S T
Enclosed PAN Card Copy
Please (
)
Know Your Customer (KYC)
KYC Mandatory for Investment of Rs.50,000 & above
Copy of KYC acknowledgement enclosed
Yes No
*PAN OF 2nd Applicant
Name of 3rd Applicant Mr. Ms. Mrs. M/s.
d d m m y y y y
Date of Birth
F I R S T M I D D L E L A S T
Enclosed PAN Card Copy
Please (
)
Know Your Customer (KYC)
KYC Mandatory for Investment of Rs.50,000 & above
Copy of KYC acknowledgement enclosed
Yes No
*PAN of 3rd Applicant
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
INVESTMENT DETAILS (Please )
NOMINATION DETAILS
I / We hereby nominate the undermentioned Nominee to receive the amounts to my / our credit 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 a valid discharge by the AMC
/ Mutual Fund / Trustee.
Name and Address of Nominee To be furnished in case nominee is a minor
Name Date of Birth Name of the guardian
(in case of nominee is a minor)
Address of guardian
Address
Signature of Nominee / guardian
(for minor)
DECLARATION AND SIGNATURE OF APPLICANT/s
I / We have read and understood the contents of the Scheme Information Document and Key Information Memorandum, addenda issued till date and apply to the Trustee of
UTI Mutual Fund as indicated above. I / We agree to abide by the terms and conditions, rules and regulations of the scheme as on the date of investment. I / We undertake
to confirm that this investment has been duly authorised by appropriate authorities in terms of all relevant documents and procedural requirements.
I / We have not received nor been induced by any rebate or gifts, directly or indirectly in making investments.
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 different competing
Schemes of various Mutual Funds from amongst which the Scheme is being recommended to me/us.
* I / We confirm that we are Non-Residents or Indian Nationality / Origin and that the funds are remitted from abroad through approved banking channels or from my / our
NRE / NRO Account. I / We undertake to provide further details of source of funds and any such other relevant documents, if called for by UTI Mutual Fund.
* Applicable to NRIs
Signature of 1st Applicant / Guardian
Name of 1st Authorised Signatory
______________________________________
Designation ___________________________
Signature of 2nd Applicant
Name of 2nd Authorised Signatory
______________________________________
Designation ___________________________
Signature of 3rd Applicant
Name of 3rd Authorised Signatory
______________________________________
Designation ___________________________
Notes :
1. If the application is incomplete and any other requirement is not fulfilled, the application is liable to be rejected.
2. In case the applicant does not receive the Statement of Account within 30 days from the date of acceptance of the application, he/she may please write to the Registrar quoting serial number,
date of acknowledgement and the name of the accepting authority to the Registrar.
3. All communication relating to issue of Statement of Account, Change in name, Address or Bank particulars, Nomination, Redemption, Death Claims etc., may please be addressed to the
Registrar :
M/s. Karvy Computershare Private Limited, Narayani Mansion, H.No.1-90-2/10/E, Vittalrao Nagar, Madhapur, Hyderabad – 500 081. Tel. 040-23421944 to 47, Fax: 040-23115503,
E-mail: uti@karvy.com
UTI-G-Sec Fund
Investment Plan Short Term Plan
Dividend Option* Growth Option
(Default Plan / Option - Investment Plan & Growth Option)
UTI-Bond Fund
UTI-MIS UTI-Mahila Unit Scheme UTI-CRTS (Default Option - Growth Option)
Dividend Option* Growth Option $
$ I/We wish to opt for Systematic Withdrawal Plan under Growth Option of UTI-Bond Fund UTI-Monthly Income Scheme (MIS) UTI-CRTS as under :
Fixed Withdrawal Plan Monthly Payment : Rs. _______________________ Quarterly Payment : Rs. _______________________
Variable Withdrawal Plan (available under UTI-Bond Fund only)
UTI-Liquid Fund
Cash Plan (Regular) Dividend Monthly Growth
Cash Plan (Institutional) Dividend Option Daily Weekly Monthly* Growth Option
d d m m y y y y
UTI-GILT
Advantage
Fund-LTP
Growth Plan Dividend Plan* PF Plan Growth Option Dividend Option*
Prescribed Date Auto Redemption Option (PDAR) #
Prescribed Appreciation Auto Redemption Option (PAAR) # # both options available under PF Plan
Payout Reinvestment Principal Amount Whole Amount
In case of PDAR please specify a ‘Desired Maturity Date’
In case of PAAR please specify a ‘Desired Appreciation Rate’ _________________% (Default Plan - Growth Plan)
UTI-Treasury
Advantage Fund
Growth Daily Dividend Weekly Dividend* Monthly Dividend* Quarterly Dividend* Annual Dividend* Bonus (Default - Daily Div. Plan / Option)
Institutional Plan Growth Option Daily Dividend Weekly Dividend* Monthly Dividend Quarterly Dividend* Annual Dividend* Bonus Option
UTI-MIS-Advantage Plan
d d m m y y y y
Growth Plan Monthly Dividend Plan* Flexi Dividend Plan* Monthly Payment Plan (Default Option - Growth Option)
UTI-Money Market Fund
Regular Plan Institutional Plan (Default Option - Growth Option)
Daily Dividend Option Weekly Dividend Option* Growth Option
UTI-Fixed Maturity Plan (Use separate application form for each series)
Cheque / DD should be drawn in favour of UTI-Fixed Maturity Plan - YFMP (mm/yy) / HFMP (mm/yy) / QFMP (mm/yy-Plan No.)
Regular Plan Institutional Plan (Default Plan - Regular Plan)
Yearly Series (YFMP) Half Yearly Series (HFMP) Quarterly Series (QFMP) (Rs. 1 crore and above default is Institutional)
Growth Option Dividend Option (Default Option - Growth Option)
UTI-VIS-ILP
Growth Option Dividend Option* (Default Option - Growth Option)
* Please tick your option for Dividend Plan / Option / Sub-option
Dividend Payout Dividend Reinvestment
Investor opting for SIP, STRIP UTI - STRIP Advantage, SWP & Trigger Facility may fill in Separate Form/s presicribed for the same & attach with this application form.
UTI-Short Term
Income Fund
Regular Option Institutional Option
Dividend Monthly Dividend Sub Option* Growth Sub Option
(Default Plan - Cash Plan (Regular), Default Option - Dividend Option (Daily Reinvestment) under Cash Plan and Dividend Option (Reinvestment) under UTI-Short Term Income Fund)
[For Rs. 1 crore and above default is Cash Plan (Institutional)]
Investors who wish to nominate two or three persons may fill in the separate Form prescribed for the same and attach herewith.
UTI-Floating Rate Fund-STP
UTI-Floating
Rate Fund (STP)
Regular Plan Institutional Plan (Default Option - Growth Option)
Daily Dividend Option Weekly Dividend Option* Growth Option
Mutual fund India
Mutual fund Khar
Mutual fund
Mutual Fund India
Mutual fund India
Mutual fund India
Mutual fund India
