HDFC Mutual Fund Common SIP NACH Mandate Application Form
HDFC Mutual Fund Common SIP NACH Mandate Application Form
HDFC Mutual Fund Common SIP NACH Mandate Application Form
Investors must read the Key Information Memorandum, the instructions and Product Labeling on cover page before completing this Form.
The Application Form should be completed in English and in BLOCK LETTERS only.
KEY PARTNER / AGENT INFORMATION (Investors applying under Direct Plan must mention “Direct” in ARN column.) (Refer Instruction 1) FOR OFFICE USE ONLY
Internal Code Employee Unique
(TIME STAMP)
ARN/RIA Code ARN/RIA Name Sub Agent’s ARN Bank Branch Code for Sub-Agent/ Identification Number
Employee (EUIN)
ARN-35540 E048529
EUIN Declaration (only where EUIN box is left blank) (Refer Instruction 1)
I/We hereby confirm 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.
SIGN
3. UNIT HOLDER INFORMATION (Refer instruction 4) DATE OF BIRTH@ D D M M Y Y Y Y Proof of date of birth@ Please (P)
NAME OF FIRST / SOLE APPLICANT (In case of Minor, there shall be no joint holders) Ensure that name is as per Aadhaar Card Attached
Mr. Ms. M/s.
Nationality PAN#/ PEKRN#
KYC Number KYC # [Please tick (P )] (Mandatory) Proof Attached
Status of First/ Sole Applicant [Please tick (P
)] Individual Non - Individual [Please attach FATCA, CRS & Ultimate Beneficial Ownership (UBO) Self Certification Form and
Aadhaar Updation Form ] (Refer Instruction 4, 19 & 18 c) (Mandatory)
Resident Individual NRI-Repatriation NRI-Non Repatriation Partnership Trust HUF AOP PIO Company FIIs Minor through guardian BOI OCI
Body Corporate LLP Society / Club Foreign National Resident in India FPI Sole Proprietorship Non Profit Organisation Others _________________________
(please specify)
NAME OF GUARDIAN (in case of First / Sole Applicant is a Minor) / NAME OF CONTACT PERSON – DESIGNATION (in case of non-individual Investors)
Mr. Ms.
Nationality Designation Contact No.
PAN#/ PEKRN#
KYC Number KYC # [Please tick (P )] (Mandatory) Proof Attached
Relationship with Minor@ Please (P
) Father Mother Court appointed Legal Guardian Proof of relationship with minor@ Please (P) Attached @ Mandatory
MAILING ADDRESS OF FIRST / SOLE APPLICANT (Mandatory) (Refer Instruction 4a)
Guardian
Professional
Agriculturist Authorised Signatories
Promoters
October 2017
Retired
Housewife Partners
Student Karta
Proprietorship Whole-time Directors
Others (Please specify) Trustee
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
# Please attach Proof. Refer instruction No 16 for PAN/PEKRN and No 18a for KYC (KRA). Refer instruction No 18b for KYC Identification Number issued by CKYCR.
ACKNOWLEDGEMENT SLIP (To be flled in by the Investor) [For any queries please contact our nearest Investor Service Centre or call us at our Customer Service Number 1800 3010 6767 / 1800 419 7676 (Toll Free)]
HDFC MUTUAL FUND Date :
Head Office : HDFC House, 2nd Floor, H.T. Parekh Marg,
165-166, Backbay Reclamation, Churchgate, Mumbai - 400 020.
ISC Stamp & Signature
Received from Mr. / Ms. / M/s. ________________________________________________________________________________________________
an application for Purchase of Units of the Scheme(s) alongwith Cheque / DD / Payment Instrument as detailed overleaf.
DD MM YYYY
AADHAAR DETAILS (Ensure all details are as per Aadhaar Card) (for Individual including Sole Proprietor) Not mandatory for NRIs (Refer instruction 18c)
Particulars Aadhaar Number* Date of Birth PIN Code Mobile No. Enrolment
(Please enclose copy of front & back side) Proof#
1st Applicant D D M M Y Y Y Y
2nd Applicant D D M M Y Y Y Y
3rd Applicant D D M M Y Y Y Y
Guardian D D M M Y Y Y Y
POA D D M M Y Y Y Y
* All the applicants whose Aadhaar Number is mentioned are required to sign the form.
# If Aadhaar number is applied for, please enclose proof of enrolment.
6. FATCA AND CRS INFORMATION (for Individual including Sole Proprietor) (Self Certification) (Refer instruction 4)
The below information is required for all applicant(s)/ guardian
Address Type: Residential or Business Residential Business Registered Office (for address mentioned in form/existing address appearing in Folio)
Is the applicant(s)/ guardian's Country of Birth / Citizenship / Nationality / Tax Residency other than India? Yes No
If Yes, please provide the following information [mandatory]
Please indicate all countries in which you are resident for tax purposes and the associated Tax Reference Numbers below.
Category First Applicant (including Minor) Second Applicant/ Guardian Third Applicant
Place/ City of Birth
Country of Birth
Identification Type
[TIN or other, please specify]
Identification Type
[TIN or other, please specify]
Identification Type
[TIN or other, please specify]
#To also include USA, where the individual is a citizen/ green card holder of USA. ^In case Tax Identification Number is not available, kindly provide its functional equivalent.
7. POWER OF ATTORNEY (PoA) HOLDER DETAILS
Name of PoA Mr. Ms. M/s.
PAN#/ PEKRN#
KYC Number KYC # [Please tick (P
)] (Mandatory) Proof Attached
# Please attach Proof. Refer instruction No 16 for PAN/PEKRN and No 18a for KYC (KRA). Refer instruction No 18b for KYC Identification Number issued by CKYCR.
8. BANK ACCOUNT DETAILS OF THE FIRST / SOLE APPLICANT (For redemption/ dividend if any) (refer instruction 5)
(Mandatory to attach proof, in case the pay-out bank account is different from the bank account mentioned under Section 10 below.)
For unit holders opting to hold units in demat form, please ensure that the bank account linked with the demat account is mentioned here.
Bank Name
Mandatory
MICR Code (The 9 digit code appears on your cheque next to the cheque number)
Account Type (Please P
) Savings Current NRO NRE FCNR Others (please specify) _______________________
*** Refer Instruction 5C (Mandatory for Credit via NEFT / RTGS) (11 Character code appearing on your
IFSC Code*** cheque leaf. If you do not find this on your cheque leaf, please check for the same with your bank)
Particulars
Scheme Name / Plan / Option / Sub-option / Cheque / DD / Payment Instrument /
Drawn on (Name of Bank and Branch) Amount in figures (Rs.)
Payout Option UTR No. / Date
Please Note: All Purchases are subject to realisation of cheques / demand drafts / Payment Instrument.
9. MODE OF PAYMENT OF REDEMPTION / DIVIDEND PROCEEDS (refer instruction 11)
Unitholders will receive redemption/ dividend proceeds directly into their bank account (as furnished in Section 8) via Direct credit/ NEFT/ECS facility
I/We want to receive the redemption / dividend proceeds (if any) by way of a demand draft instead of direct credit / credit through NEFT system / credit through ECS into my / our bank account
11. UNIT HOLDING OPTION DEMAT MODE* PHYSICAL MODE (Default) ( refer instruction 13)
*Demat Account details are mandatory if the investor wishes to hold the units in Demat Mode
Beneficiary
NSDL DP Name DP ID I N Account No.
Beneficiary
CDSL DP Name Account No.
*Investor opting to hold units in demat form, may provide a copy of the DP statement enable us to match the demat details as stated in the application form.
12. NOMINATION (refer instruction 15) (Mandatory for new folios of Individuals where mode of holding is single) (For Units in Non-Demat Form)
[Please (P
) and sign] I/We do not wish to Nominate
Relationship Date of Birth Name and Address of Guardian Signature of Nominee Proportion (%) in which
Name and Address of Nominee(s) with (Optional)/ Guardian of the units will be shared by
Applicant Nominee (Mandatory) each Nominee
(to be furnished in case the Nominee is a minor) (should aggregate to 100%)
Nominee 1
Nominee 2
Nominee 3
October 2017
and in case of any dispute regarding the eligibility, validity and authorization of my/our transactions.
Second
(e) The ARN holder (AMFI registered Distributor) has disclosed to me/us all the commissions (in the form of trail
Applicant
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.
(f) I/WE HEREBY CONFIRM THAT I/WE HAVE NOT BEEN OFFERED/ COMMUNICATED ANY INDICATIVE PORTFOLIO SIGN
AND/ OR ANY INDICATIVE YIELD BY THE FUND/AMC/ITS DISTRIBUTOR FOR THIS INVESTMENT.
Consent for Telemarketing (Refer Instruction 20):
I/We hereby accord my/our consent to HDFC AMC for receiving the promotional information/ material via email, SMS,
telemarketing calls etc. on the mobile number and email provided by me/us in this Application Form.
Consent for authentication and sharing of Aadhaar data:
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 Third
fund and their Registrar and Transfer Agent (RTA) for the purpose of updating the same in my/our folios with my PAN. Applicant
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
SIGN
all consequences (including taxation) arising out of the failure to redeem on account of change in residential status.
For NRIs/ PIO/OCIs only:
I/We confirm that my application is in compliance with applicable Indian and foreign laws.
Please (P ) Yes No If Yes, (P
) Repatriation basis Non-repatriation basis
APPLICATION FORM FOR SIP
[For Investments through NACH/ ECS (Debit Clearing)/
Direct Debit Facility/ Standing Instruction]
Important: Please strike out the Section(s) that is/are not used by you to avoid any unauthorised use July 2017
ARN-35540 E048529
EUIN Declaration (only where EUIN box is left blank) (Refer Item No. 3a)
I/We hereby confirm 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.
NEW REGISTRATION CHANGE OTM DEBIT MANDATE (Refer Item No. 7(e)(iv)) CANCELLATION (Refer Item No. 11)
1) INVESTOR DETAILS
Application No. (For new investor)/ Folio No. (For existing Unitholder)
First/ Sole Applicant Details
Second Applicant
Third Applicant
Guardian/POA Holder
# Please attach Proof. If PAN/PEKRN/KYC is already validated please don’t attach any proof. PEKRN mandatory for Micro SIP. Refer Item No. 15 and 16.
NAME OF THE GUARDIAN (In case of minor) / CONTACT PERSON - DESIGNATION / PoA HOLDER (In case of Non-individual Investors)
Mr. Ms. M/s.
RELATIONSHIP WITH MINOR
I/WE WOULD LIKE TO INVEST TO MEET MY/OUR FINANCIAL GOALS (choose anyone (P
) (Refer Item No. 19)
Target Amount
*TOP-UP CAP amount: Please refer Instruction 7(c){ii}] # TOP-UP CAP Month-Year: Please refer Instruction 7(c){ii}]
Maximum amount of debit (SIP+Top-up) under direct debit facility for investors with bank accounts with State Bank of India shall not exceed Rs. 5,00,000/- per installment.
First SIP Transaction via Cheque No. Cheque Dated D D M M Y Y Y Y Amount@ (Rs.)
Mandatory Enclosure (if 1st Installment is not by cheque) Blank cancelled cheque Copy of cheque @The first cheque amount should be same
The name of the first/ sole applicant must be pre-printed on the cheque. as each/total SIP Amount.
3) BANK DETAILS
OTM Bank Details to be debited for the SIP (OTM already Registered)
Bank Name: Account Number:
NOTE: In case the OTM is not registered, please fill in the attached OTM Debit Mandate.
ARN-35540 E048529
4) UNIT HOLDING OPTION DEMAT MODE* PHYSICAL MODE (Default) (refer instruction 10)
*Demat Account details are mandatory if the investor wishes to hold the units in Demat Mode
Beneficiary
NSDL DP Name DP ID I N Account No.
Beneficiary
CDSL DP Name Account No.
*Investor opting to hold units in demat form, may provide a copy of the DP statement enable us to match the demat details as stated in the application form.
First/ Sole Unit holder/ Guardian/ POA Holder Second Unit holder Third Unit holder
Please note: Signature(s) should be as it appears on the Application Form and in the same order.
In case the mode of holding is joint, all Unit holders are required to sign.
% %
OTM Debit Mandate Form NACH/ECS/DIRECT DEBIT/SI Date D D M M Y Y Y Y
[Applicable for Lumpsum Additional Purchases as well as SIP Registrations]
to D D M M Y Y Y Y
or Until Cancelled 1. 2. 3.
Name as in Bank Records Name as in Bank Records Name as in Bank Records
This is to confirm that the declaration has been carefully read, understood & made by me/us. I am authorizing the User entity/ corporate to debit my account, based on the instructions as agreed and signed by me.
I have understood that I am authorized to cancel/ amend the mandate by appropriately communicating the cancellation/ amendment request to the User entity/ corporate or the bank where I have authorized the debit.
HDFC Mutual Fund - Key Information Memorandum Dated October 27, 2017 77