COMMON APPLICATION FORM
(PLEASE READ THE INSTRUCTIONS BEFORE FILLING UP THE FORM. ALL SECTIONS TO BE COMPLETED IN ENGLISH IN BLACK/BLUE COLOURED
INK AND IN BLOCK LETTERS)
Distributor Sub-Distributor Internal Sub-Broker/ Application No.
ARN ARN Sol ID
EUIN Employee RIA CODE^
Code
PMR (Portfolio Manager's Registration) Number ^^ Serial No., Date & Time Stamp
Upfront commission shall be paid directly by the investor to the AMFI registered distributor based on the investor's assessment of various factors including the service rendered by the distributor.
^I/We, have invested in the scheme(s) of Axis Mutual Fund under Direct Plan. I/We hereby give my/our consent to share/provide the transactions data feed/portfolio holdings/ NAV etc. in
respect of my/our investments under Direct Plan of all schemes of Axis Mutual Fund, to the above mentioned SEBI Registered Investment Adviser. ^^I/We, have invested in the scheme(s) of
Axis Mutual Fund under Direct Plan. I/We hereby give my/our consent to share/provide the transactions data feed/portfolio holdings/ NAV etc. in respect of my/our investments under
Direct Plan of all schemes of Axis Mutual Fund, to the above mentioned SEBI Registered Portfolio Manager.
“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.”
You/ Sole Applicant /Guardian Second Applicant Third Applicant Power of Attorney Holder
TRANSACTION CHARGES FOR APPLICATIONS THROUGH DISTRIBUTORS ONLY (Refer Instruction No. 20)
I confirm that I am a first time investor across Mutual Funds. OR I confirm that I am an existing investor across Mutual Funds.
In case the subscription amount is ` 10,000 or more and your Distributor has opted to receive Transaction Charges, the same are deductible as applicable from the
purchase/subscription amount and payable to the Distributor. Units will be issued against the balance amount invested.
EXISTING INVESTOR’S FOLIO NUMBER (If you have an existing MODE OF HOLDING (in case of Demat Purchase Unit Holding Option
folio with KYC validated, please mention here and skip to section 4) Mode of Holding should be same as in Demat Account)
Folio number Single Joint (Default) Physical Mode Demat Mode
Anyone or Survivor (in case of Demat, please fill sec 6)
I/ We want to create new Folio (Instruction No. 26)
1. YOUR PERSONAL DETAILS (MANDATORY) (In case of investment "On behalf of minor", Please refer instruction No. 11)
First Applicant Mr. Ms. M/s. FIRST APPLICANT Gender M F O
PAN
(Mandatory)
DOB D D M M Y Y Y Y CKYC No. 14 digit CKYC Number
(Optional)
Address
City State Pincode
Mobile Email ID*
Occupation Pvt. Sector Service Public Sector Service Govt. Service Business Professional Agriculturist
Details Retired Housewife Forex Dealer Student Others Specify
Gross Annual Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs 25 Lacs - 1 Crore > 1 Crore
Income (`) Net worth (Mandatory for Non - Individuals) ` D D M M Y Y Y Y
as on
Email ID provided pertains to Self Family Member (Note: If Email pertains to Family Spouse Dependent Parents Dependent Children
Member please select any one)
I / we hereby prefer to ‘OPT-IN’ to receive physical copies of scheme Annual Report or Abridged summary. (Refer Instruction No. 25)
BANK ACCOUNT DETAILS FOR PAYOUT (Please note that as per SEBI Regulations it is mandatory for investors to provide their bank account details. Refer Instruction No. 6)
Name of the bank
Branch Address
City State Pincode
Account No.
Account type Savings Current NRE NRO FCNR Others Specify
IFSC Code (11 digit) MICR Code (9 digit)
Note: Legal Entity Identifier Number is Mandatory
LEI Code Valid up to D D M M Y Y Y Y for Transaction value of INR 50 crore and above for
Non-Individual investors. refer Instruction No. 27.
Second Applicant Mr. Ms. M/s. SECOND APPLICANT Gender M F O
PAN
(Mandatory)
DOB D D M M Y Y Y Y CKYC No. 14 digit CKYC Number
(Optional)
Address
City State Pincode
Pvt. Sector Service Public Sector Service Govt. Service Business Professional Agriculturist
Occupation Details
Retired Housewife Forex Dealer Student Others Specify
Gross Annual
Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs 25 Lacs - 1 Crore > 1 Crore
Income (`)
Third Applicant Mr. Ms. M/s. THIRD APPLICANT Gender M F O
PAN
(Mandatory)
DOB D D M M Y Y Y Y CKYC No. 14 digit CKYC Number
(Optional)
Address
City State Pincode
Pvt. Sector Service Public Sector Service Govt. Service Business Professional Agriculturist
Occupation Details
Retired Housewife Forex Dealer Student Others Specify
Gross Annual
Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs 25 Lacs - 1 Crore > 1 Crore
Income (`)
GUARDIAN DETAILS (In case First / Sole Applicant is minor) / CONTACT PERSON - DESIGNATION / PoA HOLDER (In case of Non-individual Investors)
Mr. Ms. M/s. GUARDIAN Gender M F O
PAN
(Mandatory)
DOB D D M M Y Y Y Y CKYC No. 14 digit CKYC Number
(Optional)
Address
City State Pincode
Pvt. Sector Service Public Sector Govt. Service Business Professional Agriculture
Occupation Details
Retired Housewife Forex Dealer Student Others Specify
Gross Annual
Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs 25 Lacs - 1 Crore > 1 Crore
Income (`)
Relationship Of Guardian (Refer Instruction No. 11) Mother Father Court Appointed Guardian
Email ID
Proof of the Relationship with Minor Birth Certificate School Certificate Passport Others Specify
TAX STATUS (Applicable for First / Sole Applicant) Resident Individual FIIs NRI-NRO HUF Club / Society PIO Body Corporate
Minor Government Body Trust NRI - NRE Bank & FI Sole Proprietor Partnership Firm QFI Provident Fund
Others Specify
For Individuals For Non-Individual Investors (Companies, Trust, Partnership etc.)
I am a Politically Exposed Person Is the company a Listed Company or Subsidiary of Listed Company or Controlled by a Yes No
Listed Company: (If No, please attach mandatory UBO Declaration)
Foreign Exchange / Money Charger Services Yes No
I am related to a Politically Exposed Person
Gaming / Gambling / Lottery / Casino Services Yes No
I am not related to Politically Exposed Person Money Lending / Pawning Yes No
2. FATCA AND CRS DETAILS FOR INDIVIDUALS (Including Sole Proprietor. Refer Instruction No. 23)
T
N
DE
SI S
RE IAN
R D
The below information is required for all applicants/guardian.
FO IN
Place / City of Birth Country of Birth Country of Citizenship / Nationality
First Applicant / Guardian Indian U.S. Others
Second Applicant Indian U.S. Others
Third Applicant Indian U.S. Others
NT Are you a tax resident (i.e., are you assessed for tax) in any other country outside India?
DE
SI
RE S If ‘YES’ please fill for ALL countries (other than India) in which you are a Resident for tax purpose Yes No
N- IAN
NOND
FOR I i.e. where you are a Citizen / Resident / Green Card Holder / Tax Resident in the respective countries.
Country of Tax Identification Number or Identification Type
Address Type
Tax Residency Functional Equivalent (TIN or other please specify)
First Applicant / Guardian Resi Regd. Office Business
Second Applicant Resi Regd. Office Business
Third Applicant Resi Regd. Office Business
Overseas Address
City
State Country Zipcode
For Non Individual investors Annexure I and Annexure II are available on the website of AMC i.e. www.axismf.com or at the Investor Service
Centres (ISCs) of Axis Mutual Fund.
3. NOMINATION DETAILS (Mandatory) (Refer Instruction No. 18)
Sr. Allocation Relationship Nominee date Guardian Guardian
Nominee Name PAN with Name
No. (%) of birth (in case of Minor) Signature
Investor
1 D D M M Y Y
2 D D M M Y Y
3 D D M M Y Y
I/We DO NOT wish to nominate and sign here You/ Sole Applicant Second Applicant Third Applicant
4. INVESTMENT DETAILS (For multiple schemes ref instruction no. 22) (Investors applying under Direct Plan must select "DIRECT" against scheme name, Refer Instruction No. 2.)
Option
Sr. No. Scheme Name Plan [Growth/*IDCW (Dividend) Amount
Option]
1 Regular Direct
2 Regular Direct
3 Regular Direct
*The dividend amounts can be distributed out of investors capital (Equalization Reserve), which is part of sale price that represents realized gains.
5. PAYMENT DETAILS
Non-Third Party Payment Third Party Payment (Please attach 'Third Party Payment Declaration Form')
Mode Cheque DD Axis Bank Debit Mandate Date D D M M Y Y Y Y Cheque / DD No.
(Please fill section 9.)
Amount (in words)
(in figures)
Pay-in A/c No.
Account type Savings Current NRE NRO FCNR Others Specify
IFSC code (11 digit) MICR Code (9 digit)
Drawn on bank / branch name & address
6. DEMAT ACCOUNT DETAILS (OPTIONAL)
(Please ensure that the sequence of names as mentioned in the application form matches with that of the A/c held with the depository participant) Refer Instruction No. 19.
Depository Participant Name DP ID: I N
NSDL:
Beneficiary A/c No.
Depository Participant Name
CDSL:
Beneficiary A/c No.
Enclosed Client Master Transaction / Statement Copy / DIS Copy
7. DECLARATION AND SIGNATURE
Having read and understood the content of the SID / KIM of the scheme and SAI of the Axis Mutual Fund (The Fund), I/we hereby apply for units of the scheme. I have read and
understood the terms, conditions, details, rules and regulations governing the scheme. I/We hereby declare that the amount invested in the scheme is through legitimate
source only and does not involve designed for the purpose of the contravention of any Act, Rules, Regulations, Notifications or Directives of the provisions of the Income Tax
Act, Anti Money Laundering Laws, Anti Corruption Laws or any other applicable laws enacted by the Government of India from time to time. I/we have not received nor have
been induced by any rebate or gifts, directly or indirectly in making this investment. I/We confirm that the funds invested in the Scheme, legally belongs to me/us. In event
“Know Your Customer” process is not completed by me/us to the satisfaction of the Mutual Fund, (I/we hereby authorize the Mutual Fund, to redeem the funds invested in the
Scheme, in favour of the applicant, at the applicable NAV prevailing on the date of such redemption and undertake such other action with such funds that may be required by
the law.) The ARN holder has disclosed to me/us all the commissions (trail commission or any other mode), payable to him for the different competing Schemes of various
Mutual Funds amongst which the Scheme is being recommended to me/ us. I / we give my / our consent to collect personal data or information as prescribed in the privacy
policy which is available on the website of the AMC / Fund. I/We hereby give consent to the Company or its Authorized Agents and third party service providers to use
information/data provided by me to contact me through any channel of communication including but not limited to email, telephone, sms, etc. and further authorise the
disclosure of the information contained herein to its affiliates/group companies or their Authorized Agents or Third Party Service Providers in order to provide information and
updates to me on various financial and investment products and offering of other services. I/We agree that all personal or transactional related information
collected/provided by me can be shared/transferred and disclosed with the above mentioned parties including with any regulatory, statutory or judicial authorities for
compliance with any law or regulation in accordance with privacy policy as available at the website of the Company.
I/We confirm that I/We do not have any existing Micro SIP/Lumpsum investments which together with the current application will result in aggregate investments exceeding
` 50,000 in a year (Applicable for Micro investment only.) with your fund house. For NRIs only - I / We confirm that I am/ we are Non Residents of Indian nationality/origin and
that I/We have remitted funds from abroad through approved banking channels or from funds in my/ our Non Resident External / Non Resident Ordinary / FCNR account.
I/We confirm that details provided by me/us are true and correct.
I/ We give my consent to Axis Asset Management Company Limited and its agents to contact me over phone, SMS, email or any other mode to address my investment related
queries and/or receive communication pertaining to transactions/ non-commercial transactions/ promotional/ potential investments and other communication/ material
irrespective of my blocking preferences with the Customer Preference Registration Facility.
I/ We hereby provide my/our 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) (if provided) in accordance with the Aadhaar Act, 2016 (and regulations made thereunder) and
PMLA. I/ We hereby provide my/our consent for sharing/disclosing of the Aadhaar number(s) including demographic information with the asset management companies of
SEBI registered mutual fund (s)and their Registrar and Transfer Agent (RTA) for the purpose of updating the same in my/our folios with my PAN.
CERTIFICATION: 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.
You/ Sole Applicant /Guardian Second Applicant Third Applicant Power of Attorney Holder
Date D D M M Y Y Y Y Place
8. QUICK CHECKLIST
KYC acknowledgement letter (Compulsory for MICRO Investments)
Self attested PAN card copy
Plan / Option / Sub Option name mentioned in addition to scheme name
Multiple Bank Accounts Registration form (if you want to register multiple bank accounts so that
future payments can be made from any of the accounts)
Email id and mobile number provided for online transaction facility
SIP Registration Form for SIP investments
Relationship proof between guardian and minor (if application is in the name of a minor)
FATCA Declaration
Additional documents attached for Third Party payments. Refer instruction No. 7.
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9. DEBIT MANDATE (Only for Axis Bank Account holders. Now you don't have to issue a cheque if you hold an Axis Bank Account). To be processed in CMS software under client code "AXISMF"
I/ We Name of the account holder(s) Application No.
authorise you to debit my/our account no.
Account type Savings NRO NRE Current FCNR Others Specify to pay for the purchase of
Axis Bluechip Fund Axis Long Term Equity Fund Axis Regular Saver Fund Axis Triple Advantage Fund Axis Midcap Fund
Axis Focused 25 Fund Axis Arbitrage Fund Axis Equity Saver Fund Axis Flexi Cap Fund Axis Dynamic Equity Fund
Axis Equity Hybrid Fund Axis Growth Opportunities Fund Axis Small Cap Fund Axis ESG Equity Fund Axis Nifty 100 Index Fund
Axis Special Situations Fund Axis Global Equity Alpha Fund Of Fund Axis Quant Fund Axis Value Fund
Axis Greater China Equity Fund Of Fund Axis Global Innovation Fund of Fund OR Axis MF Multiple Schemes
Amount (in Figures)
(in words)
Signature of Signature of Signature of
First Account Holder Second Account Holder Third Holder
Date D D M M Y Y Y Y
WE ACKNOWLEDGE YOUR APPLICATION Received subject to realisation, verification and conditions, an application for purchase of Units as mentioned in the application form.
From
Cheque No. Date Amount Scheme Stamp & Signature Application No.
