ASSOCIATION OF MUTUAL FUNDS IN INDIA
One Indiabulls centre, Tower 2, Wing B, 701, 7th Floor, 841, Senapati Bapat Marg,
Elphinstone Road, Mumbai - 400013
1.6 *1.8cm
REGISTRATION FORM FOR EMPLOYEE W * H Two
Colour
Photographs
NAME OF THE APPLICANT
FIRST NAME :
MIDDLE NAME :
LAST NAME :
GENDER : F M
DATE OF BIRTH : D D M M Y Y Y Y
NAME OF ORGANISATION
:
EMPLOYED WITH
ARN OF THE ORGANIZATION :
DATE OF APPOINTMENT : D D M M Y Y Y Y
DESIGNATION/ POSITION HELD :
BREIF DESCRIPTION OF
:
RESPONSIBILITIES
PERMANENT ACCOUNT
:
NUMBER (PAN)
(PAN card copy to be attached)
GSTIN (OF THE EMPLOYER) :
(Attach a copy of the GST
Certificate)
TEST/ CPE DETAILS (NISM-Series-V-A: Mutual Fund Distributors Certification Examination /
NISM Series-V-A: Mutual Fund Distributors Continuing Professional Education
NISM PASSING/ CPE
:
CERTIFICATE NUMBER
DATE OF PASSING TEST/
: D D M M Y Y Y Y
ATTENDING CPE
ADDRESS DETAILS
OFFICE ADDRESS :
CITY :
PIN CODE :
STATE :
COUNTRY :
TELEPHONE NUMBER OFF. :
FAX :
RESIDENTIAL ADDRESS :
CITY :
PIN CODE :
STATE :
COUNTRY :
TELEPHONE NUMBER RES. :
MOBILE NUMBER :
E-MAIL ID
QUALIFICATIONS
COURSE :
UNIVERSITY/INSTITUTE :
YEAR OF PASSING : Y Y Y Y
PAYMENT DETAILS
DEMAND DRAFT NUMBER :
DEMAND DRAFT DATE : D D M M Y Y Y Y
AMOUNT :
DRAWN ON (Name of the Bank
:
and Branch)
SIGNATURE OF THE
:
APPLICANT
PLACE :
DATE : D D M M Y Y Y Y
ATTESTED BY AUTHORIZED SIGNATORY
NAME OF AUTHORISED
:
SIGNATORY
DESIGNATION :
SIGNATURE OF THE AUTHORISED SIGNATORY WITH COMPANY STAMP:
LIST OF DOCUMENTS TO BE SUBMITTED ALONGWITH THE APPLICATION
1) The prescribed fees along with applicable GST is to be paid only by a demand draft (DD) in Favor of ‘Association
of Mutual Funds In India’ payable at the place of CAMS Center at which form is submitted. For more details about
fees please visit www.amfiindia.com
2) Two Stamp Size Colour Photographs
3) PAN Card Copy
4) GST Certificate Copy (if any)
5) Certified Copy of NISM Passing Certificate
6) Proof of Residential Address (Such as Copy Of Ration Card /Latest Bank Statement/ Landline Telephone Bill/
Electricity Bill)
ACKNOWLEDGEMENT
Received Registration Form from __________________________________________along with a Demand Draft
No.
_________________ dated_______________ for Rs.__________ (Rs.
____________________________________
_____________________________________) being Fees for Registration with
AMFI.
(SIGNATURE OF THE RECEIVER)
