For any enquiries, Please contact Branch Address, Ground Floor, Mafatlal House,H.

T Parekh, Marg, 165-166, Backbay Reclamation,, Churchgate,

Mumbai-400 020, Maharashtra, Phones : 1800 3010 6767 / 1800 419 7676, Email : hello@hdfcfund.com

Page 1 of 2
Account Statement

Folio No. : 28318513 / 68 Statement Date : 24-May-2025

Mode of Holding : Single

Sushila Mokha Warjri Tax Status : Individual

69 Chinapatti
Town/vill-shillong
Shillong - 793001
Meghalaya , India

Email : suziewarjri1979@gmail.com
Mobile No. : +917005424749

PAN/PEKRN PAN-Aadhar linking CKYC No. KYC FATCA / CRS UBO

1st Unit Holder ABLPW4184F Successful Please provide Validated Complete Not applicable

2nd Unit Holder Not applicable Not Applicable Not applicable Not applicable Not applicable Not applicable

3rd Unit Holder Not applicable Not Applicable Not applicable Not applicable Not applicable Not applicable

Guardian, If any Not applicable Not Applicable Not applicable Not applicable Not applicable Not applicable

POA, If any Not applicable Not Applicable Not applicable Not applicable Not applicable Not applicable

Nominee Details
Sr. No. Nominee Name Date of Birth Guardian Name (in case of minor) Share (%)
1 ABDUL JAMIR 01-Jan-1979 Not Applicable 100

Account Summary as on 23-MAY-2025 THANK YOU FOR INVESTING WITH HDFC MUTUAL FUND
Maturity Mode of NAV as on Market
Scheme Nav Date NAV Units Cost (INR)
Date Investment 31-Jan-2018 * Value (INR)
HDFC Ultra Short Term Fund - Lump sum 23-May-2025 15.0562 NA 39,848.700 600,000.00 599,970.00
Reg Gr

HDFC Small Cap Fund - Systematic 23-May-2025 133.789 NA 539.749 70,000.00 72,212.48
Regular Growth Plan Transactions

Grand Total : 670,000.00 672,182.48

*This field is applicable only for Equity oriented Schemes

Systematic Registration(s)
Debit Bank /
Registration Installment Top up Registration MFD*/ Top up
Scheme From Date To Date Date Frequency Payout Bank
Type Amount(INR) Frequency Date Intermediary Amount(INR)
Account No
HDFC Small Cap
SIP Fund - Regular Plan 10-Apr-2024 10-Mar-2064 10 Once A Month 5,000.00 NA 30191862325 05-Apr-2024 ARN-270293 NA
- Growth Plan
EISC-CAMSWEB-16.12.0-240525080415(I)-A1612016--1130-YN

8515 / HDFC Small Cap Fund - Regular Plan - Growth Plan* - INF179KA1RZ8 UCC : MFHDFC0500

NAV Amount Price Number of Balance

Date Transaction Type
in INR in INR Units Units
Opening Balance as on 13/01/2025 335.477
Gross SIP Purchase-NSE - Instalment No - 10/480 Online 5,000.00
Less: Stamp Duty 0.25
13/01/2025 Net Purchase 129.537 4,999.75 129.5370 38.597 374.074
Gross SIP Purchase-NSE - Instalment No - 11/480 Online 5,000.00
Less: Stamp Duty 0.25
11/02/2025 Net Purchase 122.556 4,999.75 122.5560 40.796 414.870
Gross SIP Purchase-NSE - Instalment No - 12/480 Online 5,000.00
Less: Stamp Duty 0.25
11/03/2025 Net Purchase 115.407 4,999.75 115.4070 43.323 458.193
Gross SIP Purchase-NSE - Instalment No - 13/480 Online 5,000.00
Less: Stamp Duty 0.25
11/04/2025 Net Purchase 118.013 4,999.75 118.0130 42.366 500.559
Gross SIP Purchase-NSE - Instalment No - 14/480 Online 5,000.00

MFD* is Mutual Fund Distributor

continued...
 Page 2 of 2
Account Statement (Folio No. : 28318513 / 68)
8515 / HDFC Small Cap Fund - Regular Plan - Growth Plan* - INF179KA1RZ8 UCC : MFHDFC0500

NAV Amount Price Number of Balance

Date Transaction Type
in INR in INR Units Units

Less: Stamp Duty 0.25

13/05/2025 Net Purchase 127.576 4,999.75 127.5760 39.190 539.749
Available Units to Redeem : 539.749
Market Value of Balance Units at NAV of 133.789 on 23/05/2025 (INR) : 72,212.48 Total Units Under Lien : 0.000
IDCW reinvested / paid (INR) : 0.00 Total IDCW reinvested / paid (INR) : 0.00
Redemption Payout Mode : Electronic
Primary Bank Account : SB XXXX2325 / State Bank of India / SHILLONG / SHILLONG / SBIN0006729

MFD*/Intermediary : ARN-270293 / SAPIENT FINSERV PRIVATE LIMITED; Sub Broker Code : ARN163804
Sub Broker ARN : ARN-163804; EUIN : E311099

*Due to change in fundamental attributes of the Scheme w.e.f. May 23, 2018, the type of the Scheme has been changed to an open-ended equity scheme predominantly
investing in small cap stocks. Current Load Structure - Entry Load: Not Applicable; Exit Load: 1% if units are redeemed/switched-out within 1 year from the allotment date; No
Exit Load if units are redeemed /switched-out after 1 year. The rate of exit load levied on units redeemed/switched-out will be the rate prevailing at the time of allotment of the
units. For further details visit www.hdfcfund.com or contact any of our Investor Service Centre. GST Identification Number : 27AAATH1809A1Z9

Details regarding your primary Bank account and Email Id maybe masked to ensure security of information.
(#)switch-in will be processed based on the settlement cycle of the switch-out scheme.
This is a computer generated statement and does not require any signature.

8714 / HDFC Ultra Short Term Fund - Regular Growth* - INF179KB11R3 UCC : MFHDFC0650

NAV Amount Price Number of Balance

Date Transaction Type
in INR in INR Units Units
Opening Balance as on 23/05/2025 0.000
Gross Purchase-NSE - Online 600,000.00
Less: Stamp Duty 30.00
23/05/2025 Net Purchase 15.0562 599,970.00 15.0562 39,848.700 39,848.700
Available Units to Redeem : 39,848.700
Market Value of Balance Units at NAV of 15.0562 on 23/05/2025 (INR) : 599,970.00 Total Units Under Lien : 0.000
IDCW reinvested / paid (INR) : 0.00 Total IDCW reinvested / paid (INR) : 0.00
Redemption Payout Mode : Electronic
Primary Bank Account : SB XXXX2325 / State Bank of India / SHILLONG / SHILLONG / SBIN0006729

MFD*/Intermediary : ARN-270293 / SAPIENT FINSERV PRIVATE LIMITED; Sub Broker Code : ARN163804
Sub Broker ARN : ARN-163804; EUIN : E311099

HDFC Ultra Short Term Fund, an open ended ultra-short term debt scheme investing in instruments such that the Macaulay Duration of the portfolio is between 3 months and 6
months. Current Load Structure: Entry Load: Not Applicable; Exit Load: NIL. For further details visit www.hdfcfund.com or contact any of our Investor Service Centres. GST
Identification Number 27AAATH1809A1Z9. It is certified that there are more than 20 unit holders in the captioned Scheme and no single holder holds more than 25% of the
corpus of the Scheme as on the date of allotment.

Details regarding your primary Bank account and Email Id maybe masked to ensure security of information.
(#)switch-in will be processed based on the settlement cycle of the switch-out scheme.
This is a computer generated statement and does not require any signature.

EISC-CAMSWEB-16.12.0-240525080415(I)-A1612016--1130-YN

continued...
 TRANSACTION REQUEST FOR TIMESTAMP (FOR OFFICE USE ONLY)

PURCHASE / SWITCH / REDEMPTION

(Please use separate transaction slip for each scheme.
For updating your contact details, please submit a separate request)
Folio Number : 28318513 / 68 Scheme / Plan / Option* :
Name of sole / (Switch-out scheme
First Unit Holder : Sushila Mokha Warjri for switch request) :
*Default Plan / Option in terms of KIM will apply if the choice of Plan / Option is not indicated.
KEY PARTNER / AGENT INFORMATION
Internal Code for Employee Unique
ARN ARN Name Sub Agent’s ARN Bank Branch Code
Sub-Agent/ Employee Identification Number (EUIN)
ARN-270293 SAPIENT FINSERV PRIVATE ARN-163804 ARN163804 E311099
LIMITED

Note: Upfront commission shall be paid directly by the investor to the ARN Holder (AMFI registered Distributor) based on the investors’ assessment of various factors including the service rendered by the ARN Holder.
Important: Please strike off any unused portion of this sheet.
ADDITIONAL PURCHASE (Please write your folio number and name on the reverse of the cheque/DD/Payment Instrument no.)
Payment Mode: (Please tick any one only) OTM (One Time Bank Mandate) Cheque DD Funds Transfer RTGS / NEFT
Cheque/DD/Instrument No: IF APPLICABLE Payment Date/Instrument Date : / / Amount (Rs.) :
Bank Name: Branch: City :
MANDATORY FOR OTM
Investors desiring to get allotment of units in dematerialized mode instead of physical mode should provide the details in their demat account below:
NSDL CDSL

DP Name
DP ID
Beneficiary Account No.
Please attach a copy of the DP statement / Client Master Form to enable us to verify the demat account details.
IMPORTANT : Names, mode of holding , PAN details, etc. of the Investor will be verified against the Depository data.The units will be credited to the beneficiary (demat) account only after
successful verification with the depository records and realization of payment.

at - our offices,www.hdfcfund.com,with your distributor,if any

Please check exit load, if applicable. Information available
SWITCH REQUEST (Please tick any one only) All Free Units No. of units : Amount (in Rs.) :
To Scheme / Plan / Option ^ :
^Default Plan / Option in terms of KIM will apply if the choice of Plan / Option is not indicated.

REDEMPTION - Subject to Lock-in Period, if any (Please tick only one of the below options.)
Redeem All Free Units No. of units : Amount (in Rs.) (in words)
IFSC Code : (If not provided earlier for electronic payment)
Note : If a redemption request is submitted alongwith a request for changing the bank account details, the redemption will be processed into the registered /default bank
account in the aforesaid scheme/folio and the request for changing the bank account details will not be processed.
For investors who have registered for Multiple Bank Accounts facility# in the above folio:
The redemption should be processed into the following bank account as per the payout mechanism indicated by me/us (This bank account has already been registered in the folio):
Name of the Bank : Branch :
Account No.: Account Type: Bank City :
This transaction request is not valid for HDFC Gold Exchange Traded Fund,

#Important
Note: If the bank account mentioned above is different from those already registered in your folio OR if the bank account details are not filled above ,the redemption will be
processed into the "Default" bank account registered for the aforesaid folio .HDFC Mutual Fund or HDFC Asset Management Company Ltd. will not be liable for any loss arising to the
unitholder(s) due to the credit of redemption proceeds into any of the bank accounts registered with us for the aforesaid folio. If the balance in my/our account does not cover the amount /
units of the redemption request, I/we authorise you to send the entire such (lesser) balance to me/us.
DECLARATION :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:-
HDFC NIFTY ETF,HDFC SENSEX ETF.

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 HDFC Mutual Fund (‘Fund’) indicated above.
2) I/We am/are eligible Investor(s) as per the scheme related documents and am/are authorised to make this investment as per the Constitutive documents/ authorization(s). 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 HDFC Asset Management Company Limited (AMC)/ 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.
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.
Applicable to 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.
Applicable to NRIs/PIO/OCIs only:I/We confirm that my application is in compliance with applicable Indian and foreign laws.
Please ( ) Yes No If Yes, ( ) Repatriation basis Non-repatriation basis
Declaration for Purchase/Switch transaction where EUIN box is left blank
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.
TO BE SIGNED BY ALL UNIT HOLDERS IF MODE OF HOLDING IS JOINT. ALTERATIONS, IF ANY, SHOULD BE COUNTERSIGNED.
Signature(s)

EISC-CAMSWEB-16.12.0-240525080415(I)-A1612016--1130-YN

Sole/ First Unit holder/ Guardian/ POA Second Unit holder Third Unit holder
Important alert: Incase there is any change to your KYC information please update the same by using the prescribed "KYC Change Request Form"
and submit the same at the point of sevice of any KYC Registration Agency

FATCA & CRS - SELF CERTIFICATION FOR INDIVIDUALS

(To be filled and signed by folio(s) with Single holders only.In case of folio(s) with joint holders/Entities,separate SUPPLEMENTARY
KNOW YOUR CLIENT (KYC),FATCA & CRS-SELF CERTIFICATION FORM needs to be submitted)
PAN: Name:
Is the applicant/guardian's Country of Birth/Citizenship/Nationality/Tax Residency other than India? Yes No
If yes, then please submit a Supplementary Know Your Client(KYC), FATCA and CRS - Self certification form attached along-with this transaction.
Declaration: I have read and understood the information requirements and the Terms and Conditions mentioned in the SUPPLEMENTARY KNOW
YOUR CLIENT(KYC), FATCA & CRS-SELF CERTIFICATION FORM and hereby confirm that the information provided by me/us on this Form is true,
correct and complete. I hereby agree and confirm to inform HDFC Asset Management Company Limited/HDFC Mutual Fund/Trustees for any
modification to this information promptly. I further agree to abide by the provisions of the Scheme related documents inter alia provisions on
'Foreign Account Tax Compliance Act(FATCA) and Common Reporting Standards(CRS) on Automatic Exchange of Information(AEOI)'. I 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 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. Sign of Sole Holder