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UTI Applicaiton Form

This document is a common application form for investing in open-ended equity and hybrid schemes of UTI Mutual Fund, requiring detailed personal and financial information from applicants. It includes sections for distributor information, transaction charges, applicant personal details, investment details, and nominee details. The form must be filled out in block letters and includes mandatory fields for compliance with regulatory requirements.

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0% found this document useful (0 votes)
50 views6 pages

UTI Applicaiton Form

This document is a common application form for investing in open-ended equity and hybrid schemes of UTI Mutual Fund, requiring detailed personal and financial information from applicants. It includes sections for distributor information, transaction charges, applicant personal details, investment details, and nominee details. The form must be filled out in block letters and includes mandatory fields for compliance with regulatory requirements.

Uploaded by

Nitin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
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COMMON APPLICATION FORM FOR Sr.No.

2022/
OPEN-ENDed EQUITY AND HYBRID SCHEMES
(OCBs are not allowed to invest in units of any of the schemes of UTI MF)
TIME STAMP
Registrar Sr. No.

(Please read instructions carefully before filling the form and use BLOCK LETTERS only) [Fields Marked with (*) must be Mandatorily filled in] Ê
DISTRIBUTOR INFORMATION (only empanelled Distributors/Brokers will be permitted to distribute Units) (refer instruction ‘h’) BDA / CA Code

ARN/RIA Code^ Name of Financial Advisor Sub ARN Code Sub Code/ M O Code EUI No.@ UTI RM No.
Bank Branch Code

^ By mentioning RIA code, I/we authorise you to share with the Investment Adviser the details of my/our transactions.
Upfront commission shall be paid directly by the investor to the AMFI / NISM certified UTI MF registered Distributors based on the investors’ assessment of
various factors including the service rendered by the distributor.
@ I/We confirm that the EUIN box is intentionally left blank by me/us as this is an “execution-only” transaction without any interaction or advice by the
distributor personnel concerned or notwithstanding the advice of in-appropriateness, if any, provided by such distributor personnel and the distributor
has not charged any advisory fees for this transaction. ( Please tick and sign below when EUIN box is left blank) (refer instruction ‘w’).

Ê
Signature of 1st Applicant / Guardian Signature of 2nd Applicant Signature of 3rd Applicant

TRANSACTION CHARGES TO BE PAID TO THE DISTRIBUTOR (Please tick any one of the below) (Refer Instruction ‘i’)
I AM A FIRST TIME INVESTOR IN MUTUAL FUNDS I AM AN EXISTING INVESTOR IN MUTUAL FUNDS
OR
` 150 will be deducted as transaction charges per Subscription of ` 10,000 and above ` 100 will be deducted as transaction charges per Subscription of ` 10,000 and above
Existing Unit Holder information : If you have an existing Folio No. with PAN & KYC validation, mention your Folio No. :

APPLICANT’S PERSONAL DETAILS Mr. Ms. Mrs. M/s * Denotes Mandatory Fields
Name of First Applicant
F I R S T M I D D L E
L a s t Date of Birth d d m m y y y y Mandatory for minors
Date of birth will be taken as per the KYC record (Not applicable for minor child)
Name in full of the Father (OR) Mother / Guardian (In case of minor) $$ / Contact person for institutional applicants
Mr. Ms. Mrs.

F I R S T M I D D L E L A S T
$$ Proof of date of birth and proof of relationship with minor to be attached or else sign the declaration on the reverse (Refer instruction ‘f ’).
*PAN/PEKRN$ OF 1ST APPLICANT/FATHER/MOTHER/GUARDIAN Enclosed PAN/PEKRN CARD/ID PROOF COPY

CKYC ID Enclosed Know Your Customer (KYC)* Acknowledgement Copy

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)

Village/Flat/Bldg./Plot*
Street/Road/Area/Post
City/Town* State Pin*

Overseas Address (Overseas address is mandatory for NRI / FPI applicants in addition to mailing address in India)

City*
State Country* Zip/Pin*

DETAILS OF OTHER APPLICANTS


Name of 2nd Applicant Mr. Ms. Mrs. Date of Birth of 2nd Applicant d d m m y y y y
F I R S T M I D D L E L A S T

*PAN/PEKRN$ OF 2 APPLICANT
nd
Enclosed PAN/PEKRN CARD/ID PROOF COPY

CKYC ID Enclosed Know Your Customer (KYC)* Acknowledgement Copy


Date of Birth of 3rd Applicant d d m m y y y y
Name of 3rd Applicant Mr. Ms. Mrs.
F I R S T M I D D L E L A S T

*PAN/PEKRN$ OF 3rd APPLICANT Enclosed PAN/PEKRN CARD/ID PROOF COPY

CKYC ID Enclosed Know Your Customer (KYC)* Acknowledgement Copy

$ Required for MICRO Investment upto ` 50,000/-. (refer instruction ‘q’)

payment details  (Refer Instruction ‘y’) (Please ensure that the cheque complies to the CTS 2010 standard)

#Cheque/DD/NEFT/RTGS Ref. No. Savings Current NRE


/ Unique Serial No. (For Cash) Cash Account type
(please ) NRO DD issued from abroad
Account No.
UTI Smart Form if already registered (Applicable
Date Amt. of investment (i) for existing investors)
# Please mention the application No. on the reverse
Bank DD Charges if any (ii) of the cheque / DD, NEFT / RTGS advice. Cheque
Net amount paid (i-ii) / DD must be drawn in favour of “The Name of the
Branch
Scheme” & crossed “A/c Payee Only”
Amt. in words

Investment amount shall be ` 2 lacs and above
in case of payments through RTGS.
Bank Particulars of 1st applicant (Mandatory as per SEBI Guidelines)
Bank Name Branch

Address MICR Code


(this is a 9-digit number next to your cheque number)

IFS Code
City Pin*
(this is a 11-digit number)

Account type (please ) Savings Current NRO NRE

Account No.

INVESTMENT DETAILS (Please use separate form for each scheme)


Equity Schemes: UTI India Consumer Fund UTI Nifty 200 Momentum 30 Index Fund
UTI Mastershare Unit Scheme UTI Infrastructure Fund UTI S&P BSE Low Volatility Index Fund
UTI Core Equity Fund UTI MNC Fund UTI Nifty Midcap 150 Quality 50 Index Fund
UTI Flexi Cap Fund UTI Banking and Financial Services Fund
Hybrid Schemes:
UTI Focused Equity Fund UTI Healthcare Fund
UTI Transportation and Logistics Fund UTI Arbitrage Fund
UTI Mid Cap Fund
UTI Small Cap Fund Index Schemes: UTI Equity Savings Fund
UTI Value Opportunities Fund UTI Sensex Index Fund UTI Regular Savings Fund
UTI Dividend Yield Fund UTI Nifty Index Fund UTI Hybrid Equity Fund
UTI Long Term Equity Fund (Tax Saving) UTI Nifty Next 50 Index Fund UTI Multi Asset Fund
PLAN (For All Schemes) Regular Plan Direct Plan (refer instruction ‘j’)
OPTION
1. For All Schemes (except UTI Regular Savings Fund and UTI Equity Savings Fund)
Growth IDCW (Payout) IDCW (Reinvestment) [not available under UTI LTEF (Tax Saving), UTI Small Cap Fund and UTI Focused Equity Fund]
For UTI Sensex Index Fund, UTI Nifty 200 Momentum 30 Index Fund, UTI S&P BSE Low Volatility Index Fund & UTI Nifty Midcap 150 Quality 50 Index Fund there is only Growth Option
2. For UTI Regular Savings Fund Growth Monthly IDCW (Payout) Monthly IDCW (Reinvestment)
Flexi IDCW (Payout) Flexi IDCW (Reinvestment) Monthly Payment (Default-Growth)
3. For UTI Equity Savings Fund Growth IDCW (Payout) IDCW (Reinvestment) Monthly IDCW (Payout)
Monthly IDCW (Reinvestment) Quarterly IDCW (Payout) Quarterly IDCW (Reinvestment) (Default-Growth)

Unitholding Option Physical Mode Demat Mode (if Demat account details are provided below, units will be allotted, by default, in Electronic Mode only)
DEMAT ACCOUNT DETAILS - Please ensure that the sequence of names as mentioned in the application form matches with that of the account held with any one
of the Depository Participant. Demat Account details are compulsory if demat mode is opted above
National Depository Name _________________________________ Central Depository Name ___________________________________________________
Securities Depository
Depository DP ID No. Services Target
Limited Beneficiary (India) ID No.
Account No. Limited

Enclosures : Client Master List (CML) Transaction cum Holding Statement Delivery Instruction Slip (DIS)
Friend in nEed details In case UTI MF is unable to communicate with me/us at my / our registered address, I / we authorize UTI MF to correspond
with the following person to ascertain my/our updated contact details. (refer instruction - k)

Name F I R S T M I D D L E L A S T
Address:

Relationship with the applicant (optional) Email Mobile

Details of Beneficial Ownership (Please tick applicable category).


Ownership details to be provided if the Ownership percentage/interest in the trust of any Beneficiary is as per the threshold limit provided
below. Details to be provided for each such beneficiary. (Refer instruction q)
Category Unlisted Partnership Unincorporated Association Trust Foreign
Company Firm / Body of Individuals Investor $$$
Ownership per cent @@@ >25% >15% >15% >=15%
@@@ Ownership percentage of shares/capital/profits/property of juridical person/interest in the Trust as on the date of the application shall be furnished
by the investor.
$$$ In the case of Foreign investors, the beneficial ownership will be determined as per SEBI guidelines. For details refer to SAI/relevant Addendum.
In case of any change in the beneficial ownership, the investor will be responsible to intimate UTI AMC / its Registrar / KRA as may be applicable
immediately about such change.
Details of Beneficial Ownership (Please attach a separate sheet with this format if the space provided is insufficient)
Details of Identity
Sr.
Name Address such as PAN / % of ownership
No.
Passport

[Please attach self attested copy of PAN/Passport (proof of photo identity) along with application form]
Note : IDCW - Income Distribution cum Capital Withdrawal
GENERAL INFORMATION - Please () wherever applicable
STATUS: Resident Individual Minor through guardian HUF Partnership Trust
Sole Proprietorship Society / Club Body Corporate AOP BOI
FPI NRI Foreign Nationals## Listed Company LLP
Unlisted ‘Not for Profit’^^ Company Other Unlisted Company PIO
Others (Please specify) ________________________________________________________________________________________

^^ ‘Not for Profit’ Company as defined under Companies Act (Act of 1956/2013).
##
Overseas Corporate Bodies (OCBs) are not allowed to invest in units of any of the schemes of UTI MF

Occupation: Business Student Agriculture Self-employed Professional


Housewife Retired Private Sector Service Public Sector Service Government Service
Forex Dealer Others (Please specify) ____________________________________________________________________

mode of holding: Single Anyone or survivor Joint

Marital Status: Unmarried Married Wedding Anniversary D D M M

Other Details (MANDATORY)


For Individuals Only
1st Applicant: (A) Gross Annual Income Details Please tick ()
Below 1 Lac 1-5 lacs 5-10 Lacs 10-25 Lacs >25 Lacs - 1 Crore >1 Crore
[OR]
(Net worth should not be older than 1 year)
Net-worth in ` _______________________________________________________________________ as on (date) D D M M Y Y Y Y

(B) Please tick if applicable: Related to a Politically Exposed Person (PEP)


Politically Exposed Person (PEP) (For definition of PEP, please refer instruction ‘x’).
(C) Any other information: _____________________________________________________________________________________
2nd Applicant: (A) Gross Annual Income Details
Below 1 Lac 1-5 lacs 5-10 Lacs 10-25 Lacs >25 Lacs - 1 Crore >1 Crore
[OR]
(Net worth should not be older than 1 year)
Net-worth in ` _______________________________________________________________________ as on (date) D D M M Y Y Y Y
(B) Please tick if applicable: Politically Exposed Person (PEP) Related to a Politically Exposed Person (PEP)
(C) Any other information: _____________________________________________________________________________________
3rd Applicant: (A) Gross Annual Income Details
Below 1 Lac 1-5 lacs 5-10 Lacs 10-25 Lacs >25 Lacs - 1 Crore >1 Crore
[OR]
(Net worth should not be older than 1 year)
Net-worth in ` _______________________________________________________________________ as on (date) D D M M Y Y Y Y
(B) Please tick if applicable: Politically Exposed Person (PEP) Related to a Politically Exposed Person (PEP)
(C) Any other information: _____________________________________________________________________________________
For non-Individuals Only
(A) Gross Annual Income Details
Below 1 Lac 1-5 lacs 5-10 Lacs 10-25 Lacs >25 Lacs - 1 Crore >1 Crore
[OR]
(Net worth should not be older than 1 year)
Net-worth in ` _______________________________________________________________________ as on (date) D D M M Y Y Y Y
(B) Is the entity involved in / providing any or the following services
– foreign Exchange / Money Changer Services YES NO – Gaming / Gambling/Lottery Services (e.g. casinos, betting syndicates) YES NO
– Money Lending / Pawning YES NO
(C) Any other information: _____________________________________________________________________________________

details under fatca (Foreign Tax Compliance Act) and CRS (Common Reporting Standard) (Refer instruction ‘z’)
Information to be provided by all Applicants in the same sequence of Names as given in this Application form
Are you a tax resident of any country other than India ?
If No, please tick here: First Applicant Second Applicant Third Applicant
If Yes, please fill in the Particulars in the prescribed Form for FATCA/CRS and attach it with this Application Form.

 
ACKNOWLEDGEMENT
(To be filled in by the Applicant)
[UTI-LTEF (Tax Saving) is eligible for deduction under section 80C Sr. No. 2022/
of the Income Tax Act, 1961]
Received from Mr / Ms / M/s
(scheme name)
An application under
along with Cheque /DD /NEFT/RTGS
$ $
dated
Ref. No./Unique Serial No. (For Cash)
Drawn on (Bank) Stamp of UTI AMC Office/
Authorised Collection Centre
for ` (in figures)
$
Cheques and drafts are subject to realisation.
NOMINATION DETAILS (Please ) (please sign if you do not wish to nominate)

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.

To be furnished in case nominee is a minor


Name of Nominee
Name of the guardian
Address of guardian
Date of Birth d d m m y y y y (in case of nominee is a minor) Signature of Nominee / guardian
(for minor)
*PAN
*PAN of the nominee/guardian (in case the nominee is minor)

Ê Investors who wish to nominate two or three persons may fill in the separate form prescribed for the same and attach it with this application form.
I / We hereby confirm that I / We do not wish to appoint any nominee(s) for my mutual fund units held in my / our mutual fund folio and understand the issues
Sign.
here involved in non appointment of nominee(s) and further are aware that in case of death of all the account holder(s), my / our legal heirs would need to submit all
the requisite documents issued by Court or other such competent authority, based on the value of assets held in the mutual fund folio.
Ê

Signature of 1st Applicant / Guardian Signature of 2nd Applicant Signature of 3rd Applicant

declaration and signature of applicant/s


l I/We have read and understood the contents of the Scheme Information Document, statement of additional information 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. l I/We have not received nor been induced by any rebate or gifts, directly or indirectly in
making investments. l 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. l I/We hereby authorize
UTI MF/UTI AMC to share my data furnished in the Form to my distributor and other service providers of the UTI MF for the purpose of servicing, issue of
account statement/consolidated statement of account etc and cross selling of products/schemes of the UTI MF. l I/We confirm that we are Non-Residents
of 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 NRI’s).
l I hereby solemnly declare that I am the father/mother/guardian of the minor child in whose name the application is made. The date of birth stated by me is true
and correct. l I/We wish to receive E-mail and SMS communication from UTI AMC/ UTI MF.

OPTION FOR DESPATCH OF STATEMENT OF ACCOUNT (SoA) / AbridgeD Annual Report (aaR)∞
Applicable to NRIs
SoA in Physical Form At my Overseas address as mentioned above
AAR in Physical Form To be dispatched to my resident relative’s address in India as mentioned above
Ê ∞ On providing email-id investors shall receive scheme wise annual report or an abridged summary thereof/ account statements/ transaction confirmation, communication of change of address, change of bank details etc. through email only.

First *Mobile No. Tel. (R) STD CODE Tel. (O) STD CODE
Applicant
Details *E-mail _________________________________________________________ Alternate E-mail _________________________________________________________
*If the Mobile Number or Email ID belongs to a family member please fill-in below details of the family member.

For E-mail ID For Mobile Number

Name of the family member Name of the family member

Relationship Relationship

PAN PAN

Folio Number Folio Number


Please note that as per the existing regulatory guidelines, the contact details can only be of self or any of the Family members. Family members mean spouse,
dependent children, dependent siblings, dependent parents, and a guardian in case of a minor
I/we hereby authorise UTI AMC/ UTI MF to send important information, transaction updates and/or any other relevant details to me/us on
WhatsApp number. If you DO NOT wish to receive communication on WhatsApp, tick the box o
Sign.
here
Ê

Signature of 1st Applicant / Guardian / POA^^ Signature of 2nd Applicant / POA^^ Signature of 3rd Applicant / POA^^
Name of 1st Authorised Signatory Name of 2nd Authorised Signatory Name of 3rd Authorised Signatory
____________________________________ __________________________________ ___________________________________
Designation ___________________________ Designation __________________________ Designation _________________________
^^Power of Attorney (POA) Registration No._________________________(if already registered) (refer instruction ‘ab’)
 
Notes :
1. If the application is incomplete and any other requirement is not fulfilled, the application is liable to be rejected.
2. Consolidated Account Statement (CAS) will be sent within 10 days of the following month of the transaction.
3. Please ensure that all KYC Compliance Proof and PAN details are given, failing which your application will be rejected. PAN not
applicable for Micro SIP.
4. 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 Kfin Technologies Limited; Unit : UTIMF, Selenium Tower B, Plot Nos. 31 & 32, Financial District ,Nanakramguda, Serilingampally Mandal,
Hyderabad - 500032 | India Board: 040-6716 2222, Fax no: 040-6716 1888, Email: uti@kfintech.com
" "
Registration of SIP
Renewal of SIP
Micro SIP
ARN / RIA EUIN Sub ARN Code Sub Code MO Code UTI RM No.
Salary Saving SIP
Change in Bank Details
Upfront commission shall be paid directly by the investor to the AMFI / NISM certified UTI MF registered distributors based on the investors’ assessment of various factors including the service rendered by the distributor. I/We confirm that
the EUIN box is intentionally left blank by me/us as this is an “execution-only” transaction without any interaction or advice by the distributors personnel concerned or not withstanding the advice of in-appropriateness, if any, provided by
such distributor personnel and the distributor has not charged any advisory fees for this transaction.
APPLICANT DETAILS APPLICATION NO./FOLIO NO. +
Name of Sole / 1st Holder / Beneficiary Child
Name of Guardian (in case of Minor)
PAN DETAILS (If not registered in the folio already)
First Applicant/Guardian Second Applicant Third Applicant

Mandatory Enclosure Mandatory Enclosure Mandatory Enclosure


PAN Proof KYC Complied PAN Proof KYC Complied PAN Proof KYC Complied
PAN Exempt KYC Ref no. PAN Exempt KYC Ref no. PAN Exempt KYC Ref no.
(PEKRN for Micro investments) (PEKRN for Micro investments) (PEKRN for Micro investments)

SIP DETAILS
SIP Period SIP Step Up
Instalment
Scheme Name, Plan, Option SIP Date Frequency Regular Perpetual Amount
Amount In Multiple of ` 500/- Frequency
(MM/YY) (MM/YY)
5000 Daily
10000 Weekly From From Half Yearly
D D
25000 Monthly
To To 1 2 9 9 Yearly
OR `
Quarterly
5000 Daily
10000 Weekly From From Half Yearly
D D
25000 Monthly
To To 1 2 9 9 Yearly
OR `
Quarterly
5000 Daily
10000 Weekly From From Half Yearly
D D
25000 Monthly
To To 1 2 9 9 Yearly
OR `
Quarterly

Amount in the mandate to bank should be equal or more than this total amount. Total `

My Financial Goal for this SIP (choose anyone)


Retirement Corpus Child Education Child Marriage Dream Car Dream House Marriage Holiday
(In case of saving for Child, mention name of Child) Target Amount
I/We hereby authorise UTI Mutual Fund and their authorised service providers and my banker, to debit my/our bank account using the Mandate Form. If the transaction is delayed or not effected at all for reason of incomplete or incorrect information or other reasons,
I/we would not hold UTI Mutual Fund responsible. I/We will also inform UTI Mutual Fund, about any changes in my bank account. I/We have read and understood the contents of the SAI, SID, KIM, Instructions and Addenda issued from time to time of the respective
Scheme(s) of UTI Mutual Fund, have read and agreed to the instructions cum terms and conditions of SIP/Micro SIP, I/We do not have any existing Micro SIPs which together with the current application will result in aggregate investment exceeding ` 50,000 in a year
(applicable only for Micro SIP applicants.) 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 Scheme of various Mutual Fund from amongst which the Scheme is
being recommended to me/us. I/We hereby authorize UTIMF/UTIAMC to share my data furnished in the Form with other service providers of the UTIMF for the purpose of servicing, issue of account statement, consolidated statement of account, etc and cross selling of
products/scheme of the UTIMF. I/We hereby request you to register me/us for availing this facility and the carrying out transactions of Purchase/SIP/Redemption/Switch in my/our above mentioned folio wherever applicable. I/We have read and understood the Terms &
Conditions of the facility in which I/We wish to subscribe as available on UTI MF website (http:/www.utimf.com/customerservice/Pages/default.aspx) and also displayed/available at the UFC wherever applicable.
By Signing this SIP enrolment form I/We understand, that the amount will be debited from the Bank account mentioned in SIP Mandate (Should be signed as per mode of holding in the folio)

1st Unit Holder / Guardian 2nd Unit Holder 3rd Unit Holder
" "

Unit Holding Option : Demat Mode Physical Mode


DEMAT ACCOUNT DETAILS-(Please ensure that the sequence of name to mentioned in the application form matches with that of the account held with any one of the Depository Participant. Demat Account details are compulsory if demat mode is opted below.
(Investor client ID should be printed in proof.)

Depository Depository
Central National
participant Name participant Name
Depository Securities
Securities Target ID Depository DP ID No.
Limited Limited Target ID

Proof enclosed (Any one) Client Master List (CML) Transaction cum Holding Statement Cancelled Delivery Instruction Slip (DIS)

Registration of SIP

Renewal of SIP
For Post Dated Cheque (Only CTS - 2010 compliant cheques are allowed) Micro SIP
ARN / RIA EUIN Sub ARN Code Sub Code MO Code UTI RM No. Salary Saving SIP

Change in Bank Details


Upfront commission shall be paid directly by the investor to the AMFI / NISM certified UTI MF registered distributors based on the investors’ assessment of various factors including the service rendered by the distributor. I/We confirm that
the EUIN box is intentionally left blank by me/us as this is an “execution-only” transaction without any interaction or advice by the distributors personnel concerned or not withstanding the advice of in-appropriateness, if any, provided by
such distributor personnel and the distributor has not charged any advisory fees for this transaction.
APPLICANT DETAILS APPLICATION NO./FOLIO NO. +
Name of Sole / 1st Holder / Beneficiary Child
Name of Guardian (in case of Minor)
PAN DETAILS (If not registered in the folio already)
First Applicant/Guardian Second Applicant Third Applicant

Mandatory Enclosure Mandatory Enclosure Mandatory Enclosure


PAN Proof KYC Complied PAN Proof KYC Complied PAN Proof KYC Complied
PAN Exempt KYC Ref no PAN Exempt KYC Ref no PAN Exempt KYC Ref no
(PEKRN for Micro investments)) (PEKRN for Micro investments)) (PEKRN for Micro investments))

DETAILS OF SIP (For “DIRECT PLAN“ please tick here & write the Scheme Name, Plan/Option below)

Scheme UTI PLAN OPTION


Each SIP/Micro SIP Amount (`)
Initial Investment Amount (`) # (Default amount is ` 500)

SIP / Micro SIP Date (Please tick) 01 07 15 25 Frequency : Monthly Quarterly Post Dtd. Chq. Amt. (`)

SIP / Micro SIP Period : Start from M M Y Y End On M M Y Y

Cheque Nos. From To No. of Cheques

Account No. Drawn on

Branch PIN Code

Mandatory Enclosure (if 1st instalment is not by cheque) Bank cancelled cheque Copy of cheque
I/We have attached PAN card/Document copies of all applicants.

1st Unit Holder / Guardian 2nd Unit Holder 3rd Unit Holder

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