Website Application Form
COMMON APPLICATION FORM (Please fill in BLOCK Letters)
ARN & Name of Distributor Branch Code Sub-Broker ARN Code Sub-Broker Code EUIN* Reference No.
(only for SBG) (Employee Unique Identification Number)
DIRECT DIRECT
Declaration for "execution-only" transaction (only where EUIN box is left blank) (Refer Instruction 1 (p))
* I/We hereby confirm that the EUIN box has been intentionally left blank by me/us as this is an execution-only transaction without any interaction or advice by the employee/relationship manager/sales person of the above
distributor or notwithstanding the advice of in-appropriateness, if any, provided by the employee/relationship manager/sales person of the distributor and the distributor has not charged any advisory fees on this transaction.
SIGNATURE(S)
1st Applicant / Guardian / Authorised Signatory 2nd Applicant / Authorised Signatory 3rd Applicant / Authorised Signatory
Upfront commission shall be paid directly by the investor to the AMFI registered Distributors based on the investors assessment of various factors including the service rendered by the distributor
TRANSACTION CHARGES FOR APPLICATIONS THROUGH DISTRIBUTORS/AGENTS ONLY (SEE NOTE 16)
In case the subscription amount is Rs. 10,000/- or more and if your Distributor has opted to receive Transaction Charges, Rs. 150 (for first time mutual fund investor) or Rs. 100/- (for
investor other than first time mutual fund investor) will be deducted from the subscription amount and paid to the distributor. Units will be issued against the balance amount invested.
1. PARTICULARS OF FIRST APPLICANT (SEE NOTE 1)
I confirm that I am a First time investor across Mutual Funds I confirm that I am an existing investor in Mutual Funds
1 6 0 4 3 3 7 5 (For Exisiting unitholders: Please mention your Folio number, Name and PAN
EXISTING FOLIO NO. details and then proceed to Investment and Payment details- 8)
Name A M I T K U M A R S H I N D E
(Mr./Ms./M/s.)
Gender Male Female Other (Third Gender) Date of Birth 1 4 0 2 1 9 8 7
Father's Name M A H A D E V T . S H I N D E
Spouse's Name
Name of Guardian / Name of Contact Person
(in case of Minor) (in case of Institutional Investor)
Relationship of Guardian in case of Minor [Please mandatorily enclose the document evidencing the relationship of Minor with Guardian (See Note 1 h)] Father Mother Legal Guardian
(In case of Minor, please fill the following details of Guardian)
Email ID AMITSHINDE14@GMAIL.COM
Mobile No. 7 7 3 8 1 8 7 5 7 9
County Code
Please register your E-mail address & Mobile number to get alerts & communication via E-mail & SMS.
Telephone (O) 0 7 7 3 8 1 8 7 5 7
Mandatory Enclosures PAN Proof KYC Acknowledgement
County Code
Telephone (R)
County Code
Type of address given at KRA Residential Business Registered Office
Address of tax residence would be taken as available in KRA database. In case of any change, please approach KRA & notify the changes.
PAN Exempt KYC Ref no (PEKRN for Micro investments) - ______________________
PAN C O U P S 4 7 0 5 Q Type of Identification Document given at KRA________________________
Identification Document No.______________________________________
AADHAAR No 3 1 8 4 0 1 2 9 6 2 9 1
Document Issuing Country______________________________________
Occupation Professional Business Government Service Private Sector Service Public Sector Service Agriculturist
))
(Please ( Retired Housewife Student Forex Dealer Doctor Others [Please specify]
)):
Gross Annual Income in Rs. (Please tick ( Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs 25 Lacs - 1 Cr. > 1 Cr. OR
Networth in Rs. as of (date)
Politically Exposed Person [PEP] : Yes No Related to PEP
For Non-individuals : Is the entity involved / providing any of the following services Yes No
- For Foreign Exchange / Money Changer Services Yes No - Gaming / Gambling / Lottery Services (e.g. Casinos, Betting Syndicates) Yes No
- Money Lending / Pawning Yes No
NOTE: Non-individual applicants should mandatorily fill Annexure - I alongwith this form.
2. PARTICULARS OF SECOND APPLICANT (SEE NOTE 1 & 2)
Name
Mr./Ms./M/s.
Gender Male Female Other (Third Gender) Date of Birth
Father's Name
Spouse's Name
Type of address given at KRA Residential Business Registered Office
Address of tax residence would be taken as available in KRA database. In case of any change, please approach KRA & notify the changes.
Investors subscribing to the scheme through SIP must complete Registration cum Mandate form compulsorily alongwith application form
TEAR HERE
Sponsor : State Bank of India
Investment Manager : SBI Funds Management Pvt. Ltd. ACKNOWLEDGEMENT SLIP APPLICATION NO.
(A Joint Venture between SBI & AMUNDI) To be filled in by the Investor
(To be filled in by the First applicant/Authorized Signatory) :
Received from : Signature,
Date &
Scheme Name )
Plan ( )
Option ( )
Dividend Facility( Cheque/ DD Amount (Rs.) Bank and Branch Cheque / DD No. & Date Stamp
Regular Growth Reinvestment Payout
Direct Dividend Transfer
Attachments All purchases are subject to realisation of cheque / demand draft
Mandatory Enclosures PAN Proof KYC Acknowledgement
PAN PAN Exempt KYC Ref no (PEKRN for Micro investments) - __________________
Type of Identification Document given at KRA________________________
AADHAAR No
Identification Document No.______________________________________
Document Issuing Country_______________________________________
Occupation Professional Business Government Service Private Sector Service Public Sector Service Agriculturist
))
(Please ( Retired Housewife Student Forex Dealer Doctor Others [Please specify]
)):
Gross Annual Income in Rs. (Please tick ( Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs 25 Lacs - 1 Cr. > 1 Cr. OR
Networth in Rs. as of (date)
Politically Exposed Person [PEP] : Yes No Related to PEP
3. PARTICULARS OF THIRD APPLICANT (SEE NOTE 1 & 2)
Name
Mr./Ms./M/s.
Gender Male Female Other (Third Gender) Date of Birth
Father's Name
Spouse's Name
Type of address given at KRA Residential Business Registered Office
Address of tax residence would be taken as available in KRA database. In case of any change, please approach KRA & notify the changes.
Mandatory Enclosures PAN Proof KYC Acknowledgement
PAN
PAN Exempt KYC Ref no (PEKRN for Micro investments) - __________________
Type of Identification Document given at KRA________________________
AADHAAR No
Identification Document No.______________________________________
Document Issuing Country______________________________________
Occupation Professional Business Government Service Private Sector Service Public Sector Service Agriculturist
))
(Please ( Retired Housewife Student Forex Dealer Doctor Others [Please specify]
)):
Gross Annual Income in Rs. (Please tick ( Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs 25 Lacs - 1 Cr. > 1 Cr. OR
Networth in Rs. as of (date)
Politically Exposed Person [PEP] : Yes No Related to PEP
4. FATCA & CRS RELATED INFORMATION (Only for Individuals/Proprietor)
DETAILS OF FIRST APPLICANT
Country of Birth INDIA Place of Birth KOLHAPUR
Nationality INDIAN
Are you a tax resident of any country other than India? Yes No
If Yes, please indicate all countries in which you are resident for tax purposes and the associated Tax Identification Numbers below:
Country Tax Payer Identification Number * Identification Type
(also include USA, where the individual is a citizen/ green card holder of USA) (TIN or Other, please specify)
* It is mandatory to supply a TIN or functional equivalent if the country in which you are tax resident issues such identifiers. If no TIN is yet available or has not yet been issued,
please provide an explanation and attach this to the form.
(Please attach additional sheets if necessary and mention all countries in which applicant is a tax resident & provide relevant details)
DETAILS OF SECOND APPLICANT
Country of Birth Place of Birth
Nationality
Are you a tax resident of any country other than India? Yes No
If Yes, please indicate all countries in which you are resident for tax purposes and the associated Tax Reference Numbers below:
Country Tax Payer Identification Number Identification Type
(also include USA, where the individual is a citizen/ green card holder of USA) (TIN or Other, please specify)
It is mandatory to supply a TIN or functional equivalent if the country in which you are tax resident issues such identifiers. If no TIN is yet available or has not yet been issued,
please provide an explanation and attach this to the form.
(Please attach additional sheets if necessary and mention all countries in which applicant is a tax resident & provide relevant details)
TEAR HERE
Any communication in connection with this application should be addressed to the Registrar or the Invesment Manager
Investment Manager : Registrar:
SBI Funds Management Pvt. Ltd. Computer Age Management Services Pvt. Ltd.,
(A Joint Venture between SBI & AMUNDI) SEBI Registration No. : INR000002813)
9th Floor, Crescenzo, C-38 & 39, Rayala Towers, 158, Anna Salai,Chennai 600 002
G Block, Bandra Kurla Complex,
Tel: 044 28881101 / 36
Bandra (East), Mumbai 400 051
Tel: 022- 61793511 Email: enq_L@camsonline.com
Email: customer.delight@sbimf.com Website: www.camsonline.com
DETAILS OF THIRD APPLICANT
Country of Birth Place of Birth
Nationality
Are you a tax resident of any country other than India? Yes No
If Yes, please indicate all countries in which you are resident for tax purposes and the associated Tax Reference Numbers below:
Country Tax Payer Identification Number Identification Type
(also include USA, where the individual is a citizen/ green card holder of USA) (TIN or Other, please specify)
It is mandatory to supply a TIN or functional equivalent if the country in which you are tax resident issues such identifiers. If no TIN is yet available or has not yet been issued,
please provide an explanation and attach this to the form.
(Please attach additional sheets if necessary and mention all countries in which applicant is a tax resident & provide relevant details)
5. GENERAL INFORMATION Please ( ) wherever applicable (SEE NOTE 1 m & n)
))
Tax Status (Please ( )
Mode of Holding (
Resident Individual Sole-Proprietor Government Body NGO Single
Resident Minor (through Guardian) Public Limited Company Society
LLP Joint
NRI (Repatriable) Private Limited Company Trust
PIO
NRI (Non-Repatriable) Body Corporate NPS Trust Any one or
NRI Minor (Repatriable) Partnership Firm Fund of Fund NPO Survivor
NRI Minor (Non-Repatriable) Gratuity Fund [Please specify]
FII / FPI
Pension and Retirement Fund HUF AOP Others
Financial Institutions Bank BOI [Please specify]
6. CONTACT DETAILS (SEE NOTE 1 )
Local
A - 5 0 7 , O R B I T B O N N E V I L L E , S H
Address of
1st Applicant
M O S H I
City P U N E Pin 4 1 2 1 0 5
State M A H A R A S H T R A
) ) Indian by Default
Address for Correspondence for NRI Applicants only ( Please ( Foreign
Foreign Address
(Mandatory for NRI / FII )
City
Country Zip
7. BANK PARTICULARS (As per SEBI Regulations it is mandatory for Investors to provide their bank account details) (SEE NOTE 3)
Name of Bank S T A T E B A N K O F I N D I A
Branch Name N A S H I K R O A D
and Address
R I G V E D , D R V A Z E H O S P I T A L C O
City N A S H I K Pin 4 2 2 1 0 1
Account No. 3 2 4 2 7 5 7 6 5 0 6
Account Type (Please )
(This is 9 digit number next to the cheque number. Please provide a Savings NRO FCNR
9 digit MICR Code copy of CANCELLED cheque leaf)
Current NRE Others
IFS Code S B I N 0 0 0 1 2 4 7
8. INVESTMENT AND PAYMENT DETAILS : I/We would like to invest in the following Scheme of SBI Mutual Fund (SEE NOTE 5)
One time Investment Systematic Investment Plan (SIP) (if Yes, please tick any one)
PDC
(Incase of SIP through Post Dated Cheques (PDC) it is mandatory to submit Transaction Slip mentioning PDC details)
Auto Debit / ECS
(Incase of SIP through ECS/Auto Debit mode it is mandatory to submit SIP Enrolment Cum Auto Debit/ECS Mandate Form)
Scheme Name
Plan (Please ) Regular Direct In case of Dividend Transfer facility, please mention target scheme along with plan/option.
Option (Please ) Growth Dividend
Scheme / Plan / Option
Dividend Facility (Please ) Reinvestment Payout Transfer
Cheque / DD Amount (Rs.) Drawn on Bank and Branch Cheque / D.D. No. & Date
Investment Amount (Rs. in Figures) Investment Amount (Rs. in Words)
For third party cheques please see Note 3 vii.
9. STP ENROLLMENT DETAILS Opted for STP: Yes No (If Yes, it is mandatory to submit STP Enrollment Form/Transaction slip)
10. DEMAT ACCOUNT DETAILS
If you wish to hold units in Demat mode, please provide below details and enclose the latest Client Master / Demat Account Statement (Mandatory).
Please ensure that the sequence of names as mentioned in the application form matches with that of the account held with the Depository Participant.
National Securities Depository Limited (NSDL) Central Depository Services (India) Limited (CDSL)
Depository Depository
Participant Name Participant Name
DP ID No. I N Target ID No.
Beneficiary Account No.
Please note wherever units are allotted in Demat Mode, Statement of Account will be issued by the Depository concerned. Further allotment of units (through
additional purchase / SIP) in the same scheme/plan will be allotted in Demat mode and investors can do further transactions through their Depository Participant only.
11A. NOMINATION : I wish to nominate the following person/s to receive the proceeds in the event of my death. (With effect from 01/04/2011, for
individual investors applying with single holding, Nomination is mandatory. However, in case you do not wish to nominate please sign point 11 B.) (SEE NOTE 10)
Name of the Nominee S A N T O S H S H I N D E
Name of the Guardian
Percentage 100
Relationship BROTHER Date of Birth* 2 5 1 2 1 9 8 8
Address of Nominee/ 09, JAI HARI ROW HOUSES, GOSAVI NAGAR,DASAK, JAIL ROAD,NASHIK-422101,MAHARASHTRA,INDIA Signature of Nominee/Guardian
Guardian (*Mandatory in case of Minor nominee)
Name of the Nominee
Name of the Guardian
Percentage
Relationship Date of Birth*
Address of Nominee/ Signature of Nominee/Guardian
Guardian (*Mandatory in case of Minor nominee)
Name of the Nominee
Name of the Guardian
Percentage
Relationship Date of Birth*
Address of Nominee/ Signature of Nominee/Guardian
Guardian (*Mandatory in case of Minor nominee)
11B. NOMINATION : I do not wish to nominate any person at the time of making the investment.
Signature
12. DECLARATION (SEE NOTE 11) : I/We confirm that the information provided in this form is true & accurate. I/We have read and understood the contents
of all the scheme related documents and I/We hereby confirm and declare that (i) I/We have not received or been induced by any rebate or gifts, directly or
indirectly, in making this investment; (ii) the amount invested/to be invested by me/us in the scheme(s) of SBI Mutual Fund (the Fund) is derived through
legitimate sources and is not held or designed for the purpose of contravention of any act, rules, regulations or any statute or legislation or any other applicable
laws or any notifications, directions issued by any governmental or statutory authority from time to time; (iii) the monies invested by me in the schemes of the
Fund do not attract the provisions of Foreign Contribution Regulations Act (FCRA); (iv) I/We am/are aware that a U.S. person (within the definition of the term US
Person under the US Securities laws) / resident of Canada are not eligible for investments with the Fund and I/We am/are not a U.S. person/resident of Canada;
(v) the ARN holder has disclosed to me/us all the commissions (in the form of trail commission or any other mode), payable to him/her for the different competing
schemes of various mutual funds from amongst which a scheme of the Fund is being recommended to me/us; (vi) * as per the Memorandum and Articles of
Association of the Company, Bye laws, Trust Deed or Partnership Deed and resolutions passed by the Company / Firm / Trust, I/We am/are authorised to enter into
the transactions for and on behalf of the Company/Firm/Trust; (vii) ** I/We am/are Non Resident of Indian Nationality/Origin and that funds for the subscriptions
have been remitted from abroad through approved banking channels or from my/our Non Resident External/Ordinary account/FCNR Account; (viii) *** I/We do not
hold a Permanent Account Number and hold only a single PAN Exempt KYC Reference No. (PEKRN) issued by KYC Registration Agency and also confirm that the
aggregate of lump sum and SIP installments in a rolling 12 months period or financial year does not exceed Rs. 50,000/- (Rupees Fifty Thousand); (ix) all
information provided in this application form together with its annexures is/are true and correct to the best of my/our knowledge and belief and I/We shall be
liable in case any of the specified information is found to be false or untrue or misleading or misrepresenting; (x) that we authorize you to disclose, share, remit
in any form, mode or manner, all / any of the information provided by me/ us, including all changes, updates to such information as and when provided by me/
us to the Fund, its Sponsor, AMC, trustees, their employees/RTAs or any Indian or foreign governmental or statutory or judicial authorities/agencies including but
not limited to SEBI, the Financial Intelligence Unit-India, the tax/revenue authorities in India or outside India wherever it is legally required and other such
regulatory/investigation agencies or such other third party, on a need to know basis, without any obligation of advising me/us of the same; (xi) I/We shall keep
you forthwith informed in writing about any changes/modification to the information provided or any other additional information as may be required by you from
time to time; (xii) Towards compliance with tax information sharing laws, such as FATCA and CRS: (a) the Fund may be required to seek additional personal, tax
and beneficial owner information and certain certifications and documentation from investors. I/We ensure to advise you within 30 days should there be any
change in any information provided; (b) In certain circumstances (including if the Fund does not receive a valid self-certification from me) the Fund may be obliged
to share information on my account with relevant tax authorities; (c) I/We am aware that the Fund may also be required to provide information to any institutions
such as withholding agents for the purpose of ensuring appropriate withholding from the account or any proceeds in relation thereto; (d) as may be required by
domestic or overseas regulators/ tax authorities, the Fund may also be constrained to withhold and pay out any sums from my/our account or close or suspend
my account(s) and (e) I/We understand that I am / we are required to contact my tax advisor for any questions about my/our tax residency;
* Applicable to other than Individuals / HUF; ** Applicable to NRIs; *** Applicable to Micro investments
SIGNATURE(S)
(ALL Applicants
must sign)
1st Applicant / Guardian / Authorised Signatory 2nd Applicant / Authorised Signatory 3rd Applicant / Authorised Signatory
Date Place
