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Save Tax
Under Section 80C, Indian Government allows every Individual to invest Rs. 1 Lakh and save on tax.

Get Rich!!
One can invest Rs. 1 Lakh p.a. in a monthly fashion (Rs. 8,333/- p.m.) and compounding the investment at a healthy rate and create wonderful fortune in life and get super rich!!
Returns Rate 12% 15% 10 Years 19.65 Lacs 23.34 Lacs 15 Years 41.75 Lacs 54.71 Lacs 20 Years 80.69 Lacs 1.78 Crore 25 Years 1.49 Crore 2.44 Crore 30 Years 2.70 Crore 4.999 Crore

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About ELSS Mutual Funds: There are various options available to you, to save tax under section 80C of Income tax Act, like Public Provident Fund (PPF), National Savings Certificate (NSC), 5-Year FD, Insurance Policy. When compared to these traditional tax savings instruments, an Equity Linked Savings Scheme Mutual Fund (ELSS MF) is more opportunistic for you, as it provides a shorter lock-in period of three years and potential for higher returns, which are exempt from taxes. ELSS MFs provide opportunities aimed at harnessing the benefits of investing in equity and also providing tax benefits. Your Salary Up to Rs. 2,00,000/2,00,001 5,00,000/5,00,001 10,00,000/Above 10,00,000/Income Tax Slab 0% 10% 20% 30% By investing in ELSS MF, You can Save Rs. 10,000/Rs. 20,000/Rs. 30,000/-

Comparison of various Tax Saving Instruments: ELSS Instrument Lock-In Period Returns History (at end of lockin period) Any Hidden Charges Do you have to pay Tax on Profit / Returns Earned? Preference for Investment PF / PPF 15 Years 8.8% 5-Year FD 5 Years Around 8% Insurance (LIC, ULIP) More than 5 Years Varies, but there are a lot of deductions and charges. Yes Varies between schemes NSC 5 Years / 10 Years 8.6% / 8.9% ELSS Mutual Fund 3 Years (Shortest) 9% - 12.9% for the top performing funds No No

No No

No No

No Yes

1*

* What should you choose? You should choose ELSS Mutual Fund for saving tax since it is the best option considering the above.

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Our Recommendation: Based on comparison of some of the Top Performing Mutual Funds, Invest in any of the ELSS Funds below. DSP-BR Tax Saver Fund Returns History 1 Year 3 Years 5 Years 14.1% 26.2% 16.8%
10,000/- invested has become 11,410 12,620 11,680

ICICI Pru Tax Plan Returns History 1 Year 3 Years 5 Years 11.8% 38.6% 37.4%
Rs.10,000/- invested has become 11,180 13,860 13,740

Reliance Tax Saver Returns History 1 Year 3 Years 5 Years 18.0% 44.1% 28.7%
Rs.10,000/- invested has become 11,800 14,410 12,870

Mutual Fund investments are subject to market risks, read all scheme related documents carefully.

Instructions For Filling up the forms: 1. Depending on the funds of your choice, write an A/C Payee Crossed Cheque favoring: I. DSP BlackRock Tax Saver Fund II. ICICI Prudential Tax Plan III. Reliance Tax Saver Fund 2. In the attached Application Forms, fill your: I. Name, Address, Email Id, Phone Number II. PAN Number III. Nominee Details IV. Cheque and Bank Details V. Your Signature in the space provided for Sole/First Applicant 3. Give us a Missed Call at

94 8300 8300

to pick up the application/for any guidance.

We will provide Free Service / Assistance within 24 hours.

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Save Tax! Get Rich

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We provide various financial services including: 1. Tax Planning and Saving. 2. Retirement Planning using Mutual Funds. 3. Life Insurance Planning (We have insured more than 100 people for an amount of Rupees 1 Crore each at a cost of less than Rs. 40/- per day). We recommend The Best Term Insurance Plans only. 4. Childrens Donation and Recurring Education Fees Planning. 5. Financial Planning for Buying Your Own House/Apartment/Site. 6. Full-fledged Financial Planning for All Your Lifes Goals. 7. Mutual Fund Recommendations. 8. Child Insurance Plans with Triple Benefits. We would love to provide our services to you, and your Friends, Colleagues and Relatives. Kindly provide their contact details so that we can help them also: Sl. Name No. Contact Number (Mobile) Email Id. (if available) Where do they work?

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APPLICATION FORM
Please read instructions before filling this Form

Application No.:
01-08-2012 V2.2012

Distributor Name and ARN

Sub Broker Code

Branch / RM Code

For Office use only

Raghavendra Prasad Raghavendra Prasad


Distributor Contact No:ARN

ARN - 74461 - 74461

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.

1. TRANSACTION CHARGES (Please refer instructions and tick any one)


Applicable for transactions routed through a distributor who has opted in for transaction charges. I am a First Time Investor in Mutual Fund Industry. I am an Existing Investor in Mutual Fund Industry.
(Rs 150 will be deducted.) (Rs 100 will be deducted.)

2. FIRST APPLICANTS DETAILS


Name of First Applicant (Should match with PAN Card) Gender Male Female Title Mr. Ms. M/s

Existing Folio Number Date of Birth


(Mandatory for minor)

For Investments On behalf of Minor


(* Attach Mandatory Documents as per instructions).

Proof of DoB attached *

PAN
(1st Applicant / Guardian)

Birth Certificate School Certificate / Mark sheet Passport Any other ......................... Father Mother Court Appointed*

Guardian named below is :


KYC Acknowledgement

Enclose

Name of Guardian if minor / Contact Person for non-individuals / PoA Holder name:

PoA PAN*
KYC*

Correspondence Address

*PoA PAN & KYC is mandatory

Landmark City State Status of Sole/1st Applicant (Please tick ) Resident Individual On Behalf Of Minor HUF Sole Proprietorship NRI (Repatriable) NRI (Non-Repatriable) LLP Partnership Firm Company AOP/BOI Body Corporate Trust Society FII FOF - MF schemes Provident Fund Superannuation / Pension Fund
DSPBR eServices Email ID (in capital) DSPBR eSMS
Pin Code (Mandatory)

Gratuity Fund

Bank / FI

Government Body

Insurance Companies

Others

(Please specify)

Mobile

+91 Tel. (Off)

Fax Tel. (Resi.)

STD Code
DSPBR Online PIN (Please tick )

NEW

Yes, I wish to have a PIN for internet / telephone transactions and agree to terms and conditions of PIN Issuance and Usage as available in SID/SAI and www.dspblackrock.com
Email ID, Date of Birth, Mobile Number, PAN are mandatory details for issuance of PIN and Online Facility.

3. JOINT APPLICANTS DETAILS


Mode of Holding (Please tick ) Joint (Default) Anyone or Survivor Single Title Enclose
KYC Acknowledgement

Name of Second Applicant (Should match with PAN Card) PAN (2nd applicant ) Name of Third Applicant (Should match with PAN Card) PAN (3rd applicant )

Mr.

Ms.

M/s

Title Enclose
KYC Acknowledgement

Mr.

Ms.

M/s

ACKNOWLEDGEMENT SLIP (To be filled in by the investor)


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

DSP BLACKROCK MUTUAL FUND


Application No.

4. BANK ACCOUNT DETAILS (Refer Instruction 4 and avail Multiple Bank Registration Facility)
Bank Name Bank A/C No. Branch Address City IFSC code: (11 digit) MICR code (9 digit) A/C Type Savings Current NRE NRO FCNR Others

Pin
(This is a 9 digit number next to your cheque number)

5. INVESTMENT AND PAYMENT DETAILS (Refer Instruction 5)

(Cheque DD should be in favour of Scheme Name)

Scheme/Plan Plan Scheme /Option/Sub Option DSP BlackRock - TAX SAVER FUND - Growth Option (Default plan/option/sub option will be applied incase of no information, ambiguity or discrepancy) One time Lump sum Investment: Payment Mode: Cheque DD Please fill the details hereunder. RTGS NEFT Funds transfer

Option/Sub Option

Do not submit SIP Auto Debit Form. Cheque/RTGS/ NEFT/DD Date Payment from Bank A/c No. Bank Name

LUMPSUM

Cheque/DD/RTGS/NEFT No. Amount (Rs.) (i) DD charges, (Rs.)(ii) Total Amount (Rs.) (i) + (ii)
In Words In figures

Pay In A/c No.

Branch Account Type Savings Current NRE NRO FCNR

Documents Attached to avoid Third Party Payment Rejection, where applicable:

Bank Certificate, for DD

Third Party Declarations

SIP

SIP: Systematic Investment Plan. Please fill up SIP Auto Debit form and attach with this form . First SIP Cheque Details: (Mention Amount in SIP Auto Debit Form) (Refer instruction 4(i) on Third Party Payments) Cheque / DD No. Cheque/DD Date Drawn on Bank A/c No. Bank & Branch
(Refer Instruction 6) Individuals (single or joint applicants) are advised to avail Nomination facility. Pay In A/c No.

6. NOMINATION DETAILS
I/We wish to nominate.

I/We DO NOT wish to nominate and sign here Guardian Name (In case of Minor)

1st Applicant Signature (Mandatory) Allocation % Nominee/ Guardian Signature

Nominee Name Nominee 1 Nominee 2 Nominee 3 Address

Total = 100%
(It is mandatory to tick any one option or Account Statement Mode option will be considered) Refer Instruction 7).

7. UNIT HOLDING OPTION:


In Account Statement Mode (default):
(Switch/Redemption through Fund/RTA offices only.)

In Demat mode, in demat account provided below: (Switch not allowed. Redemption through SE platforms/ DPs only)
Depository Participant (DP) ID (NSDL only) Beneficiary Account Number (NSDL only)

NSDL: CDSL:

Enclose for demat option:

Client Master List

Transaction/Holding Statement

DIS Copy

8. DECLARATION & SIGNATURES


Having read and understood the contents of the Scheme Information Document and Statement of Additional Information, Key Information Memorandum, Instructions and addenda issued by DSP BlackRock Mutual Fund, I / We, hereby apply to the Trustee of DSP BlackRock Mutual Fund for Units of the relevant Scheme and agree to abide by the terms and conditions, rules and regulations of the Scheme. I / We have neither received nor been induced by any rebate or gifts, directly or indirectly in making this investment. I / We hereby nominate the above nominee to receive all the amounts to my/our credits in the event of my/our death and have read the instructions for nomination. Signature of the nominee acknowledging receipts of my/our credit will constitute full discharge of liabilities of DSP BlackRock Mutual Fund. I / We declare that the amount invested in the Scheme is through legitimate sources only and is not designed for the purpose of contravention or evasion of any Act, Regulation, Rule, Notification, Directions or any other applicable laws enacted by the Government of India or any Statutory Authority. 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. Applicable to NRIs only: I/We confirm that I am/We are Non-Resident(s) of Indian Nationality / Origin and I/We hereby confirm that the funds for subscription have been remitted from abroad through normal banking channels or from funds in my / our Non-Resident External / Ordinary Account/FCNR Account(s).

Sole / First Applicant / Guardian

Second Applicant

Third Applicant

Email: service@dspblackrock.com Website: www.dspblackrock.com


Quick Checklist Name, Address are correctly mentioned Email ID / Mobile number are mentioned PAN / KYC requirements are enclosed Complete Bank details provided

Contact Centre: 1800 200 4499


Additional documents provided if investor name is not pre-printed on payment cheque or if Demand Draft is used. Additional documents provided in case of specific exceptional Third Party Payments.

Full scheme name, plan, option is mentioned Pay-In bank details and supportings are attached Nomination facility opted Form is signed by all applicants

COMMON APPLICATION FORM


FOR LUMPSUM INVESTMENTS
BROKER ARN - ARN-74461 ARN-74461 CODE SUB-BROKER CODE

Application No.

Please read INSTRUCTIONS (Page 24-26) carefully. All sections to be completed in ENGLISH in BLACK / BLUE COLOURED INK and in BLOCK LETTERS. FOR OFFICIAL USE ONLY
SERIAL NUMBER, DATE & TIME OF RECEIPT

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.

EXISTING UNITHOLDERS INFORMATION If you have an existing folio no. with PAN & KYC validation, please mention your name & folio No. and proceed to Step 4
Mr. Ms. M/s FIRST MIDDLE LAST Folio No.

Name

APPLICANT(S) DETAILS (Please Refer to Instruction No. II (b) )


Mr. Ms. M/s FIRST

Mandatory information If left blank the application is liable to be rejected. LAST Date of Birth* Attested PAN Card D D M M Y Y Y Y

1st Applicant PAN* Name of * # PAN*

MIDDLE Enclosed (Please )

KYC Acknowledgement Letter

Mr. Ms.

GUARDIAN IN CASE FIRST APPLICANT IS A MINOR Relationship with Minor applicant

OR

CONTACT PERSON IN CASE OF NON-INDIVIDUAL APPLICANTS Enclosed (Please ) Attested PAN Card KYC Acknowledgement Letter D D M M Y Y Y Y

Natural guardian Court appointed guardian LAST

2nd Applicant PAN*

Mr. Ms.

FIRST

MIDDLE Enclosed (Please )

Date of Birth Attested PAN Card Date of Birth Attested PAN Card

KYC Acknowledgement Letter

3rd Applicant PAN*

Mr. Ms.

FIRST

MIDDLE Enclosed (Please )


#

LAST

D M M

KYC Acknowledgement Letter

For PAN & KYC requirements, please refer to the instruction Nos. II b(4), V(I) & X Mode of holding [Please tick ()] Single Anyone or Survivor Joint (Default option: Anyone or Survivor)

Name of Guardian/Contact Person is Mandatory in case of Minor/Non-Individual Investor. For documents to be submitted on behalf of minor folio refer instruction IIb(2) Others HUF Club/Society PLEASE SPECIFY Sole Proprietorship Company Partnership Firm FII

Status of First Applicant [Please tick ()] Minor Trust NRI/PIO Bank/FI

Resident Individual AOP/BoI

Correspondence Address (Please provide full address)* HOUSE / FLAT NO. STREET ADDRESS STREET ADDRESS CITY / TOWN COUNTRY Tel. (Off.) Email Occupation [Please tick ()] Professional Business Retired Housewife Service STATE PIN CODE Tel. (Res.)

Overseas Address (Mandatory for NRI / FII Applicants) HOUSE / FLAT NO. STREET ADDRESS STREET ADDRESS CITY / TOWN COUNTRY Fax Mobile Student Others (Please specify) STATE PIN CODE

Please 9 if you wish to receive Account statement / Annual Report/ Other statutory information via Post instead of Email Please 9 any of the frequencies to receive Account Statement through e-mail : Daily Weekly Monthly Quarterly Half Yearly Annually

* Mandatory information If left blank the application is liable to be rejected. Please refer to instruction no.IX

3
MANDATORY

BANK ACCOUNT DETAILS OF FIRST APPLICANT (Please Refer to Instruction No. III)
Account Type Name of Bank Branch Details 9 Digit MICR code BRANCH NAME 11 Digit IFSC Code (Please refer Instruction No. XI) Current Savings NRO NRE FCNR Account Number

Mandatory information If left blank the application is liable to be rejected.

BRANCH CITY

4 DEMAT ACCOUNT DETAILS OF FIRST APPLICANT


Depository Participant (DP) ID (NSDL only)

NSDL

OR

CDSL

Beneficiary Account Number (NSDL only)

Depository Participant (DP) ID (CDSL only)

FOR ANY ASSISTANCE OR FURTHER INFORMATION PLEASE CONTACT US

Application No.

ICICI Prudential Asset Management Company Limited


3rd Floor, Hallmark Business Plaza, Sant Dyaneshwar Marg, Bandra (East), Mumbai - 400 051. India

SIGNATURE STAMP & DATE

SIGNATURE STAMP & DATE

SIGNATURE STAMP & DATE


WEBSITE

TOLL FREE NUMBER 1800 222 999 (MTNL/BSNL) 1800 200 6666 (OTHERS) EMAIL

enquiry@icicipruamc.com

www.icicipruamc.com

Note: All future communications in connection with this application should be addressed to the nearest ICICI Prudential Mutual Fund Customer Service Centre, quoting full name of the first applicant, the application serial number, the name of the scheme, the amount invested, date and the place of the Customer Service Centre where application was lodged.

5 1

INVESTMENT & PAYMENT DETAILS (Refer Instruction No. IV) Name of scheme ICICI PRUDENTIAL
Retail Option Institutional Option

For Plans & Sub-options please see key features for scheme specific details

TAX PLAN
Dividend Monthly Reinvestment or Quarterly Payout OR AEP^ Regular* or Monthly Quarterly NEFT ` Appreciation Half Yearly RTGS

Option & Sub option (Please 9 the appropriate boxes only if applicable to the scheme in which you plan to invest)
Growth Daily Weekly OR Fortnightly
* Cumulative AEP Regular Option: Encashment of units is subject to declaration of dividend in the respective Scheme(s). Please refer to Instruction no. IV(c)

Dividend Frequencies

Half Yearly Cheque DD

AEP Frequencies

Payment Details for Scheme 1


Amount Paid Cheque / DD Number `

Mode of Payment
DD Charges
(if applicable)

Funds Transfer Amount Invested

A
Date

B Y Y

A+B

BANK / BRANCH

BANK ACCOUNT DETAILS


Account Type Bank Details Current Savings

(For Payment Details of Scheme 1 ) NRO NRE FCNR

Mandatory information If left blank the application is liable to be rejected. Account Number BRANCH NAME / CITY

NAME OF BANK

Applications with Third Party Cheques, prefunded instruments etc. and in circumstances as detailed in AMFI Circular No.135/BP/16/10-11 shall be processed in accordance with the said circular. For Third Party Payment Declaration form and instructions please refer to pages 19-20 and 25 respectively.

Name of scheme ICICI PRUDENTIAL


Retail Option Institutional Option

Option & Sub option (Please 9 the appropriate boxes only if applicable to the scheme in which you plan to invest)
Growth OR Dividend Reinvestment or Payout OR AEP^ Regular* or Appreciation
* Cumulative AEP Regular Option: Encashment of units is subject to declaration of dividend in the respective Scheme(s). Please refer to Instruction no. IV(c)

Dividend Frequencies

Daily

Weekly

Fortnightly

Monthly

Quarterly

Half Yearly Cheque DD

AEP Frequencies

Monthly

Quarterly NEFT

Half Yearly RTGS

Payment Details for Scheme 2


Amount Paid Cheque / DD Number `

Mode of Payment
DD Charges
(if applicable)

Funds Transfer Amount Invested `

A
Date

B Y Y

A+B

BANK / BRANCH

BANK ACCOUNT DETAILS


Account Type Bank Details Current Savings

(For Payment Details of Scheme 2 ) NRO NRE FCNR

Mandatory information If left blank the application is liable to be rejected. Account Number BRANCH NAME / CITY

NAME OF BANK

For Third Party Payment Declaration form and instructions please refer to pages 19-20 and 25 respectively and refer instruction VI(e). Please ensure that the Bank Account details are mentioned separately, for Cheque and Demand Draft (DD) payments for Investments in Scheme 1 and in Scheme 2. ^AEP - Automatic encashment plan

NOMINATION DETAILS (Refer instruction VII) For Multiple nominations, please use the form on page 23. Nomination is mandatory if the mode of holding is SINGLE.
I/We do not wish to nominate [Please tick () & sign] SIGNATURE OF FIRST APPLICANT SIGNATURE OF SECOND APPLICANT SIGNATURE OF THIRD APPLICANT

I/We hereby nominate the under-mentioned nominee to receive the amount to my/our credit in the event of my/our death and Date of Birth is MANDATORY in case Nominee is a minor confirm that I/we have read and understood the nomination clause under instruction no. VII.

Nominee Guardian Nominees Address

NAME OF NOMINEE MANDATORY, IF NOMINEE IS A MINOR HOUSE / FLAT NO CITY / TOWN PIN CODE

Date of Birth

Relationship with Minor applicant ()

Natural guardian Court appointed guardian

STREET ADDRESS SIGNATURE OF NOMINEE / GUARDIAN, IF NOMINEE IS A MINOR

INVESTOR(S) DECLARATION & SIGNATURE(S)

The Trustee, ICICI Prudential Mutual Fund, I/We have read and understood the Scheme Information Document/Key Information Memorandum of the Scheme(s). I/We apply for the units of the Fund and agree to abide by the terms, conditions, rules and regulations of the scheme and other statutory requirements of SEBI, AMFI, Prevention of Money Laundering Act, 2002 and such other regulations as may be applicable from time to time.I/We confirm to have understood the investment objectives, investment pattern, and risk factors applicable to Plans/Options under the Scheme(s). I/we have not received nor been induced by any rebate or gifts, directly or indirectly, in making this investment. I/We declare that the amount invested in the Scheme is through legitimate sources only and is not designed for the purpose of contravention or evasion of any Act, Regulations or any other applicable laws enacted by the Government of India or any Statutory Authority. I/We agree that in case my/our investment in the Scheme is equal to or more than 25% of the corpus of the plan, then ICICI Prudential Asset Management Co. Ltd.(the 'AMC'), has full right to refund the excess to me/us to bring my/our investment below 25%. I/We hereby declare that I am/we are not US Person(s). I/We hereby declare that I/we do not have any existing Micro SIPs which together with the current application will result in a total investments exceeding Rs.50,000 in a year. 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. I/We interested in receiving promotional material from the AMC via mail, SMS, telecall, etc. If you do not wish to receive, please call on tollfree no. 1800 222 999 (MTNL/BSNL) or 1800 200 6666 (Others).

D
SIGNATURE OF FIRST APPLICANT SIGNATURE OF SECOND APPLICANT SIGNATURE OF THIRD APPLICANT

ACKNOWLEDGEMENT SLIP To be filled in by the Investor. Subject to realization of cheque and furnishing of Mandatory Information. Please Retain this Slip 1 2 Scheme Scheme
ICICI PRUDENTIAL ICICI PRUDENTIAL

TAX PLANSCHEME ANDOption - Growth OPTION


SCHEME AND OPTION 2 ` ` AMOUNT AMOUNT CHEQUE / DD No. CHEQUE / DD No.

D D

D D

M M

M M

Y Y

Y Y

DRAWN ON BANK & BRANCH

DRAWN ON BANK & BRANCH

EXISTING FOLIO NO.

Reliance Capital Asset Management Limited A Reliance Capital Company

APP No.:

WE-00012343

COMMON APPLICATION FORM


All Columns marked * are mandatory. TO BE FILLED IN CAPITAL LETTERS & IN BLUE/BLACK INK ONLY.

1. DISTRIBUTOR / BROKER INFORMATION (Refer Instruction No. I.9)


Name & Broker Code / ARN Sub Broker / Sub Agent Code

2. EXISTING UNIT HOLDER INFORMATION


For existing investors please fill in your Folio number, FOLIO NO.

ARN-74461
3. APPLICANT INFORMATION (Refer Instruction No. II)
APPLICATION FOR MODE OF HOLDING OCCUPATION Zero Balance Folio Single Business Civil Servant Retired Political Party Official 1st Applicant 2nd Applicant 3rd Applicant Resident Indian Resident Indian Resident Indian Mr. Ms. Professional Service
Politician

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.
Invest Now Joint Retired Forex Dealer STATUS NONINDIVIDUAL Student House wife FIIs Minor Any One or Survivor(s) (Default Joint) Current/Former MP/MLA/MLC/Head of State Senior Executive of State owned corporation Society Fls Trust HUF

Others _________________ NRI NRI NRI Banks AOP/BOI Company/Body Corporate Partnership firm Others _________________

STATUS INDIVIDUAL

Name of First / Sole applicant

M/s.

1st holder PAN

PAN Proof Enclosed

KYC Acknowledgement Copy

#Document Category No.


(Refer Instruction No. IX.4)

Date of Birth**
D D M M Y Y Y Y

(**Date of birth mandatory if the applicant is minor) Mr. Ms. Relation with Minor / Designation M a n d a t o r y

Name of Guardian (In case of Minor)/(Contact Person Name - In case of non-individual Investors)

Guardians PAN

y
Mr.

PAN Proof Enclosed Ms.

KYC Acknowledgement Copy

#Document Category No.


(Refer Instruction No. IX.4)

Name of Second applicant

2nd holder PAN

y Mr.

PAN Proof Enclosed

KYC Acknowledgement Copy

#Document Category No.


(Refer Instruction No. IX.4)

Name of Third applicant

Ms.
PAN Proof Enclosed KYC Acknowledgement Copy #Document Category No.
(Refer Instruction No. IX.4)

3rd holder PAN

#Mandatory for MICRO SIP Investors (Refer Instruction No. IX) Mailing Address Add 1 Add 2 Add 3 State Add 1 Add 2 City Country PIN Country District City PIN

Overseas Address (Mandatory for NRI / FII Applicant) (Please provide your complete address. P.O. Box alone is not adequate)

CONTACT DETAILS OF SOLE/FIRST APPLICANT (For Receiving SMS Alert) Tel. No. STD Code __________ Office ____________________ Residence _____________________ Mobile no. ______________________________________

Email ID

(For Receiving Email Alert)

Investors providing Email Id would mandatorily receive only E - Statement of Accounts in lieu of physical Statement of Accounts. (Refer Instruction No. VI)

I WISH TO APPLY FOR TRANSACT ONLINE


I have read & understood the Terms & Conditions attached M

I WISH TO APPLY FOR RELIANCE ANY TIME MONEY CARD (Please refer to ATM Instruction)
Name as you would like to appear on Any Time Money Card (Max. 19 characters) a n d a t o r r y y

Mothers maiden name in full M a n d a t o

Please collect your time stamped acknowledged slip for future references Received from ___________________________________________________________________________an application for allotment of

TAX SAVER FUND Units under Reliance ________________________________________________________as per details below.
Growth Option Bonus Option Dividend Reinvestment Dividend Payout

APP No.:

WE-00012343

Cheque / DD No. ____________________________ Dated ______________Rs. _______________________ drawn on ________________________________________________________________________________


Time Stamp & Date of receiving office

4 . BANK ACCOUNT DETAILS (Refer Instruction No.III) MANDATORY for Redemption/Dividend/Refunds, if any A/c. Type Bank Branch PIN IFSC Code M SB a n d Current a t o NRO r y Branch City For Credit via NEFT 9 Digit MICR Code* F o r C r e d i t v i a E C S NRE FCNR Account No. M a n d a t o r y

Please ensure the name in this application form and in your bank account are the same

5. INVESTMENT & PAYMENT DETAILS (Separate Application Form is required for investment in each Plan/Option (Refer instruction no. IV) PAYMENT BY CASH IS NOT PERMITTED.
Scheme Plan Growth Plan Dividend Plan Option Growth Option Bonus Option Reinvestment Payout DD Charge Rs. Net Cheque / DD Amount Rs. Cheque / DD No. & Date Bank / Branch

RELIANCE TAX SAVER FUND


SIP ENROLLMENT DETAILS
Frequency (Please ) REGULAR Enrollment Period: From: M M

PDC
Quarterly Y To:

Auto Debit / ECS (Refer Instruction No. I-12)


SIP Date: Enrollment Period: From: M 2 Y Y To: 1 2 10 9 9 18 28 PERPETUAL (Default) (Not applicable for PDCs) Amount per Instalment: Rs. _______________________

Monthly Y

6. DOCUMENTS ENCLOSED (Please

) (MANDATORY) (Refer to Instruction No.I-9)

For Corporate For Systematic Transactions For Additional Document Memorandum & Articles of Association SIP Enrollment Form (Cheque or Auto Debit and ECS) Cheques Power of Attorney Trust Deed Bye-Laws Partnership Deed Systematic Transfer Plan & Dividend Transfer Plan Enrollment Form Others ________________ Resolution / Authorization to invest Systematic Withdrawal Plan Enrollment Form Reliance SMART List of Authorised Signatories with Specimen Signature(s) STEP Enrollment Form Trigger Form Reliance SIP Insure Form

7. NOMINATION (Refer to Instruction No.V)

(Mandatory if mode of holding is single)

I/ We _______________________________________, __________________________________and__________________________________________* (Unit holder 1) (Unit holder 2) (Unit holder 3) do hereby nominate the person(s) more particularly described hereunder/ and*/cancel the nomination made by me/ us on the ________ day of________________ in respect of the Units under Folio No.___________________ (* strike out which is not applicable) Date of Signature of Signature of Proportion (%) by which the units will be shared by each Name and Address of Nominee(s) Name and Address of Guardian Birth (Minor) Nominee Guardian Nominee (should aggregate to 100%)
(to be fur nished in case the Nominee is a minor)

Nominee 1 Nominee 2 Nominee 3 I/ We _______________________________________, _____________________________________and__________________________________________ (Unit holder 1) (Unit holder 2) (Unit holder 3) do hereby declare that we do not wish to nominate any person/person(s) in the folio/account.

Sole / 1st applicant/ Authorised Signatory

2nd applicant/ Authorised Signatory

3rd applicant/ Authorised Signatory

8. DECLARATION
I/We would like to invest in Reliance_____________________________ subject to terms of the Statement of Additional Information (SAI), Scheme Information Document (SID), Key Information Memorandum (KIM) and subsequent amendments thereto. I/We have read, understood (before filling application form) and is/are bound by the details of the SAI, SID & KIM including details relating to various services including but not limited to ATM/ Debit Card. I/We have not received nor been induced by any rebate or gifts, directly or indirectly, in making this investment. I / We declare that the amount invested in the Scheme is through legitimate sources only and is not designed for the purpose of contravention or evasion of any Act / Regulations / Rules / Notifications / Directions or any other Applicable Laws enacted by the Government of India or any Statutory Authority. I accept and agree to be bound by the said Terms and Conditions including those excluding/ limiting the Reliance Capital Asset Management Limited (RCAM) liability. I understand that the RCAM may, at its absolute discretion, discontinue any of the services completely or partially without any prior notice to me. I agree RCAM can debit from my folio for the service charges as applicable from time to time. 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. I hereby declare that the above information is given by the undersigned and particulars given by me/us are correct and complete. Applicable for NRI Investors: I confirm that I am resident of India. I/We confirm that I am/We are Non-Resident of Indian Nationality/Origin and I/We hereby confirm that the funds for subscription have been remitted from abroad through normal banking channels or from funds in my/our Non-Resident External / Ordinary Account/FCNR Account. I/We undertake that all additional purchases made under this folio will also be from funds received from abroad through approved banking channels or from funds in my/ our NRE/FCNR Account.

S i g n a t u r e

Sole / 1st applicant/Guardian/ Authorised Signatory

2nd applicant/ Authorised Signatory

3rd applicant/ Authorised Signatory

ACKNOWLEDGMENT SLIP (To be filled in by the Applicant)


One Indiabulls Centre, Tower 1, 11th & 12th Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg Elphinstone Road, Mumbai-400 013

Call : 30301111 | Toll free: 1800-300-11111 www.reliancemutual.com

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