ICICI Prudential Banking and Financial Services Fund

(New Fund Offer from ICICI Prudential Mutual Fund)

Application Form (for Resident Indians and NRIs/PIOs)

Broker Code Sub-Broker Code Bank Serial No. Date & Time
(Please read the instructions before
completing the application form)
ARN- 0155 NJ IndiaInvest 54934
of Receipt

New Fund Offer Opens On New Fund Offer Closes On Earliest Closing On
July 09, 2008 August 07, 2008 August 07, 2008
1 FOR EXISTING UNITHOLDERS Date:
If you have an existing folio with PAN validation & KYC validation (if applicable), please Folio No.
mention the folio number in the space provided and proceed to Step 5. Please note that Application No.
the applicable details and mode of holding will be as per the existing folio.

2 ABOUT YOU
Name of First Applicant Date of Birth (Mandatory)
Mr. Ms. M/s. D D M M Y Y Y Y

Name of Guardian (in case of minor) / Contact Person (In case of non-individual investors) Status [Please tick ()]

Mr. Ms. Minor Trust

NRI/PIO* Bank/FI
Designation of the Contact Person (In case of non-individual investors) Resident Individual AOP/BoI
HUF Club/Society
Sole Proprietorship Company
Mailing Address (Please provide full address) (Mandatory) Partnership Firm
Others (Please specify) _______
_______________________
*NRIs/PIOs applications to be
City PIN submitted ONLY at any of the
(Mandatory) designated ICICI Bank, Citibank,
HDFC Bank Collection Centres or
State Country at AMC branches.
Communication
Tel. Tel.
(Off.) Mobile

E-Mail
Overseas Address (in case of NRIs/FIIs)

City ZIP/P I N
(Mandatory)
Country
State (Mandatory)

Name of Second Applicant Mode of holding [Please tick ()]

Mr. Ms. Single Joint

Name of Third Applicant Anyone or Survivor

Mr. Ms. (Default option: Anyone or Survivor)

Permanent Account Number (PAN) - Mandatory Know Your Customer (KYC) Occupation [Please tick ()]
{Please submit a copy of PAN card. In case the 1st applicant is minor, (Please refer to instruction no. IX) Please tick ()
please provide Guardian’s PAN. Refer to Instruction No. II-b(4) } (Mandatory for investment of Rs.50,000 & above) Professional Housewife
1st Applicant Copy of KYC acknowledgement enclosed Business Service

Guardian (in case 1st Retired Student

applicant is minor)/POA Copy of KYC acknowledgement enclosed
Others (Please specify)
2nd Applicant Copy of KYC acknowledgement enclosed _____________________________
_________________________
3rd Applicant Copy of KYC acknowledgement enclosed _________________________

3 E-MAIL COMMUNICATION – I/We wish to receive the following via e-mail instead of physical document:
Account Statement Quarterly Review & Annual Report Other statutory information

 
ACKNOWLEDGEMENT SLIP (To be filled in by the investor) Application No.

Received from: Mr./Ms./M/s.

ess
Addr

Signature, Stamp & Date

 4 BANK ACCOUNT DETAILS OF FIRST APPLICANT (Refer instruction No.III)
Bank Particulars (Name of the Bank)

MANDATORY
Branch Address
City
Account Number Account Type
If “Mandatory Details” are not provided,
Current Savings NRO NRE your application is liable to be rejected.
9 Digit IFSC Code
MICR code (11 digit)
(a) Please quote 9 Digit Code No. of your Bank and Branch corresponding to Bank Account details. (This number appears on every leaf of your cheque book after your cheque
number). (b) Please attach a blank “cancelled” Cheque or a clear photocopy of a cheque issued by your bank verifying of the Code No. (c) The AMC reserves the right to
make dividend payments through ECS where MICR code is available.
5 YOUR INVESTMENT DETAILS
Retail Option: In case, the investor has not selected the sub-option for his investments or selected multiple sub-options, the default sub-option will be Dividend Reinvestment. SIP through:
Institutional Option I : Please use a separate application form available on the website www.icicipruamc.com. Standing Instruction/
Option Retail Option Direct Debit
Scheme Name:
ICICI PRUDENTIAL BANKING & Dividend ECS
FINANCIAL SERVICES FUND Sub-Options (Please tick)
Growth Dividend Payout Dividend Reinvestment
(Optional)
AMOUNT INVESTED AND PAYMENT DETAILS
Amount Paid (A) DD Charges (B) Amount Invested (C) = (A) + (B) TOP UP Amount*:
Rs. Rs. Rs. Rs.___________________
* TOP UP amount has to be
Bank Name & Branch
in multiples of Rs.500 only.
TOP UP Frequency:
City Cheque/DD No. Cheque/DD Date Account Type (For NRI Investors) Half Yearly Yearly
D D M M Y Y NRO NRE FCNR [Please refer to Instruction
No.X]

6 NOMINATION DETAILS (Optional) • For single nomination, please fill in the details below. • For multiple nominations, please use the nomination form overleaf.
I/We hereby nominate the undermentioned Nominee to receive the amounts to my/our credit in 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/Trustees. Date of Birth (If nominee is
Name of the Nominee minor) (Mandatory)
Mr. Ms. M/s. D D M M Y Y Y Y
Address of Nominee (Please provide full address)

PIN
Name of the Guardian (If nominee is minor) - Mandatory Relationship with minor

Address of Guardian Signature of Guardian

PIN
Code

7 YOUR CONFIRMATION
To the Trustee, ICICI Prudential Mutual Fund – I/We have read and DD MM YYYY
understood the Offer Document/Key Information Memorandum of ICICI Pru- First
dential Banking and Financial Services Fund. I/We apply for the units of ICICI Prudential Banking and Applicant
SIGNATURE(S)

Financial Services Fund and I/we agree to abide by the terms, conditions, rules and regulations of the scheme.
I/We confirm to have understood the terms & conditions, investment objectives, investment pattern, funda-
mental objectives and risk factors applicable to the Scheme. I/We have understood the details of the scheme
and I/we have not received nor been induced by any rebate or gifts, directly or indirectly, in making this Second
investment. I/We agree to abide by the terms, conditions, rules, regulations and other statutory requirements Applicant
of SEBI, AMFI, Prevention of Money Laundering Act, 2002 and such other regulations as may be applicable
from time to time. 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, Direc-
tions or any other applicable laws enacted by the Government of India or any Statutory Authority. I/We agree Third
that in case my/our investment in the Scheme is equal to or more than 25% of the corpus of the Scheme, then Applicant
ICICI Prudential Asset Management Co. Ltd., Investment Manager to the Scheme, has full right to refund the
excess to me/us to bring my/our investment below 25%.

Please ensure that the following details are complete and accurate, in the absence of which the application will be rejected & refunded.
1. First applicant’s Bank name. 5. KYC acknowledgement for all the holders, if applicable.
2. First applicant’s Bank account number. 6. Application amount should be equal to or greater than the
3. Cheque/DD date should be on or before the NFO closure date. minimum subscription amount.
4. PAN details and copy of PAN for all the holders. The above mentioned cases are not an exhaustive list of situations in which the
rejection could happen.

 
Application for Units of ICICI Prudential Banking and Financial Services Fund
Option Retail Option
Dividend
Sub-Options (Please tick) Growth Dividend Payout Dividend Reinvestment

Application Amount Rs. Cheque/DD No. Dated

drawn on branch

SIP TOP UP Amount (Rs.) _______________________________________ Frequency: Half Yearly Yearly

 ICICI Prudential Banking and Financial Services Fund
(New Fund Offer from ICICI Prudential Mutual Fund)

SYSTEMATIC INVESTMENT PLAN (SIP) AUTO DEBIT (ECS) INSTRUCTION FORM APPLICATION NO.:
List of Cities for SIP Auto Debit via ECS (Debit Clearing): • Agra • Ahmedabad • Allahabad • Amritsar • Asansol • Aurangabad • Bangalore • Baroda • Bhilwara • Bhopal • Bhubaneshwar • Burdwan • Calicut
• Chandigarh • Chennai • Cochin • Coimbatore • Dehradun • Delhi • Dhanbad • Durgapur • Erode • Gorakhpur • Guwahati • Gwalior • Hubli • Hyderabad • Indore • Jabalpur • Jaipur • Jalandhar • Jammu •
Jamnagar • Jamshedpur • Jodhpur • Kakinada • Kanpur • Kolhapur • Kolkata • Lucknow • Ludhiana • Madurai (SIP Dates: 1st, 7th & 25th only) • Mangalore • Mumbai • Mysore • Nagpur • Nasik • Nellore •
Panjim • Patna • Pondicherry (SIP Dates: 10th, 15th & 25th only) • Pune • Raipur • Rajkot • Ranchi • Salem • Shimla • Sholapur • Siliguri • Surat • Tirupati • Tirupur • Trichur • Trichy (SIP Dates: 7th, 10th & 25th
only) • Trivendrum • Udaipur • Udipi • Varanasi • Vijayawada (also covers Guntur, Tenali & Mangalgiri) • Vishakhapatnam.
I/We hereby apply to the Trustee of ICICI Prudential Mutual Fund for the Systematic Investment
Existing Folio No. Date:
Plan (SIP) Enrolment under the following scheme and agree to abide by the terms and conditions
Sole/First Applicant’s Name of the plan.
Option: Retail Option Each SIP Amount: Rs. _____________________________
Scheme Name: (Rupees ________________________________________ SIP Start Month/Year : October 2008
Sub-Options (Please tick)
ICICI PRUDENTIAL BANKING ______________________________________________) SIP End Month/Year
AND FINANCIAL SERVICES Dividend
Growth
FUND Payout Reinvestment SIP Date: 1st 7th 10th 15th 25th M M Y Y Y Y

SIP TOP UP Please note: SIP dates would be the 1st or 7th
(Optional) TOP UP Amount*: Rs.___________________________________ TOP UP Frequency: Half Yearly Yearly or 10th or 15th or 25th of every month except
(Tick to avail this facility) * TOP UP amount has to be in multiples of Rs.500 only. [Please refer to General Instruction No. 4] for Madurai, Trichy & Pondicherry.
We hereby authorise ICICI Prudential Mutual Fund and their authorised service providers to debit my/our following bank account by ECS (Debit Clearing) for collection of SIP payments.
PARTICULARS OF BANK ACCOUNT (Mandatory)
Bank Account Holders Name
Bank Name Branch Name
Account Number Account Type Savings Current Cash Credit
9 Digit MICR Code (Please enter the 9 digit number that appears in your cheque next to the cheque number)
In case of At Par accounts, kindly provide the correct MICR number of the bank branch.
I/We hereby declare that the particulars given above are correct and express my willingness to make payments referred above through participation in ECS. If the transaction is delayed or not effected at all
for reasons of incomplete or incorrect information, I/We would not hold the user institution responsible. I/We will also inform ICICI Prudential Mutual Fund, about any changes in my bank account. I/We
have read and understood the Offer Document/Key Information Memorandum of ICICI Prudential Banking and Financial Services Fund. I/We apply for the units of ICICI Prudential Banking and Financial
Services Fund and I/we agree to abide by the terms, conditions, rules and regulations of the scheme.
I/We hereby agree to avail the Top up facility for SIP and authorize my bank to auto debit a further increase in installment from my designated account.
I/We agree that AMC/Mutual Fund (including its affiliates), and any of its officers directors, personnel and employees, shall not be held responsible for any delay/wrong debits on the part of the bank for
executing the direct debit instructions of additional sum on a specified date from my account. If the transaction is not effected at all for reasons of incomplete or incorrect information, the user institution
would not be held responsible.
I/We agree to abide by the terms, conditions, rules and regulations of this facility. I/We confirm to have understood that the introduction of this facility may also give rise to operational risks and hereby take
full responsibilty. Signatures as in Bank Records
2nd Holder

3rd Holder
1st Holder

  
Authorisation of the Bank Account Holder for Auto Debit (ECS)
This is to inform I/we have registered for the RBI's Electronic Clearing Service (Debit Clearing) and that my Account
payment towards my investment in ICICI Prudential Mutual Fund shall be made from my/our below
mentioned bank account with your bank. I/We authorise the representative carrying this ECS mandate Form Number
to get it verified & executed.
Signatures as in Bank Records
2nd Holder

3rd Holder
1st Holder

    
STANDING INSTRUCTION/DIRECT DEBIT Existing
Folio No. APPLICATION NO.:
FOR SYSTEMATIC INVESTMENT PLAN
The Manager, _______________________________________________________________________________________________________________ (Bank Name & Branch Address)
I/We, Mr./Ms./M/s. _____________________________________________________________________________________________ hereby authorise you to debit on a monthly basis (as a Standing
Instruction) from my/our Account No. mentioned below (hereinafter referred as “funding account”) for Rs.______________________ (Rupees ________________________________________________
only) and remit the same on account of ICICI Prudential Mutual Fund.
Option: Retail Option Each SIP Amount: Rs. _____________________________ SIP Start Month/Year: October
Scheme Name: (Rupees ________________________________________ 2008
Sub-Options (Please tick) SIP End Month/Year
ICICI PRUDENTIAL BANKING ______________________________________________)
AND FINANCIAL SERVICES Dividend M M Y Y Y Y
Growth
FUND Payout Reinvestment SIP Date: 1st 7th 10th 15th 25th
Please note: SIP dates would be the 1st
SIP TOP UP or 7th or 10th or 15th or 25th of every
(Optional) TOP UP Amount*: Rs._____________________________TOP UP Frequency: Half Yearly Yearly month except for Madurai, Trichy &
Pondicherry.
(Tick to avail this facility) * TOP UP amount has to be in multiples of Rs.500 only. [Please refer to General Instruction No. 4]
Debit A/c. No._____________________________
Name of the Beneficiary: ICICI Prudential Mutual Fund Account.
I/We undertake to keep sufficient funds in the funding account on the date of execution of standing instruction. I/We hereby declare that the particulars given above are correct and
complete. If the transaction is delayed or not effected at all for reasons of incomplete or incorrect information, I/we would not hold the Mutual Fund or the Bank responsible. If the date
of debit to my/our account happens to be a non banking/business day as defined in the Offer Document of the said Scheme of ICICI Prudential Mutual Fund, execution of the SIP will
happen on the previous business day and allotment of units will happen as per the Terms and Conditions listed in the Offer Document of the Mutual Fund. I/We have read and
understood the offer document(s) of the Fund. I/We apply for the units of the scheme and I/we agree to abide by the terms, conditions, rules and regulations of the scheme. I/We confirm
to have understood the terms & conditions, investment objectives, investment pattern, fundamental objectives and risk factors applicable to the Plans and/or Options under the
Scheme(s). I/We agree to abide by the terms, conditions, rules and regulations of the Plan(s). I/We have understood the details of the scheme and I/we have not received nor been
induced by any rebate or gifts, directly or indirectly, in making this investment. I/We hereby agree to avail the TOP UP facility for SIP and authorize my bank to execute the Standing
Instruction for a further increase in installment from my designated account. I/We agree that AMC/Mutual Fund (including its affiliates), and any of its officers directors, personnel and
employees, shall not be held responsible for any delay / wrong debits on the part of the bank for executing the standing instructions of additional sum on a specified date from my
account. If the transaction is not effected at all for reasons of incomplete or incorrect information, the user institution would not be held responsible. I/We agree to abide by the terms,
conditions, rules and regulations of this facility. I/We confirm to have understood that the introduction of this facility may also give rise to operational risks and hereby take full
responsibilty.
Signatures as in Bank Records
Yours faithfully,
2nd Holder

3rd Holder
1st Holder