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Initial Commission will be paid by the investor directly to the distributor, based on assessment of various factors including the service rendered by the Distributor.
Transaction Charges: SEBI (Mutual Fund) Regulations allow deduction of transaction charges of Rs. 100/- from your investment for payment to your distributor if your distributor has opted to receive
transaction charges for investments sourced by him. The transaction charges deductible are Rs. 150/- if you are investing in Mutual Funds for the rst time. If you are making a SIP Investment, the transaction
charges would be deducted over 3-4 instalments. No transaction charges would be levied if you are not investing through a Distributor or your investment amount is less than Rs.10,000/-.
If this is the rst time, you are investing in any mutual fund, please tick here
Investor’s Declaration where EUIN is not furnished: I/We conrm 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 and/or notwithstanding the advice of inappropriateness, if any, provided by the employee/relationship manager/sales person of distributor
and the distributor has not charged any advisory fees on this transaction.
Sole/1st Applicant
2nd Applicant
3rd Applicant
1. EXISTING UNIT HOLDER’S INFORMATION
(If you hold a Folio with L&T Mutual Fund, please furnish the below information and move to Investment & Payment Information section.)
Name of Sole/1st Unit Holder Mr. Ms. M/s
First Name Middle Name Last Name
Folio No.
PAN/PEKRN
#
Aadhaar No.
First Unit Holder
KIN
^
Date of Birth
^
D D M M Y Y Y Y
Mobile No. +91- E-mail Id
2. NEW APPLICANT(S) PERSONAL INFORMATION
Name of 1st/Sole Applicant Mr. Ms. M/s
First Name Middle Name Last Name
PAN/PEKRN
#
Aadhaar No.
First Unit Holder
KIN
^
Date of Birth
^
D D M M Y Y Y Y
(Mandatory if rst applicant is a minor)
Mobile No. +91- E-mail Id
Guardian (For Minor Investments) / Contact Person (For Non-Individuals)
Name Mr. Ms. M/s
First Name Middle Name Last Name
PAN/PEKRN
#
Aadhaar No.
First Unit Holder
KIN
^
Date of Birth
^
D D M M Y Y Y Y
(Mandatory if rst applicant is a minor)
Mobile No. +91- E-mail Id
Relationship with Minor Applicant Proof of Date of Birth Proof of the Relationship with minor
Natural Guardian
Court Appointment Guardian
Birth Certicate Copy
Passport Copy
Aadhaar Card Copy
Others
(please specify)
Birth Certicate Copy
Passport Copy
Court Appointment Order
Others
(please specify)
3.
DETAILS OF OTHER APPLICANT(S) (Please note that where the sole/1st applicant is a minor, no joint holders are allowed)
Name of 2nd Applicant Mr. Ms. M/s
First Name Middle Name Last Name
PAN/PEKRN
#
Aadhaar No.
First Unit Holder
KIN
^
Date of Birth
^
D D M M Y Y Y Y
(Mandatory if rst applicant is a minor)
Mobile No. +91- E-mail Id
Name of 3rd Applicant Mr. Ms. M/s
First Name Middle Name Last Name
PAN/PEKRN
#
Aadhaar No.
First Unit Holder
KIN
^
Date of Birth
^
D D M M Y Y Y Y
(Mandatory if rst applicant is a minor)
Mobile No. +91- E-mail Id
*Investors providing e-mail id will receive Account Statements, Annual Report & other communication over e-mail. If you however wish to receive this communication in your
registered postal address, please tick here
KYC is mandatory. Please enclose copies of KYC acknowledgement letters for all applicants.
#
PEKRN required for Micro investments upto Rs. 50,000 in a year.
^ 14 digit KYC Identication Number (KIN) and Date of Birth is mandatory for Individual(s) who has registered under Central KYC Records Registry (CKYCR).
Common Application Form
App. No.
Time Stamp
For Ofce Use Only
Acknowledgement
Stamp & Date
App. No.
ACKNOWLEDGEMENT SLIP (To be lled in by the Applicant)
Received from an application for
investment in Scheme L&T
Option
Investment Type (
ü
)
Lumpsum
SIP
Micro SIP
Multi-Scheme SIP
Multi-Scheme Lumpsum
Investment Cheque Details : Instrument number
Rs. Dated
D D M M Y Y Y Y
Drawn on Bank
Branch City
Please refer to the general instructions for assistance and complete all sections in English. For legibility, please use BLOCK LETTERS in black or dark ink.
Distributor/RIA Code Sub-Distributor ARN Sub-Distributor Code EUIN Branch Code
QFUND.IN
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This is only acknowledgment of receipt of application and will be processed as per the contents lled in the application, subject to realisation of cheque and furnishing of mandatory
information/ documents. Please retain this slip till you receive your account statement.
call 1800 4190 200 or 1800 2000 400 email investor.line@lntmf.co.in www.ltfs.com
Please note our lines are open from 9 am to 6 pm, Monday to Friday and 9 am to 1 pm on Saturday
4. Address (Address as per KRA records will overwrite this address if you are KYC compliant)
Correspondence Address
City/Town Pin State Country
Overseas Address (Mandatory for NRIs/PIOs)
City/Town Pin State Country
Tel (R)
(ISD) (STD)
Tel (O)
(ISD) (STD)
Fax
(ISD) (STD)
5. Tax status of Sole/First Applicant (Please ü)
Resident Indian Individual
Non Resident Indian Individual (NRI) – Repatriable
Non Resident Indian Individual (NRI) –Non Repatriable
Minor (Resident Indian)
Minor (NRI - Repatriable)
Minor (NRI – Non Repatriable)
Hindu Undivided Family (HUF) – Indian
Hindu Undivided Family (HUF) – NRI - Repatriable
Hindu Undivided Family (HUF) – NRI – Non-
Repatriable
Person of Indian Origin (PIO)
Sole Proprietorship
Partnership Firm
Public Ltd. Co.
Private Ltd. Co.
Body Corporate
Unlisted Company
Government Body
NPS Trust
Provident Fund / EPF / PF Trust
Mutual Fund
Trust
Limited Liability Partnership (LLP)
Financial Institutions
Foreign Portfolio Investor (FPI)
Foreign Institutional Investor (FII)
Foreign Institutional Investor
FPI - Category I
FPI - Category II
FPI - Category III
Insurance Company
Defence Establishment
Society
Superannuation Fund
Gratuity Fund
Overseas Corporate Body
Non Govt. Organization (NGO)
Association of Persons(AOP)/Body
of Individuals(BOI)
Bank
Pension and Retirement Fund
Global Development Network
Others
Are you a Non Prot Organization
(NPO) Yes No
6. BANK ACCOUNT INFORMATION (Mandatory for receiving Redemption/Dividend payments)
Account Number
Account Type: Savings Current NRE NRO
Please üany one
FCNR Others
Bank Name Branch
City IFSC MICR
If you are not making the investment from the above mentioned bank account, please attach an original cancelled cheque leaf of the above account with the name
of the rst holder printed.
7. MODE OF HOLDING
Please ü Sole/1st Holder only Any one or Survivor* Joint
(If the mode of operation is not specied, for folios opened with more than one applicant, the mode of operation would be taken as “Any one or Survivor”)
8. POWER OF ATTORNEY (PoA) HOLDER DETAILS
If your investment is being made by a Constituted Attorney on your behalf, please furnish the below details and enclose a original notarised copy of the Power of Attorney for
registering the same:
POA Holder’s Name
Mr. Ms.
First Name Middle Name Last Name
POA for
Sole / First Applicant
Second Applicant
Third Applicant
E-mail Id
PAN of POA Holder
KIN
^
Date of Birth
^
D D M M Y Y Y Y
(POA Holder needs to comply with applicable KYC requirements). ^ 14 digit KYC Identication Number (KIN) and Date of Birth is mandatory for Individual(s) who
has registered under Central KYC Records Registry (CKYCR).
9. DEMAT ACCOUNT INFORMATION (Mandatory for crediting units in demat account)
If you wish to hold your investment in dematerialised mode please furnish the below details and enclose a copy of the Client Master that you may have received from your
Depository Participant.
NSDL
CDSL
NSDL/CDSL: Depository Participant Name
Depository Participant ID Beneciary A/c No.
Enclosed: Client Master Transaction / Statement Copy / DIS Copy
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10. INVESTMENT & PAYMENT INFORMATION (Please ensure that the cheque complies to the CTS 2010 standards)
1. Investment Type (ü)
Lumpsum SIP Multi-Scheme Lumpsum Multi-Scheme SIP (Please ll Multi-Scheme SIP Investment Form)
Micro SIP (For SIP/Micro SIP, please ll SIP Investment Form)
For Lumpsum & SIP Investment (Please issue cheque favouring scheme name)
Investment Amount (`)
DD Charges (if applicable `) Net Amount (`)
Scheme Name L&T
Option (ü)
Growth*
Dividend Payout
Dividend Reinvestment
Bonus^
Dividend
Frequency (
ü
wherever applicable
)
Daily
Weekly
Monthly*
Quarterly
Annual^
Semi-Annual^
For Multi-Scheme SIP/Multi-Scheme Lumpsum (Please issue cheque favouring L&T MF Multi-Scheme SIP and L&T MF Multi Scheme Lumpsum respectively)
Total
Investment Amount (`) DD Charges (if applicable `) Net Amount (`)
Scheme 1 : L&T
Amount (`)
Option (ü)
Growth*
Dividend Payout
Dividend Reinvestment
Bonus^
Dividend Frequency
Scheme 2 : L&T
Amount (`)
Option (ü)
Growth*
Dividend Payout
Dividend Reinvestment
Bonus^
Dividend Frequency
Scheme 3 : L&T
Amount (`)
Option (ü)
Growth*
Dividend Payout
Dividend Reinvestment
Bonus^
Dividend Frequency
2. Payment Details : For Lumpsum and SIP/Multi-Scheme SIP/Multi-Scheme Lumpsum
Cheque / DD / Pay Order Electronic Transfer One Time Mandate (OTM) (for Lumpsum and SIP Investment)
If cheque / DD / Pay Order, please ll Instrument No.
Instrument Date
D D M M Y Y Y Y
Instrument Amount
DD Charges (if applicable `) Net Amount (`)
Drawn on
Bank Name Bank Branch Bank City
Account Type (ü) Saving Current NRE NRO FCNR Others
If electronic transfer, please ll UTR No.
Amount
Debit Bank Name
Account No.
If One Time Mandate, Please ll, Unique Mandate Reference Number (UMRN)
Amount
Debit Bank Name
Account No.
If electronic transfer, please ll UTR No.
Debit Bank Name
Account No.
*Default option if not selected ^Available in select schemes only (Default plan / option / sub option will be applied incase of no information, ambiguity or discrepancy)
Document attached to avoid Third Party Payment rejection, wherever applicable : Banker’s Certicate for DD Third Party Payment Declaration Form
11. KYC DETAILS (Mandatory. If left blank the application is liable to be rejected)
CATEGORIES First Applicant/ Guardian Second Applicant Third Applicant
Gross Annual
Income
(For Individuals
and Non
Individuals)
Below 1 lac
5-10 Lacs
25 Lacs - 1 crore
1-5 Lacs
10-25 Lacs
> 1 Crore
Below 1 lac
5-10 Lacs
25 Lacs - 1 crore
1-5 Lacs
10-25 Lacs
> 1 Crore
Below 1 lac
5-10 Lacs
25 Lacs - 1 crore
1-5 Lacs
10-25 Lacs
> 1 Crore
Net-worth in (Mandatory for Non-Individuals)
(`)
as on
D D / M M / Y Y Y Y
(Not older than 1 year)
Net-worth
(`)
as on
D D / M M / Y Y Y Y
(Not older than 1 year)
Net-worth
(`)
as on
D D / M M / Y Y Y Y
(Not older than 1 year)
Occupation
Details
(For Individuals
only)
Private Sector Service
Public Sector Service
Government Service
Business
Professional
Retired
Student
Forex Dealer
Agriculturist
Housewife
Private Sector Service
Public Sector Service
Government Service
Business
Professional
Retired
Student
Forex Dealer
Agriculturist
Housewife
Private Sector Service
Public Sector Service
Government Service
Business
Professional
Retired
Student
Forex Dealer
Agriculturist
Housewife
Others
Please specify
Others
Please specify
Others
Please specify
Others
(For Individuals
only)
I am politically Exposed Person
I am Related to Politically Exposed Person
Not Applicable
I am politically Exposed Person
I am Related to Politically Exposed Person
Not Applicable
I am politically Exposed Person
I am Related to Politically Exposed Person
Not Applicable
Additional KYC Details for Non-Individuals
Others
(For Non-
Individuals only)
Is the company a Listed Company or Subsidiary of Listed Company or Controlled by a Listed Company
YES NO
(If No, please attach Ultimate Beneciary Ownership Declaration mandatorily)
If the Entity involved/providing any of the following services:
YES (Please ü from below) NO
Gaming/Gambling/Lottery/Casino Services Foreign Exchange/ Money Changer Services Money Lending/Pawning
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12. INFORMATION REQUIRED FOR TAX REPORTING (Mandatory. If left blank the application is liable to be rejected)
Category Sole/First Applicant/Guardian Second Applicant Third Applicant
Gender
Father's Name
Type of address given at the KRA
Residential or Business Residential or Business Residential or Business
Residential Residential Residential
Business Business Business
Registered Ofce Registered Ofce Registered Ofce
Permissible documents are Passport Election ID Card PAN Card Govt. ID Card Driving License UIDAI Card NRE/GA Card Others
Country/Place/City of Birth
Country of citizenship/nationality
Indian U.S. Others
(Please, specify _______________)
Indian U.S. Others
(Please, specify _______________)
Indian U.S. Others
(Please, specify _______________)
I am a tax resident of India and not a resident of any other country Yes No
If No, please mandatorily enclose the FATCA & CRS Declaration for Individual Investors.
FOR NON-INDIVIDUALS: Please mandatorily enclose the FATCA, CRS & UBO Declaration for Non Individuals with all the sections lled.
13. NOMINATION DETAILS (Please note that where the sole/1st applicant is a minor, no nomination is allowed)
(Please
ü
) I/We wish to Nominate I/We do not wish to Nominate
I/We do hereby nominate the person(s) named below to receive the units allotted to my/our credit in my/our folio in the event of my/our death. I/We also understand that all
payments and settlements made to Nominee(s), and signature(s) of the Nominee(s) acknowledging receipt thereof, will be noted as be a valid discharge by the AMC/Mutual Fund/
Trustee. This instruction supercedes all previous nominations made by me/us in respect of the folio indicated above.
Particulars 1st Nominee 2nd Nominee 3rd Nominee
Name
Date of Birth
(in case nominee is a minor)
D D M M Y Y Y Y D D M M Y Y Y Y D D M M Y Y Y Y
Guardian Name
(in case nominee is a minor)
Address
City
State
Country
Pincode
Allocation %
Signature of Guardian
(if nominee is minor) (mandatory)
Signature of Nominee
14. DECLARATION & SIGNATURES
I/We have read and understood the contents of the Scheme Information Document, Statement of Additional Information and Key Information Memorandum of the aforesaid Scheme(s) of L&T Mutual Fund including the sections on “Who cannot
invest”, “Foreign Account Tax Compliance Act (FATCA) / Common Reporting Standard (CRS)” (“Reporting Guidelines”)” and “Important Note on Anti Money Laundering, Know-Your-Customer and Investor Protection”. I/We hereby apply for
allotment/purchase of Units in the Scheme(s) and agree to abide by the terms and conditions applicable thereto. I/We hereby declare that I/We am/are authorised to make this investment and that the amount invested in the Scheme(s) is through
legitimate sources only and does not involve and is not designed for the purpose of any contravention or evasion of any Act, Rules, Regulations, Notications or Directions issued by any authority in India. I/We hereby authorise L&T Mutual
Fund (“the Fund”), its Investment Manager (“LTIM”) and its agents to disclose details of my investment to my bank(s)/ Fund’s bank(s) and/or Distributor/Broker/Investment Adviser/any governmental or regulatory 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(s) is being recommended to me/us. I/We
have neither received nor been induced by any rebate or gifts, directly or indirectly, in making this investment. I/We declare that the information given in this application form is correct, complete and truly stated.
I/We accept and agree to abide by the terms and conditions (as mentioned on HYPERLINK “www.ltfs.com/) with respect to my/our dealings with L&T Mutual Fund/its Investment Manager through various channels.
In case there is any change in the information (especially pertaining to Reporting Guidelines) already provided to LTIM / Fund, I/We agree that I/We shall inform the same to LTIM/Fund within 30 days of the change. I/We authorize updation of
the records (including pertaining to the Reporting Guidelines) basis the information / documents received by LTIM/Fund/Registrar and Transfer Agent (“RTA”) from other SEBI Registered Intermediaries. I/We authorize LTIML/Fund/RTA, to share
the information provided by me / us with other SEBI Registered Intermediaries to facilitate single submission /updation. I / We authorize LTIM/ Fund/RTA to provide relevant information to upstream payors to enable withholding to occur and pay
out any sums from the my/our account or close or suspend my/our account(s) under intimation me/us.”
APPLICABLE FOR NON-ADVISORY TRANSACTIONS ONLY:
I/We, hereby acknowledge and conrm that the above transaction is “Execution Only” as explained vide SEBI Circular No. CIR/IMD/DF/13/2011 dated 22 August 2011. This investment is being made notwithstanding the advice of the
appropriateness/inappropriateness of the same. On such transaction(s), I am not being charged any kind of transaction fee(s) by the AMFI registered distributor. On this transaction, the distributor would be compensated by the Mutual Fund
House/Asset Management Company concerned in lines with the commission rate(s)disclosed by the distributor.
*APPLICABLE FOR NRIs/PIOs/FIIs/FPIs INVESTING ON REPATRIATION BASIS ONLY: I/We conrm that I am/we are Non-Resident(s) of Indian Nationality/Origin and that I/We have remitted funds from abroad through approved banking
channels or from funds in my/our NRE/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.
APPLICABLE FOR INVESTMENT THROUGH RIA (REGISTERED INVESTMENT ADVISER) :
I/We hereby give you my/our consent to share/provide the transactions data feed/portfolio holdings/NAV etc. in respect of my/our investments under Direct Plan to the above mentioned SEBI Registered Investment Adviser.
Date:
D D M M Y Y Y Y
Sole/First Applicant/Guardian Second Applicant Third Applicant