FATCA AND CRS DETAILS FOR INDIVIDUALS (including Sole Proprietor) (Mandatory)
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Annexure I and Annexure II are available on the website of AMC i.e. www.idfcmf.com or at the Investor Service centres (ISCs) of IDFC Mutual Fund
Country of Birth
Country of Citizenship / Nationality
Place/City of Birth
Non-Individual investors should mandatorily fill separate FATCA Form (Annexure II). The below information is required for all applicants / guardian
First Applicant / Guardian
Second Applicant
Third Applicant
Indian
Please specify
U.S. Others
Indian
Please specify
U.S. Others
Indian
Please specify
U.S. Others
Are you a tax resident (i.e. are you assessed for tax) in any other country outside India?
(please tick )ü
If YES please fill for ALL countries (other than India in which you are a Resident for tax purpose i.e. where you are a Citizen/ Resident/ Green Card holder/ Tax Resident in the respective countries.“ ”
YES NO
First Applicant / Guardian
A
Tax Identification Number
or Functional Equivalent
Identification Type
(TIN or other please specify)
Identification Type
(TIN or other please specify)
Country of Tax Residency
Reasons
B C
A
Reasons
B C
A
Reasons
B C
Second Applicant
Third Applicant
Address Type of Sole /1st Holder Address Type of 2nd Holder
Residential
Registered Office
Business Residential
Registered Office
Business
Address Type of 3rd Holder
Residential
Registered Office
Business
Reason A è The country where the Account Holder is liable to pay tax does not issue Tax Identification Number to its residents.
Reason B è No TIN required (Select this reasons Only if the authorities of the country of tax residence do not require the TIN to be collected) Reason C è Others please state the reasons thereof :
Instrument No. Dated
Amount (Rs.)
Scheme
D D M
M Y
Y
INVESTMENT & DETAILS (Please refer to the Instruction No. E & J) (Please refer SID for Plans and Sub-options)PAYMENT
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Nominee 1
Nominee 2
Nominee 3
NOMINATION DETAILS Individuals (single or joint applicants) are advised to avail Nomination facility.
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I/We wish to nominate
1st Applicant
signature (mandatory)
I/We DO NOT wish to nominate and sign here
Nominee Name & Address
In case of Minor
Allocation %
Nominee/ Guardian sign
Relationship
with Investor
Date of birth
D D M M Y Y
Guardian Name & Address
D D M M Y Y
D D M M Y Y
Mode of payment
Self Third Party Payment (Please fill the ‘Third Party Payment Declaration Form’)
Amount (figures)
Account No.
Payment mode
Cheque DD IDFC OTM Fund Transfer RTGS/NEFT
Account Type
Please specify
FCNR
Saving
NRO
NRECurrent Others
Cheque/DD/UTR/UMR No. Cheque Date
D D M M Y Y
Bank & Branch Name
Scheme Plan Option
KYC DETAILS (Mandatory)
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OCCUPATION [Please tick ( )]ü
First Applicant / Guardian
Second Applicant
Third Applicant
Private Sector Service Public Sector Service Government Service
Business
Professional
Agriculturist
Retired
Housewife
Student
Forex Dealer
Others
Please specify
Please specify
Please specify
GROSS ANNUAL INCOME [Please tick ( )]ü
First Applicant / Guardian
Second Applicant
Third Applicant
Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs >25 Lacs-1 crore >1 crore
OR Net worth (Mandatory for Non-Individuals) ` as on
D D M M Y Y Y Y
as on (Not older than 1 year)
Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs >25 Lacs-1 crore >1 crore OR Net worth `
Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs >25 Lacs-1 crore >1 crore OR Net worth `
OTHERS [Please tick ( )]ü
First Applicant / Guardian
For Individuals Please tick (ü)
I am Politically Exposed Person (PEP)^ I am Related to Politically Exposed Person (RPEP) Not applicable
For Non-Individuals Please tick (ü) (Please attach mandatory Ultimate Beneficial Ownership (UBO) declaration form - Refer instruction no. IV(h)):
(i) Foreign Exchange / Money Changer Services
Y N
(ii) Gaming / Gambling / Lottery / Casino Services (iii) Money Lending / Pawning
Y N Y N
Second Applicant
Politically Exposed Person (PEP)^ Related to Politically Exposed Person (RPEP) Not applicable
Third Applicant
Politically Exposed Person (PEP)^ Related to Politically Exposed Person (RPEP) Not applicable
DECLARATION & SIGNATURES (Please refer to the Instruction No. K)
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I/ We have read, understood and agree to comply with the terms and conditions of the Statement of Additional Information, Scheme Information Documents and Key Information Memorandum of the Scheme(s), Foreign Account Tax Compliance Act and
Common Reporting Standards, statutory requirements prescribed by SEBI, AMFI, Prevention of Money Laundering Act, 2002 (PMLA) and all applicable rules and regulations and hereby confirm that I/We have not received nor been induced by any rebate
or gifts, directly or indirectly, to make this investment. 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. For NRIs / PIOs /
FPIs only: I / We confirm that I am / we are Non Resident Indians / Person(s) of Indian Origin / Foreign Portfolio Investors but not (i) United States persons as per applicable Regulations or (ii) residents of Canada, and I / we have remitted funds from abroad
through approved banking channels or from funds in my / our Non-Resident External / Non-Resident Ordinary / FCNR Account maintained in accordance with applicable RBI guidelines. I/We hereby provide my/our consent to IDFC Asset Management
Company Limited (“IDFCAMC”) for (i) collecting, storing and usage; (ii) validating/authenticating with Unique Identification Authority of India (“UIDAI”) by itself or through its Registrar and Transfer Agent (“RTA”); and (ii) downloading and updating my/our
Aadhaar number(s) and associated demographic information (including updated information) in my/our accounts/folios under IDFC Mutual Fund,based on my/our Income Tax Permanent Account Number (“PAN”) in accordance with the Aadhaar Act, 2016,
PMLA and rules & regulations made thereunder and applicable SEBI guidelines. I/We hereby further authorise IDFCAMC for sharing/disclosing of the Aadhaar number(s) and associated demographic information (including any updated information) by
itself or through its RTA, depository participants, and asset management companies of other SEBI registered mutual funds, and their RTAs, for the purpose of updating the same in my/our accounts/folios based on my/our PAN.
First / Sole Applicant / Guardian /
Authorised Signatory
Second Applicant
Third Applicant
IDFC
Mutual Fund India
Mutual Fund
India
India
Mutual Fund
India
Mutual Funds
Mumbai
Mutual Funds