ACKNOWLEDGEMENT
Folio/Application No:_________________________
Investor Name: _________________________________________________________________________
Scheme (1)_____________________________________________________ SIP ` _______________________ Top-Up Amount: ` _______________________
Scheme (2)_____________________________________________________ SIP ` _______________________ Top-Up Amount: ` _______________________
Scheme (3)_____________________________________________________ SIP ` _______________________ Top-Up Amount: ` _______________________
Signature of Third ApplicantSignature of Second ApplicantSignature of Sole/First Applicant
SIP REGISTRATION FORM
Application No.
DEMAT ACCOUNT DETAILS (Optional)
FIRST MIDDLE LAST
Mr. Ms.
M/s.
Sole/First
Applicant’s Name
Existing
UMRN:
Existing
Folio No.
The Trustee, ICICI Prudential Mutual Fund, I/We have read and understood the contents of the Scheme Information Document of the following Scheme and the terms and conditions of the SIP Enrolment.
BROKER CODE (ARN CODE)
SUB-BROKER ARN CODE
Employee Unique
Identification No. (EUIN)
SUB-BROKER CODE
(As allotted by ARN holder)
SIGNATURE OF SOLE / FIRST APPLICANT SIGNATURE OF SECOND APPLICANT SIGNATURE OF THIRD APPLICANT
ARN-
E
Declaration for “execution-only” transaction (only where EUIN box is left blank) - 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.
Investor must read Key Scheme Features and Instructions before completing this form. All sections
to be completed in ENGLISH in BLACK / BLUE COLOURED INK and in BLOCK LETTERS.
Declaration: I/We read, understood and agreed to the contents of Easy Pay Form Facility, Terms and Conditions of the SIP Enrolment, the Scheme Information Document, Statement of Additional
Information, Key Information Memorandum, Instructions and Addenda issued from time to time of the respective Scheme(s) of ICICI Prudential Mutual Fund mentioned above and agreed to abide by the
same, I hereby declare that the particulars given above are correct and express my willingness to make payments towards SIP instalments referred above through participation in NACH/ECS. The ARN
holder, where applicable, has disclosed to me/us all the commissions (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 undertake to keep sufficient funds in the funding account on the date of execution of the transaction. I/We have not received nor been induced by
any rebate or gifts, directly or indirectly, in making 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.
Do you want units in demat form : Yes No (Please ) The application form should mandatorily accompany the latest Client investor master/Demat account statement.
NSDL OR CDSL (Please )
Depository Participant (DP) ID (NSDL only) Beneficiary Account Number (NSDL only) Depository Participant (DP) ID (CDSL only)
ICICI Prudential ________________________________________________
_______________________________________
SIP Installment
Amount (`) _____________________________________
Start Month/Year
End Month/Year
(Default Dec 2099)*
M M Y Y Y Y
M M Y Y Y Y
Regular Direct
SIP
Date
SIP
Frequency
1st 7th 10th
15th 25th
Monthly
Quarterly
Scheme Name (1)
Plan
Option/Sub-option
SIP TOP-UP
()
Amount:
` ____________________________
TOP-UP
Frequency ():
Half Yearly
Yearly
CAP Amount*: ` ________________________
CAP Month-Year
#
:
M M Y Y Y Y
OR
SIP TOP-UP CAP
*TOP-UP CAP amount:Please refer to T&C No. B[h(i)] # TOP-UP CAP Month-Year: Please refer to T&C No. B[h(ii)]
(Investor has to choose only one option – either CAP Amount or CAP Year)
• If TOP-UP frequency is not selected, then the default option will be Yearly. • In case of Quarterly SIP, only the Yearly option is available as SIP Top-Up frequency.
(TOP UP amount has to be in multiples of Rs.500 only. Please see Instruction (B) overleaf.)
ICICI Prudential ________________________________________________
_______________________________________
SIP Installment
Amount (`) _____________________________________
Start Month/Year
End Month/Year
(Default Dec 2099)*
M M Y Y Y Y
M M Y Y Y Y
Regular Direct
Scheme Name (2)
Plan
Option/Sub-option
SIP TOP-UP
()
Amount:
` ____________________________
TOP-UP
Frequency ():
Half Yearly
Yearly
CAP Amount*: ` ________________________
CAP Month-Year
#
:
M M Y Y Y Y
OR
SIP TOP-UP CAP
(Investor has to choose only one option – either CAP Amount or CAP Year)
(TOP UP amount has to be in multiples of Rs.500 only. Please see Instruction (B) overleaf.)
ICICI Prudential ________________________________________________
_______________________________________
SIP Installment
Amount (`) _____________________________________
Regular Direct
Scheme Name (3)
Plan
Option/Sub-option
SIP TOP-UP
()
Amount:
` ____________________________
TOP-UP
Frequency ():
Half Yearly
Yearly
CAP Amount*: ` ________________________
CAP Month-Year
#
:
M M Y Y Y Y
OR
SIP TOP-UP CAP
(Investor has to choose only one option – either CAP Amount or CAP Year)
(TOP UP amount has to be in multiples of Rs.500 only. Please see Instruction (B) overleaf.)
TRANSACTION CHARGES FOR APPLICANTS THROUGH DISTRIBUTORS ONLY [Refer Instruction XII]:
In case the subscription (lumpsum) amount Rs 10,000/- or more and your Distributor has opted to receive transactions 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 the distributor. Units will be issued against the balance amount invested.
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.
SIP
Date
SIP
Frequency
1st 7th 10th
15th 25th
Monthly
Quarterly
Start Month/Year
End Month/Year
(Default Dec 2099)*
M M Y Y Y Y
M M Y Y Y Y
SIP
Date
SIP
Frequency
1st 7th 10th
15th 25th
Monthly
Quarterly
Qfund.in
Mutual Fund India
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A) SIP Payment through NACH
1. SIP is available only on specific dates of the month viz. 1st/7th/10th/15th/25th. In case
1st/7th/10th/15th/25th is a holiday, then next business day. In case the debit does not take
effect for three consecutive times then the SIP would be liable for cancellation.
2. Investors are required to submit SIP request at least 30 days prior to the date of first
installment.
3. Investors/unitholders subscribing for SIP are required to submit SIP request at least 30 days
prior to the date of first debit date and SIP start date shall not be beyond 90 days for monthly
SIP and 100 days for Quarterly SIP from the date of submission of SIP application.
4. The applicant will have the right to discontinue SIP at any time he or she so desires by providing
a written request at the office of the ICICI Prudential Mutual Fund Customer Service Centres.
Notice of discontinuance should be received 30 days prior to the subsequent SIP date.
5. The investor agrees to abide by the terms and conditions laid by RBI.
6. Investor will not hold ICICI Prudential Mutual Fund, its registrars and other service providers
responsible if the transaction is delayed or not effected or the investor bank account is
debited in advance or after the specific SIP date due to various clearing cycles.
The Bank & AMC shall not be liable for, nor be in default by reason of, any failure or delay in
completion of its obligations under this Agreement, where such failure or delay is caused, in
whole or in part, by any acts of God, civil war, civil commotion, riot, strike, mutiny, revolution,
fire, flood, fog, war, lightening, earthquake, change of Government policies, unavailability of
Bank’s computer system, force majeure events, or any other cause of peril which is beyond
the Bank’s reasonable control and which has effect of preventing the performance of the
contract by the Bank.
The investor hereby agrees to indemnify and not hold responsible, AMC/Mutual Fund
(including its affiliates), and any of its officers directors, personnel and employees, the
Registrars & Transfer (R&T) agent and the service providers incase for any delay/wrong debits
on the part of the bank for executing the easy pay debit mandate instructions for any sum on
a specified date from your account. If the transaction is delayed or not effected at all for
reasons of incomplete or incorrect information, the investor would not hold the user institution
responsible. Investor confirm to have understood that the introduction of this facility may also
give rise to operational risks and hereby take full responsibility.
7. ICICI Prudential Mutual Fund reserves the right to reject any application without assigning any
reason thereof.
8. Incase SIP date is not selected/not legible, then the SIP will be registered on 10th (default
date) of each Month/Quarter, as applicable.
9. Further if multiple SIP dates are opted for, amount will be deducted on each date selected by
investor, which means multiple times for that Month/Quarter.
10. If the investor selects multiple SIP frequencies or fails to choose any of them, the default SIP
frequency will be Monthly.
11. If the investor has not mentioned the SIP start month, SIP will start from the next applicable
month, subject to completion of 30 days lead time from the receipt of SIP request.
12. Incase the SIP ‘End Period’ is incorrect or not mentioned by the investor in the SIP form, then
the default 'End Period' will be December 2099.
13. In case End date mentioned on SIP form, falls beyond the date mentioned in Mandate form,
then SIP shall be registered as per date mentioned on mandate.
14. Maximum Amount: The MAXIMUM AMOUNT is the per transaction maximum limit. Investor
can register multiple SIPs but the amount should not exceed the maximum amount mentioned
per transaction.
Generally speaking, your SIP amount will be lesser than this amount, but choosing a slightly
higher limit helps you to undertake additional investments as per your choice. Always
remember to mention an amount that is convenient to you.
15. The investor hereby agrees to indemnify and not hold responsible the AMC and its employees,
the R&T agent and the service providers incase his/her bank is not able to effect any of the
payment instructions for whatsoever reason.
16. Existing investors have to provide their folio numbers.
17. For minimum application amount to be invested in SIP, risk factors, features, load structurees,
etc. please refer to the scheme related documents available on www.icicipruamc.com or with
any of the customer service centres of ICICI Prudential Mutual Fund.
18. ICICI Prudential Mutual Fund, its registrars and other service providers shall not be
responsible and liable for any damages/compensation for any loss, damage etc. incurred by
the investor. The investor assumes the entire risk of using this facility and takes full
responsibility.
19. UMRN (Unique Mandate Reference Number) is provided by NPCI, which is assigned to every
mandate that has been submitted to them.
20. DEMAT/NON-DEMAT MODE:
Investors have an option to hold the Units in dematerialized form. Please tick the relevant option of
Yes/No for opting/not opting units in demat form. If no option is excercised, “No” will be the default
option. Applicants must ensure that the sequence of names as mentioned in the application form
matches with that of the account held with the Depository Participant. If the details mentioned in
the application are incomplete/incorrect or not matched with the Depository data, the application
shall be treated as invalid and the units would be allotted in Non-Demat mode. The application form
should mandatorily accompany the latest Client investor master/ Demat account statement. Demat
option will be not be available for Daily/Weekly/ Fortnightly dividend options. Investors desiring to
get allotment of units in demat mode must have a beneficiary account with a Depository
Participant (DP) of the Depositories i.e. National Securities Depositories Limited (NSDL) / Central
Depository Services Limited (CDSL).
Allotment letters would be sent to investors who are allotted units in Demat mode and a Statement
of Accounts would be sent to investors who are allotted units in non-Demat mode. Investors are
requested to note that Units held in dematerialized form are freely transferable except units held in
Equity Linked Savings Scheme’s (ELSS) during the lock-in period.
The units will be allotted based on the applicable NAV as per the SID and will be credited to investor’s
Demat account on weekly basis upon realization of funds. For e.g. Units will be credited to investors
Demat account every Monday for realization status received in last week from Monday to Friday.
The investors shall note that for holding the units in demat form, the provisions laid in the Scheme
Information Document (SID) of respective Scheme and guidelines/procedural requirements as laid
by the Depositories (NSDL/CDSL) shall be applicable. In case the unit holder wishes to convert the
units held in non-demat mode to demat mode or vice versa at a later date, such request along with
TERMS & CONDITIONS
the necessary form should be submitted to their Depository Participant(s).
Units held in demat form will be freely transferable, subject to the applicable regulations and the
guidelines as may be amended from time to time.
21. EMPLOYEE UNIQUE IDENTIFICATION NUMBER (EUIN):
Investors procuring advisory services from non Individual distributors are requested to note that
EUIN would assist in tackling the problem of misselling even if the employee/relationship
manager/sales person leave the employment of the distributor.
Distributors are advised to ensure that the sub broker affixes his/her ARN code in the column
separately provided in addition to the current practice of affixing the internal code issued by the
main ARN holder and the EUIN of the Sales Person (if any) in the EUIN space.
Investors are requested to note that EUIN is applicable for transactions such as
Purchases,Switches, Registrations of SIP / STP / Trigger / Dividend Transfer Plan and EUIN is not
applicable for transactions such as Installments under SIP/ STP / SWP / EBT Triggers, Dividend
Reinvestments, Bonus Units, Redemption, SWP Registration, Zero Balance Folio creation and
installments under Dividend Transfer Plans.
Investors are requested to note that EUIN is largely applicable to sales persons of non individual
ARN holders (whether acting in the capacity of the main distributor or sub broker). Further, EUIN
will not be applicable for overseas distributors who comply with the requirements as per AMFI
circular CIR/ ARN-14/12-13 dated July 13, 2012.
22. TRANSACTION CHARGES:
Pursuant to SEBI Circular No. Cir/ IMD/ DF/13/ 2011 dated August 22, 2011 the transaction
charge per subscription of Rs.10,000/- and above may be charged in the following manner,
in addition to trail fees charged by the AMC and upfront commission, if any:
i. The existing investors of the mutual fund industry may be charged Rs.100/- as
transaction charge per subscription of Rs.10,000/- and above;
ii. A first time investor in any mutual fund may be charged Rs.150/- as transaction charge
per subscription of Rs.10,000/- and above.
There shall be no transaction charge on subscription below Rs. 10,000/- and on
transactions other than purchases/ subscriptions relating to new inflows.
However, the option to charge “transaction charges” is at the discretion of the distributors.
In case of investment through Systematic Investment Plan (SIP), transaction charges shall
be deducted only if the total commitment through SIP amounts to Rs. 10,000/- and above.
The transaction charges in such cases shall be deducted in 4 equal installments.
The aforesaid transaction charge shall be deducted by the Asset Management Company
from the subscription amount and paid to the distributor, as the case may be and the
balance amount shall be invested subject to deduction of service tax. Unit holder’s
statement of account will reflect subscription amount, transaction charges and net
investments.
Transaction Charges shall not be deducted if:
• Purchase/Subscription made directly with the fund through any mode (i.e. not through
any distributor/agent).
• Purchase/Subscription made through stock Exchange, irrespective of investment
amount.
B) SIP TOP UP Facility:
(a) Investors can opt for SIP TOP UP facility, wherein the amount of the SIP can be increased at
fixed intervals.
(b) The TOP UP amount has to be in multiples of Rs.500 only.
(c) The frequency is fixed at Yearly and Half Yearly basis. In case the TOP UP facility is not opted
by ticking the appropriate box and frequency is not selected, the TOP UP Facility will not be
registered.
(d) In case of Quarterly SIP, only the Yearly frequency is available under SIP TOP UP.
Please see the illustration below to know how to calculate SIP Top-Up amount:
• SIP Tenure: 07Jan 2015 to 07 Dec 2016
• Monthly SIP Installment: Rs. 2000/-
• TopUp Amount: Rs.1000/- • TopUp Frequency: 6 months
Installment From To Monthly SIP SIP Top-Up Increased
No(s) Date Date Installment Amount (`) Monthly SIP
Amount (`) Amount (`)
1 to 6 7-Jan-15 7-Jun-15 2,000 N.A. 2,000
7 to 12 7-Jul-15 7-Dec-15 2,000 1,000 3,000
13 to 18 7-Jan-16 7-Jun-16 3,000 1,000 4,000
19 to 24 7-Jul-16 7-Dec-16 4,000 1,000 5,000
(e) SIP TOP UP will be allowed in Micro SIP folio subject to condition that total investment
including SIP TOP UP does not exceed Rs. 50,000/- in a rolling 12 month period or financial
year i.e. April to March, the limit on Micro SIP investments.
(f) If investor selects multiple SIP dates and opted for Top-Up facility, top-up will be applicable for
all dates opted by investor.
(g) The investor agrees to avail the TOP UP facility for SIP and authorize his/her bank to execute
the NACH/ECS for a further increase in installment from His/Her designated account.
(h) TOP-UP CAP
(i) Cap Amount: Investor has an option to freeze the SIP Top-Up amount once it reaches a
fixed predefined amount. The fixed pre-defined amount should be same as the
maximum amount mentioned by the investor in the bank mandate. In case of difference
between the Cap amount & the maximum amount mentioned in bank mandate, then
amount which is lower of the two amounts shall be considered as the default amount
of SIP Cap amount.
(ii) Cap Month-Year: It is the date from which SIP Top-Up amount will cease and last SIP
installment including Top-Up amount will remain constant from Cap date till the end of
SIP tenure.
Investor shall have flexibility to choose either Top-Up Cap amount or Top-Up Cap month-year.
In case of multiple selection, Top-Up Cap amount will be considered as default selection.
Mutual Fund investments are subject to market risks, read all scheme related documents carefully.
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FOR OFFICE USE ONLY
FOR OFFICE USE ONLY FOR OFFICE USE ONLY
1.
Signature Primary Account holder
Name as in bank records
2.
Signature of Account holder
Name as in bank records
3.
Signature of Account holder
Name as in bank records
PERIOD
From
To
Or
Until Cancelled
CREATE
MODIFY
CANCEL
I/We hereby authorize
to debit (tick )
SB/CA/CC/SB-NRE/SB-NRO/Other
Bank a/c number
with Bank
Name of customers bank
Maximum Amount (Rupees in words)
an amount of Rupees
IFSC
Folio No.
Reference
FREQUENCY
Mthly Qtly As & when presented DEBIT TYPE Fixed Amount Maximum Amount
Tick ()
Sponsor Bank Code Utility Code
Mobile No.
Email ID
or MICR
UMRN
Date
H-Yrly Yrly
EASY PAY DEBIT MANDATE INSTRUCTION
Declaration: I/We hereby declare that the particulars given on this mandate are correct and complete and express my willingness and authorize to make payments referred above through participation in NACH/ECS. I/We hereby confirm
adherence to the terms of EASY PAY facility offered by ICICI Prudential Asset Management Company Limited (the AMC) and as amended form time to time and of NACH/ECS (Debits). Authorisation to Bank: This is to inform that I/we
have registered for ECS / NACH (Debit Clearing) facility and that my/our payment towards my/our investment in ICICI Prudential Mutual Fund shall be made from my/our above mentioned bank account with your Bank. I/We authorize
the representatives of the AMC carrying this mandate form to get it verified and executed. I/We authorize the bank to debit my account for any charges towards mandate verification, registration, transactions, returns, etc, as
applicable. The AMC would not be liable for any delay in crediting the scheme collection accounts by the Service Providers which may result in a delay in application of NAV. This is to confirm that the declaration/terms & conditions
have been carefully read, understood and made by me/us.
ICICI PRUDENTIAL ASSET MANAGEMENT COMPANY LIMITED
APPLICATION NUMBER
The RIGHT SIP AMOUNT in
Equity Mutual Funds can help
fulfill his dreams
An investor education initiative
Folio No./Application No. _____________________________________________ Bank Account No. __________________________________________
Bank Name________________________________________________________ Maximum Amount `_________________________________________
Period From ___________________________ To ________________________ Or Until Cancelled
AKCNOWLEDGEMENT - EASY PAY DEBIT MANDATE INSTRUCTION
Mutual Fund India
Mutual Fund India
Mutual Fund India
Qfund
Mutual Fund India
Mandatory fields in EASY Pay form as per NPCI:
• Bank account number and Bank name
• IFSC and/or MICR Code
• Mobile no & Email ID
• Folio number or application number
• Signatures as per bank records
• SIP start date, end date or until cancelled
• Account type to be selected
• Name as per bank records
• Transaction type to be selected.
• Maximum amount to be mentioned.
Mutual Fund India
