Have you invested in UTI MF earlier. Yes No

If yes, please provide : Scheme Name ..................................................................................................................................... Folio ................................................................... (Optional)

CR / CA Code For Chief Representative

DD Amount

DD Charges

Total

DD No.: Dated: Drawn on:

DISTRIBUTOR INFORMATION

(only empanelled Distributors/Brokers will be permitted to distribute Units)

Bank Net amount paid (i-ii)

Branch Amt in words

Account Type Please () Current Savings NRE NRO DD issued from abroad

*Please mention the application No. on the

reverse of the cheque/DD. Cheque/DD must

be drawn in favour of "The Name of the

Scheme" & crossed "A/c Payee Only"

*PAN of 2nd Applicant

Name of 2nd Applicant Mr. Ms. Mrs.

Yes No

Date of Birth of 3rd Applicant

State

Country*

Zip/Pin*

PLEASE USE SEPARATE FORM FOR EACH SCHEME

(PLEASE READ INSTRUCTIONS CAREFULLY TO HELP US SERVE YOU BETTER)

COMMON APPLICATION FORM FOR OPEN-END

Received from Mr / Ms / M/s

An application under

along with Cheque / DD No.*

Drawn on (Bank)

for Rs. (in gures)

APPLICANT'S PERSONAL DETAILS (Please ll in Block Letters) Mr. Ms. Mrs.

Name of First Applicant

First Applicant’s Address (Do not repeat the name) Name & Address of resident relative in India (for NRIs) (P.O. Box No. is not sufcient)

F I R S T M I D D L E

S T D C O D E

(0) Mobile

e-mail

Alternate e-mail

S T D C O D E

*PAN OF 1ST APPLICANT/FATHER/MOTHER/GUARDIAN (whose particulars are furnished in the form)

* Applicable to NRI’s

Notes:

M/s. Karvy Computershare Pvt. Ltd.

Narayani Mansion, H. No. 1-90-2/10/E, Vittalrao Nagar, Madhapur, Hyderabad - 500 081

Tel.: 040-23421944 to 47 • Fax: 040-23115503 • Email: uti@karvy.com

I/We have read and understood the contents of the Scheme Information Document, Statement of Additional Information and Key Information Memorandum, addenda issued till date and

apply to the Trustee of UTI Mutual Fund as indicated above. I/We agree to abide by the terms and conditions, rules and regulations of the scheme as on the date of investment. I/We

undertake to conrm that this investment has been duly authorised by appropriate authorities in terms of all relevant documents and procedural requirements.

I/We have not received nor been induced by any rebate or gifts, directly or indirectly in making investments.

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.

Name

Date of Birth

(in case nominee is a minor)

Address

Name of the guardian:

Address of guardian

Signature of nominee/guardian

(For minor)

Name and address of Nominee To be furnished in case nominee is a minor

GENERAL INFORMATION - Please () wherever applicable

Status

Resident Individual Minor through guardian HUF Partnership Trust

Company Sole Proprietorship Society Body Corporate AOP

BOI FII NRI Others

Mode of Holding Single Anyone or survivor Joint

Occupation Business Student Agriculture Self-employed Professional

Housewife Retired Service Others