Save Tax Get Rich

Free Door-Step Service

Save Tax…
Get Rich !!
Give a Missed Call: 94 8300 8300
or

SMS: <Your Name> to 94 8300 8300
or

Send Email: SaveTaxGetRich @ gmail.com

Save Tax…
Under Section 80C, Indian Government allows every Individual to invest
Rs. 1 Lakh and save on tax.

Get Rich!!
One can invest Rs. 1 Lakh p.a. in a monthly fashion (Rs. 8,333/- p.m.)
and compounding the investment at a healthy rate and create
wonderful fortune in life and get super rich!!
Returns Rate 10 Years 15 Years 20 Years 25 Years 30 Years
12% 19.65 Lacs 41.75 Lacs 80.69 Lacs 1.49 Crore 2.70 Crore
15% 23.34 Lacs 54.71 Lacs 1.78 Crore 2.44 Crore 4.999 Crore

Get in touch with us…. We can do more….

Save Tax! Missed Call:
Get Rich… 94 8300 8300

About ELSS Mutual Funds:

There are various options available to you, to save tax under section 80C of Income tax Act, like
Public Provident Fund (PPF), National Savings Certificate (NSC), 5-Year FD, Insurance Policy.
When compared to these traditional tax savings instruments, an Equity Linked Savings Scheme
Mutual Fund (ELSS MF) is more opportunistic for you, as it provides a shorter lock-in period of
three years and potential for higher returns, which are exempt from taxes. ELSS MFs provide
opportunities aimed at harnessing the benefits of investing in equity and also providing tax
benefits.

Your Salary Income Tax By investing in ELSS MF, You can
Slab Save
Up to Rs. 2,00,000/- 0% -
2,00,001 – 5,00,000/- 10% Rs. 10,000/-
5,00,001 – 20% Rs. 20,000/-
10,00,000/-
Above 10,00,000/- 30% Rs. 30,000/-

Comparison of various Tax Saving Instruments:

ELSS PF / PPF 5-Year FD Insurance NSC ELSS Mutual
Instrument (LIC, ULIP) Fund
Lock-In Period 15 Years 5 Years More than 5 Years 5 Years / 3 Years
10 Years (Shortest)
Returns History 8.8% Around 8% Varies, but there 8.6% / 9% - 12.9%
(at end of lock- are a lot of 8.9% for the top
in period) deductions and performing
charges. funds
Any Hidden No No Yes No No
Charges
Do you have to No No Varies between Yes No
pay Tax on schemes
Profit / Returns
Earned?
Preference for 2 3 5 4 1*
Investment

* What should you choose? You should choose ELSS Mutual Fund for saving tax since it is the
best option considering the above.

Get Rich… 94 8300 8300

Get Rich… 94 8300 8300

Our Recommendation:

Based on comparison of some of the Top Performing Mutual Funds, Invest in any of the ELSS
Funds below.

DSP-BR Tax Saver Fund ICICI Pru Tax Plan Reliance Tax Saver
Returns History Returns History Returns History
1 Year 3 Years 5 Years 1 Year 3 Years 5 Years 1 Year 3 Years 5 Years
14.1% 26.2% 16.8% 11.8% 38.6% 37.4% 18.0% 44.1% 28.7%
₹10,000/- invested has become Rs.10,000/- invested has become Rs.10,000/- invested has become
₹11,410 ₹12,620 ₹11,680 ₹11,180 ₹13,860 ₹13,740 ₹11,800 ₹14,410 ₹12,870

Mutual Fund investments are subject to market risks, read all scheme related documents
carefully.

Instructions For Filling up the forms:

1. Depending on the funds of your choice, write an A/C Payee Crossed Cheque favoring:
I. “DSP BlackRock Tax Saver Fund”
II. “ICICI Prudential Tax Plan”
III. “Reliance Tax Saver Fund”

2. In the attached Application Forms, fill your:
I. Name, Address, Email Id, Phone Number
II. PAN Number
III. Nominee Details
IV. Cheque and Bank Details
V. Your Signature in the space provided for “Sole/First Applicant”

3. Give us a Missed Call at 94 8300 8300 to pick up the application/for any guidance.

We will provide Free Service / Assistance within 24 hours.

Get Rich… 94 8300 8300

Get Rich… 94 8300 8300

We provide various financial services including:

1. Tax Planning and Saving.
2. Retirement Planning using Mutual Funds.
3. Life Insurance Planning (We have insured more than 100 people for an amount of
Rupees 1 Crore each at a cost of less than Rs. 40/- per day). We recommend The Best
“Term Insurance Plans” only.
4. Children’s Donation and Recurring Education Fees Planning.
5. Financial Planning for Buying Your Own House/Apartment/Site.
6. Full-fledged Financial Planning for All Your Life’s Goals.
7. Mutual Fund Recommendations.
8. Child Insurance Plans with Triple Benefits.

We would love to provide our services to you, and your Friends, Colleagues and Relatives.
Kindly provide their contact details so that we can help them also:

Sl. Name Contact Number (Mobile) Email Id. (if Where do they
No. available) work?

Get Rich… 94 8300 8300

APPLICATION FORM
Please read instructions before filling this Form
01-08-2012 V2.2012 Application No.:

Distributor Name and ARN Sub Broker Code Branch / RM Code For Office use only

Raghavendra Prasad
Raghavendra Prasad
ARN - 74461
Distributor
Contact No:ARN
- 74461
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.

1. TRANSACTION CHARGES (Please refer instructions and tick any one)
Applicable for transactions routed through a distributor who has ‘opted in’ for transaction charges.
I am a First Time Investor in Mutual Fund Industry. I am an Existing Investor in Mutual Fund Industry.
(Rs 150 will be deducted.) (Rs 100 will be deducted.)
2. FIRST APPLICANT’S DETAILS
Name of First Applicant (Should match with PAN Card) Gender Male Female Title Mr. Ms. M/s

Existing Folio Number
For Investments “On behalf of Minor”
(* Attach Mandatory Documents as per instructions).
Date of Birth Proof of DoB Birth Certificate School Certificate / Mark sheet
(Mandatory for minor)
attached * Passport Any other …………….….......................…….
PAN
(1st Applicant / Guardian) Guardian named below is : Father Mother Court Appointed*
Enclose KYC Acknowledgement

PoA PAN*
Name of Guardian if minor / Contact Person for non-individuals / PoA Holder name: KYC*

Correspondence Address *PoA PAN & KYC is mandatory

Landmark
City Pin Code
State
(Mandatory)
Status of Sole/1st Applicant (Please tick ) Resident Individual On Behalf Of Minor HUF Sole Proprietorship NRI (Repatriable)
NRI (Non-Repatriable) LLP Partnership Firm Company AOP/BOI Body Corporate Trust Society FII FOF - MF schemes Provident Fund
Superannuation / Pension Fund Gratuity Fund Bank / FI Government Body Insurance Companies Others (Please specify)

DSPBR eServices Email ID
(in capital)

Mobile +91 Fax
DSPBR eSMS
STD Code Tel. (Off) Tel. (Resi.)

DSPBR Online Yes, I wish to have a PIN for internet / telephone transactions and agree to terms and conditions of PIN Issuance
NEW
PIN (Please tick ) and Usage as available in SID/SAI and www.dspblackrock.com
Email ID, Date of Birth, Mobile Number, PAN are mandatory details for issuance of PIN and Online Facility.

3. JOINT APPLICANTS’ DETAILS
Mode of Holding (Please tick ) Joint (Default) Anyone or Survivor Single
Name of Second Applicant (Should match with PAN Card) Title Mr. Ms. M/s

PAN (2nd applicant ) Enclose KYC Acknowledgement

Name of Third Applicant (Should match with PAN Card) Title Mr. Ms. M/s

PAN (3rd applicant ) Enclose KYC Acknowledgement

ACKNOWLEDGEMENT SLIP (To be filled in by the investor) DSP BLACKROCK MUTUAL FUND
Received, subject to realisation, verification and conditions, an application for purchase of Units as mentioned in the application form. Application No.
From
Cheque no. Date Amount Scheme

4. BANK ACCOUNT DETAILS (Refer Instruction 4 and avail Multiple Bank Registration Facility)
Bank Name
Bank A/C No. A/C Type Savings Current NRE NRO FCNR Others

Branch Address
City Pin
IFSC code: (11 digit) MICR code (9 digit) (This is a 9 digit number next to your cheque number)

5. INVESTMENT AND PAYMENT DETAILS (Refer Instruction 5) (Cheque DD should be in favour of “Scheme Name”)
Scheme/Plan
/Option/Sub Option DSP BlackRock - TAX SAVER FUND - Growth Option
Scheme Plan Option/Sub Option
(Default plan/option/sub option will be applied incase of no information, ambiguity or discrepancy)
One time Lump sum Investment: Please fill the details hereunder. Do not submit SIP Auto Debit Form.

Payment Mode: Cheque DD RTGS NEFT Funds transfer Cheque/RTGS/
NEFT/DD Date
LUMPSUM

Cheque/DD/RTGS/NEFT No. Payment from Pay In A/c No.
Amount (Rs.) (i) Bank A/c No.

DD charges, (Rs.)(ii) Bank Name

Total Amount (Rs.) (i) + (ii) In figures Branch
In Words Account Type Savings Current NRE NRO FCNR
Documents Attached to avoid Third Party Payment Rejection, where applicable: Bank Certificate, for DD Third Party Declarations
SIP: Systematic Investment Plan. Please fill up SIP Auto Debit form and attach with this form .
First SIP Cheque Details: (Mention Amount in SIP Auto Debit Form) (Refer instruction 4(i) on Third Party Payments)
SIP

Cheque / DD No. Drawn on Bank A/c No. Pay In A/c No.
Cheque/DD Date Bank & Branch

6. NOMINATION DETAILS (Refer Instruction 6) Individuals (single or joint applicants) are advised to avail Nomination facility.
 I/We wish to nominate.  I/We DO NOT wish to nominate and sign here 1st Applicant Signature (Mandatory)

Nominee Name Guardian Name (In case of Minor) Allocation % Nominee/ Guardian Signature
Nominee 1
Nominee 2
Nominee 3
Address
Total = 100%

7. UNIT HOLDING OPTION: (It is mandatory to tick any one option or ‘Account Statement Mode’ option will be considered) Refer Instruction 7).
In Account Statement Mode In Demat mode, in demat account provided below: (Switch not allowed. Redemption through SE platforms/ DPs only)
(default): Depository Participant (DP) ID (NSDL only) Beneficiary Account Number (NSDL only)

(Switch/Redemption through NSDL: I N
Fund/RTA offices only.)
CDSL:

Enclose for demat option: Client Master List Transaction/Holding Statement DIS Copy

8. DECLARATION & SIGNATURES
Having read and understood the contents of the Scheme Information Document and Statement of Additional Information, Key Information Memorandum, Instructions and
addenda issued by DSP BlackRock Mutual Fund, I / We, hereby apply to the Trustee of DSP BlackRock Mutual Fund for Units of the relevant Scheme and agree to abide by
the terms and conditions, rules and regulations of the Scheme. I / We have neither received nor been induced by any rebate or gifts, directly or indirectly in making this
investment. I / We hereby nominate the above nominee to receive all the amounts to my/our credits in the event of my/our death and have read the instructions for
nomination. Signature of the nominee acknowledging receipts of my/our credit will constitute full discharge of liabilities of DSP BlackRock Mutual Fund. 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, Directions or any other applicable laws enacted by the Government of India or any Statutory 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 is being recommended to me/us. Applicable to NRIs only: I/We confirm that I am/We are Non-Resident(s) of Indian Nationality / Origin and I/We hereby confirm
that the funds for subscription have been remitted from abroad through normal banking channels or from funds in my / our Non-Resident External / Ordinary
Account/FCNR Account(s).

Sole / First Applicant / Guardian Second Applicant Third Applicant

Email: service@dspblackrock.com
Contact Centre: 1800 200 4499
Website: www.dspblackrock.com

Quick Name, Address are correctly mentioned Full scheme name, plan, option is mentioned Additional documents provided if investor name is
Checklist not pre-printed on payment cheque or if
Email ID / Mobile number are mentioned Pay-In bank details and supportings are attached
PAN / KYC requirements are enclosed Nomination facility opted Demand Draft is used.
Additional documents provided in case
Complete Bank details provided Form is signed by all applicants
of specific exceptional Third Party Payments.

COMMON APPLICATION FORM Application No.

FOR LUMPSUM INVESTMENTS
Please read INSTRUCTIONS (Page 24-26) carefully. All sections to be completed in ENGLISH in BLACK / BLUE COLOURED INK and in BLOCK LETTERS.

ARN-74461 CODE
ARN - ARN-74461
BROKER SUB-BROKER CODE FOR OFFICIAL USE ONLY
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. SERIAL NUMBER, DATE & TIME OF RECEIPT
1 EXISTING UNITHOLDERS INFORMATION If you have an existing folio no. with PAN & KYC validation, please mention your name & folio No. and proceed to Step 4
Name Mr. Ms. M/s FIRST MIDDLE LAST Folio No.

2 APPLICANT(S) DETAILS (Please Refer to Instruction No. II (b) ) Mandatory information – If left blank the application is liable to be rejected.

1st Applicant Mr. Ms. M/s FIRST MIDDLE LAST Date of Birth* D D M M Y Y Y Y

PAN* Enclosed (Please )§ Attested PAN Card KYC Acknowledgement Letter

Name of * # Mr. Ms. GUARDIAN IN CASE FIRST APPLICANT IS A MINOR OR CONTACT PERSON IN CASE OF NON-INDIVIDUAL APPLICANTS

PAN* Relationship with Natural guardian Enclosed (Please )§ Attested PAN Card
Minor applicant Court appointed guardian KYC Acknowledgement Letter

2nd Applicant Mr. Ms. FIRST MIDDLE LAST Date of Birth D D M M Y Y Y Y


3rd Applicant Mr. Ms. FIRST MIDDLE LAST Date of Birth D D M M Y Y Y Y

§ For PAN KYC requirements, please refer to the instruction Nos. II b(4), V(I) X #
Name of Guardian/Contact Person is Mandatory in case of Minor/Non-Individual Investor.
For documents to be submitted on behalf of minor folio refer instruction IIb(2)
Mode of holding [Please tick ()] Status of First Applicant [Please tick ()] Others PLEASE SPECIFY
Single Joint Anyone or Survivor Minor NRI/PIO Resident Individual HUF Sole Proprietorship Partnership Firm
(Default option: Anyone or Survivor) Trust Bank/FI AOP/BoI Club/Society Company FII

Correspondence Address (Please provide full address)* Overseas Address (Mandatory for NRI / FII Applicants)
HOUSE / FLAT NO. HOUSE / FLAT NO.

STREET ADDRESS STREET ADDRESS

STREET ADDRESS STREET ADDRESS

CITY / TOWN STATE CITY / TOWN STATE

COUNTRY PIN CODE COUNTRY PIN CODE

Tel. (Off.) Tel. (Res.) Fax

Email Mobile

Occupation [Please tick ()] Professional Business Retired Housewife Service Student Others (Please specify)

Please 9 if you wish to receive Account statement / Annual Report/ Other statutory information via Post instead of Email
Please 9 any of the frequencies to receive Account Statement through e-mail £ : Daily Weekly Monthly Quarterly Half Yearly Annually
* Mandatory information – If left blank the application is liable to be rejected. £ Please refer to instruction no.IX
3 BANK ACCOUNT DETAILS OF FIRST APPLICANT (Please Refer to Instruction No. III) Mandatory information – If left blank the application is liable to be rejected.

Account Type Current Savings NRO NRE FCNR Account Number
MANDATORY

Name of Bank

Branch Details BRANCH NAME BRANCH CITY

9 Digit MICR code 11 Digit IFSC Code

4 DEMAT ACCOUNT DETAILS OF FIRST APPLICANT (Please refer Instruction No. XI) NSDL OR CDSL
Depository Participant (DP) ID (NSDL only) Beneficiary Account Number (NSDL only) Depository Participant (DP) ID (CDSL only)

£ £
FOR ANY ASSISTANCE OR FURTHER INFORMATION PLEASE CONTACT US Application No.

ICICI Prudential Asset Management Company Limited
3rd Floor, Hallmark Business Plaza, Sant Dyaneshwar Marg, Bandra (East), Mumbai - 400 051. India

SIGNATURE STAMP DATE SIGNATURE STAMP DATE SIGNATURE STAMP DATE
TOLL FREE NUMBER 1800 222 999 (MTNL/BSNL) 1800 200 6666 (OTHERS) EMAIL enquiry@icicipruamc.com WEBSITE www.icicipruamc.com
Note: All future communications in connection with this application should be addressed to the nearest ICICI Prudential Mutual Fund Customer Service Centre, quoting full name of 3
the first applicant, the application serial number, the name of the scheme, the amount invested, date and the place of the Customer Service Centre where application was lodged.

5 INVESTMENT PAYMENT DETAILS (Refer Instruction No. IV) For Plans Sub-options please see key features for scheme specific details

1 Name of scheme ICICI PRUDENTIAL TAX PLAN
Option Sub option (Please 9 the appropriate boxes only if applicable to the scheme in which you plan to invest)
Retail Option Growth OR Dividend – Reinvestment or Payout OR AEP^ – Regular* or Appreciation
Institutional Option * Cumulative – AEP Regular Option: Encashment of units is subject to declaration of dividend in the respective Scheme(s). Please refer to Instruction no. IV(c)

Dividend Frequencies Daily Weekly Fortnightly Monthly Quarterly Half Yearly AEP Frequencies Monthly Quarterly Half Yearly

Payment Details for Scheme 1 Mode of Payment Cheque DD Funds Transfer NEFT RTGS
Amount Paid DD Charges Amount `
` A ` B Invested
A+B
(if applicable)
Cheque / Y Y
Date D D M M BANK / BRANCH
DD Number

BANK ACCOUNT DETAILS (For Payment Details of Scheme 1 ) Mandatory information – If left blank the application is liable to be rejected.

Bank Details NAME OF BANK BRANCH NAME / CITY
Applications with Third Party Cheques, prefunded instruments etc. and in circumstances as detailed in AMFI Circular No.135/BP/16/10-11 shall be processed in accordance with the said
circular. For Third Party Payment Declaration form and instructions please refer to pages 19-20 and 25 respectively.

2 Name of scheme ICICI PRUDENTIAL
Option Sub option (Please 9 the appropriate boxes only if applicable to the scheme in which you plan to invest)
Retail Option Growth OR Dividend – Reinvestment or Payout OR AEP^ – Regular* or Appreciation
Institutional Option * Cumulative – AEP Regular Option: Encashment of units is subject to declaration of dividend in the respective Scheme(s). Please refer to Instruction no. IV(c)

Dividend Frequencies Daily Weekly Fortnightly Monthly Quarterly Half Yearly AEP Frequencies Monthly Quarterly Half Yearly

Payment Details for Scheme 2 Mode of Payment Cheque DD Funds Transfer NEFT RTGS
Amount Paid DD Charges Amount `
` A ` B Invested
A+B
(if applicable)
Cheque / Y Y
Date D D M M BANK / BRANCH
DD Number

BANK ACCOUNT DETAILS (For Payment Details of Scheme 2 ) Mandatory information – If left blank the application is liable to be rejected.

Bank Details NAME OF BANK BRANCH NAME / CITY
For Third Party Payment Declaration form and instructions please refer to pages 19-20 and 25 respectively and refer instruction VI(e).

Please ensure that the Bank Account details are mentioned separately, for Cheque and Demand Draft (DD) payments for Investments in Scheme 1 and in Scheme 2. ^AEP - Automatic encashment plan
6 NOMINATION DETAILS (Refer instruction VII) • For Multiple nominations, please use the form on page 23. • Nomination is mandatory if the mode of holding is SINGLE.
I/We do not wish to nominate
[Please tick () sign] SIGNATURE OF FIRST APPLICANT SIGNATURE OF SECOND APPLICANT SIGNATURE OF THIRD APPLICANT
I/We hereby nominate the under-mentioned nominee to receive the amount to my/our credit in the event of my/our death and
confirm that I/we have read and understood the nomination clause under instruction no. VII. Date of Birth is MANDATORY in case Nominee is a minor

Nominee Date of Birth D D M M Y Y
NAME OF NOMINEE
Relationship with Natural guardian
Guardian MANDATORY, IF NOMINEE IS A MINOR Minor applicant () Court appointed guardian
Nominee’s HOUSE / FLAT NO STREET ADDRESS
Address
CITY / TOWN PIN CODE SIGNATURE OF NOMINEE / GUARDIAN, IF
7 INVESTOR(S) DECLARATION SIGNATURE(S) NOMINEE IS A MINOR
The Trustee, ICICI Prudential Mutual Fund, I/We have read and understood the Scheme Information Document/Key Information Memorandum of the Scheme(s). I/We apply for the units of the Fund and agree to abide by the terms, conditions,
rules and regulations of the scheme and other statutory requirements of SEBI, AMFI, Prevention of Money Laundering Act, 2002 and such other regulations as may be applicable from time to time.I/We confirm to have understood the investment
objectives, investment pattern, and risk factors applicable to Plans/Options under the Scheme(s). I/we have not received nor been induced by any rebate or gifts, directly or indirectly, in making this investment. 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, Regulations or any other applicable laws enacted by the Government of India or any Statutory Authority. I/We
agree that in case my/our investment in the Scheme is equal to or more than 25% of the corpus of the plan, then ICICI Prudential Asset Management Co. Ltd.(the 'AMC'), has full right to refund the excess to me/us to bring my/our investment below
25%. I/We hereby declare that I am/we are not US Person(s). 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. I/We interested in receiving promotional material from the AMC via mail, SMS, telecall, etc. If you do not wish to receive, please call on tollfree no. 1800 222 999 (MTNL/BSNL) or 1800 200 6666 (Others).

D D M M Y Y
SIGNATURE OF FIRST APPLICANT SIGNATURE OF SECOND APPLICANT SIGNATURE OF THIRD APPLICANT

£ £
ACKNOWLEDGEMENT SLIP
Please Retain this Slip To be filled in by the Investor. Subject to realization of cheque and furnishing of Mandatory Information.

1 Scheme ICICI PRUDENTIAL TAX PLANSCHEME ANDOption
- Growth OPTION ` AMOUNT CHEQUE / DD No. D D M M Y Y
2 Scheme ICICI PRUDENTIAL SCHEME AND OPTION ` AMOUNT CHEQUE / DD No. D D M M Y Y
1 DRAWN ON BANK BRANCH 2 DRAWN ON BANK BRANCH EXISTING FOLIO NO.
4

Reliance Capital Asset Management Limited
A Reliance Capital Company

APP No.: WE-00012343
COMMON APPLICATION FORM
All Columns marked * are mandatory. TO BE FILLED IN CAPITAL LETTERS IN BLUE/BLACK INK ONLY.
1. DISTRIBUTOR / BROKER INFORMATION (Refer Instruction No. I.9) 2. EXISTING UNIT HOLDER INFORMATION
Name Broker Code / ARN Sub Broker / Sub Agent Code For existing investors please fill in your Folio number,
ARN-74461 FOLIO NO.
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.
3. APPLICANT INFORMATION (Refer Instruction No. II)
APPLICATION FOR Zero Balance Folio Invest Now
MODE OF HOLDING Single Joint Any One or Survivor(s) (Default Joint)
OCCUPATION Business Professional Service Retired Student Current/Former MP/MLA/MLC/Head of State
Retired Civil Servant Politician Forex Dealer House wife Senior Executive of State owned corporation
Political Party Official Others _________________
STATUS 1st Applicant Resident Indian NRI STATUS NON- FIIs Society
Banks Trust HUF
INDIVIDUAL 2nd Applicant Resident Indian NRI INDIVIDUAL Minor Fls AOP/BOI Partnership firm
3rd Applicant Resident Indian NRI Company/Body Corporate Others _________________

Name of First / Sole applicant Mr. Ms. M/s.

1st holder PAN PAN Proof Enclosed Date of Birth**
KYC Acknowledgement Copy #Document Category No.
(Refer Instruction No. IX.4) D D M M Y Y Y Y
M a n d a t o r y
(**Date of birth mandatory if the
applicant is minor)
Name of Guardian (In case of Minor)/(Contact Person Name - In case of non-individual Investors) Mr. Ms. Relation with Minor / Designation

M a n d a t o r y

Guardian’s PAN PAN Proof Enclosed KYC Acknowledgement Copy #Document Category No.
M a n d a t o r y
(Refer Instruction No. IX.4)
Name of Second applicant Mr. Ms.

PAN Proof Enclosed KYC Acknowledgement Copy #Document Category No.
2nd holder PAN M a n d a t o r y
Name of Third applicant Mr. Ms.

3rd holder PAN PAN Proof Enclosed KYC Acknowledgement Copy #Document Category No.
M a n d a t o r y
#Mandatory for MICRO SIP Investors (Refer Instruction No. IX)
Mailing Address
Add 1
Add 2 District
Add 3 City

State Country PIN
Overseas Address (Mandatory for NRI / FII Applicant) (Please provide your complete address. P.O. Box alone is not adequate)
Add 1
Add 2

City Country PIN
CONTACT DETAILS OF SOLE/FIRST APPLICANT
(For Receiving SMS Alert)
Tel. No. STD Code __________ Office ____________________ Residence _____________________ Mobile no. ______________________________________

Email ID (For Receiving Email Alert)
Investors providing Email Id would mandatorily receive only E - Statement of Accounts in lieu of physical Statement of Accounts. (Refer Instruction No. VI)
I WISH TO APPLY FOR TRANSACT ONLINE I WISH TO APPLY FOR RELIANCE ANY TIME MONEY CARD (Please refer to ATM Instruction)
I have read understood the Terms Conditions attached Name as you would like to appear on Any Time Money Card (Max. 19 characters)
M a n d a t o r y

Mother’s maiden name in full
M a n d a t o r y

Please collect your time stamped acknowledged slip for future references
Received from ___________________________________________________________________________an application for allotment of
TAX SAVER FUND
Units under Reliance ________________________________________________________as per details below. APP No.: WE-00012343
Growth Option Bonus Option Dividend Reinvestment Dividend Payout

Cheque / DD No. ____________________________ Dated ______________Rs. _______________________
Time Stamp Date
drawn on ________________________________________________________________________________ of receiving office

4 . BANK ACCOUNT DETAILS (Refer Instruction No.III) MANDATORY for Redemption/Dividend/Refunds, if any
A/c. Type SB Current NRO NRE FCNR Account No. M a n d a t o r y

Bank M a n d a t o r y
Branch
Branch City

PIN IFSC Code For Credit via NEFT 9 Digit MICR Code* F o r C r e d i t v i a E C S
Please ensure the name in this application form and in your bank account are the same
5. INVESTMENT PAYMENT DETAILS (Separate Application Form is required for investment in each Plan/Option
(Refer instruction no. IV) PAYMENT BY CASH IS NOT PERMITTED.
Scheme Plan Option DD Charge Net Cheque / Cheque / DD No. Bank / Branch
Rs. DD Amount Rs. Date
Growth Option
RELIANCE Growth Plan
Bonus Option
TAX SAVER FUND
Dividend Plan Reinvestment
Payout

SIP ENROLLMENT DETAILS PDC Auto Debit / ECS (Refer Instruction No. I-12)
Frequency (Please ) Monthly Quarterly SIP Date: 2 10 18 28
REGULAR PERPETUAL (Default) (Not applicable for PDCs) Amount per Instalment:
Enrollment Period: From: M M Y Y To: Enrollment Period: From: M M Y Y To: 1 2 9 9 Rs. _______________________
M M Y Y
6. DOCUMENTS ENCLOSED (Please ) (MANDATORY) (Refer to Instruction No.I-9)
For Corporate For Systematic Transactions For Additional Document
Memorandum Articles of Association SIP Enrollment Form (Cheque or Auto Debit and ECS) Cheques Power of Attorney
Trust Deed Bye-Laws Partnership Deed Systematic Transfer Plan Dividend Transfer Plan Enrollment Form
Resolution / Authorization to invest Systematic Withdrawal Plan Enrollment Form Reliance SMART Others ________________
List of Authorised Signatories with Specimen Signature(s) STEP Enrollment Form Trigger Form Reliance SIP Insure Form

7. NOMINATION (Refer to Instruction No.V) (Mandatory if mode of holding is single)
I/ We _______________________________________, __________________________________and__________________________________________*
(Unit holder 1) (Unit holder 2) (Unit holder 3)
do hereby nominate the person(s) more particularly described hereunder/ and*/cancel the nomination made by me/ us on the ________ day of________________
in respect of the Units under Folio No.___________________ (* strike out which is not applicable)
Date of Proportion (%) by which the Signature of Signature of
Name and Address of Nominee(s) Name and Address of Guardian Birth (Minor) units will be shared by each Nominee Guardian
Nominee (should aggregate to 100%)
(to be fur nished in case the Nominee is a minor)

Nominee 1

Nominee 2

Nominee 3

I/ We _______________________________________, _____________________________________and__________________________________________
(Unit holder 1) (Unit holder 2) (Unit holder 3)
do hereby declare that we do not wish to nominate any person/person(s) in the folio/account.

Sole / 1st applicant/ 2nd applicant/ 3rd applicant/
Authorised Signatory Authorised Signatory Authorised Signatory
8. DECLARATION
I/We would like to invest in Reliance_____________________________ subject to terms of the Statement of Additional Information (SAI), Scheme Information Document (SID), Key Information
Memorandum (KIM) and subsequent amendments thereto. I/We have read, understood (before filling application form) and is/are bound by the details of the SAI, SID KIM including details relating to
various services including but not limited to ATM/ Debit Card. I/We have not received nor been induced by any rebate or gifts, directly or indirectly, in making this investment. 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 / Regulations / Rules / Notifications / Directions or any other Applicable
Laws enacted by the Government of India or any Statutory Authority. I accept and agree to be bound by the said Terms and Conditions including those excluding/ limiting the Reliance Capital Asset
Management Limited (RCAM) liability. I understand that the RCAM may, at its absolute discretion, discontinue any of the services completely or partially without any prior notice to me. I agree RCAM can
debit from my folio for the service charges as applicable from time to time. 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. I hereby declare that the above information is given by the undersigned and
particulars given by me/us are correct and complete. Applicable for NRI Investors: I confirm that I am resident of India. I/We confirm that I am/We are Non-Resident of Indian Nationality/Origin and
I/We hereby confirm that the funds for subscription have been remitted from abroad through normal banking channels or from funds in my/our Non-Resident External / Ordinary Account/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.

S
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u Sole / 1st applicant/Guardian/ 2nd applicant/ 3rd applicant/
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e Authorised Signatory Authorised Signatory Authorised Signatory

ACKNOWLEDGMENT SLIP (To be filled in by the Applicant)
One Indiabulls Centre, Tower 1, 11th 12th Floor,
Jupiter Mill Compound, 841, Senapati Bapat Marg
Elphinstone Road, Mumbai-400 013

Call : 30301111 | Toll free: 1800-300-11111
www.reliancemutual.com

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