APPLICATION FORM
UTI – Fixed Term Income Fund Series – XV – X (368 days)
(A Close-Ended Income Scheme)
The product is suitable for investors who are seeking*:
l Regular income for short term
l Investment in Debt/Money Market Instrument/Govt. Securities
l Low risk (Blue)
* Investors should consult their financial advisers if in doubt about whether the product is suitable for them.
Note: Risk may be represented as:
(BLUE) investors understand that their principal will be at low risk
(YELLOW) investors understand that their principal will be at
medium risk
(BROWN) investors understand that their principal will be at high risk
New Fund Offer Opens on: Thursday, August 01, 2013
New Fund Offer Closes on: Wednsday, August 07, 2013
THIS PAGE HAS BEEN INTENTIONALLY LEFT BLANK
TEAR HERE
APPLICATION FORM
Offer of Units of `10/- per unit for cash during the New Fund Offer
PLEASE FILL IN ALL COLUMNS IN CAPITAL LETTERS ONLY
ACKNOWLEDGEMENT
(To be filled in by the Applicant)
UTI - FIXED TERM INCOME FUND SERIES – XV -
Sr. No. 2013/
Received from Mr / Ms / M/s
along with Cheque / DD*/ NEFT / RTGS
Ref. No./ Unique Serial No. (For Cash) dated
Drawn on (Bank)
for ` (in figures)
* Cheques and drafts are subject to realisation.
Stamp of UTI AMC Office
/Authorised Collection Centre
PAYMENT DETAILS
#Cheque/DD/*NEFT/*RTGS Ref No.
/ Unique Serial No. (For Cash)
Account No.
Date Amt. of investment (i)
Bank DD Charges if any (ii)
Branch Net amount paid (i-ii)
Amt in words
#Please mention the application No. on the reverse of the cheque / DD, NEFT / RTGS advice. Cheque / DD must be drawn in favour of “UTI - FIXED TERM INCOME FUND SERIES – XV __________________” & crossed “A/c Payee Only”
*Investment amount shall be ` 2 Lacs and above in case of payments through NEFT / RTGS.
DETAILS OF OTHER APPLICANTS
*PAN of 3rd Applicant AADHAR CARD NO.
Sr.No. 2013/
Registrar Sr. No.
(PLEASE READ INSTRUCTIONS CAREFULLY TO HELP US SERVE YOU BETTER)
BDA / CA Code
DISTRIBUTOR INFORMATION (only empanelled Distributors/ Brokers will be permitted to distribute Units) (refer instruction ‘m’)
Name of 3rd Applicant Mr. Ms. Mrs.
Date of Birth of 3rd Applicant
*PAN of 2nd Applicant AADHAR CARD NO.
Name of 2nd Applicant Mr. Ms. Mrs.
d d m m y y y y
F I R S T
M I D D L E
L A S T
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Enclosed PAN Card Copy Know Your Customer (KYC)* Acknowledgement copy Please ()
OPTION FOR DESPATCH OF STATEMENT OF ACCOUNT
Applicant’s address as mentioned above (For NRIs) At my Overseas address as mentioned above /
To be despatched to my resident relative’s address in India as given above
*PAN OF 1ST APPLICANT/FATHER/MOTHER/GUARDIAN (whose particulars are furnished in the form) AADHAR CARD NO.
NAME IN FULL OF THE FATHER (OR) MOTHER / GUARDIAN (IN CASE OF MINOR) $ / CONTACT PERSON FOR INSTITUTIONAL APPLICANTS Mr. Ms. Mrs.
F I R S T
M I D D L E
L A S T
OVERSEAS ADDRESS (Overseas address is mandatory for NRI / FII applicants in addition to mailing address in India)
City*
State
Country*
Zip/Pin*
Enclosed PAN Card Copy Know Your Customer (KYC)* Acknowledgement copy Please ()
Existing Unit Holder Information Scheme Name: Folio Number:
TRANSACTION CHARGES TO BE PAID TO THE DISTRIBUTOR (Please tick any one of the below. Refer Instruction ‘n’)
I AM A FIRST TIME INVESTOR IN MUTUAL FUNDS OR I AM AN EXISTING INVESTOR IN MUTUAL FUNDS
` 150 will be deducted as transaction charges per Subcription of ` 10,000 and above ` 100 will be deducted as transaction charges per subcription of ` 10,000 and above
APPLICANT’S PERSONAL DETAILS Mr. Ms. Mrs. M/s.
Name of First Applicant (as appearing in ID Proof given for KYC)
First Applicant’s Address (Do not repeat the name) Name & Address of resident relative in India (for NRIs) (P.O. Box No. is not sufficient)
F I R S T
M I D D L E
L A S T
Date of Birth
Mandatory for minors
d d m m y y y y
Village/Flat/Bldg./Plot*
Street/Road/Area/Post
City/Town*
State
Pin*
d d m m y y y y
F I R S T
F I R S T
M I D D L E
M I D D L E
L A S T
L A S T
Date of Birth of 2nd Applicant
Enclosed PAN Card Copy Know Your Customer (KYC)* Acknowledgement copy Please ()
$ Proof of date of birth and proof of relationship with minor to be attached or else sign the declaration on the reverse ( Refer instruction s).
FRIEND IN NEED DETAILS (refer instruction - q) In case UTI MF is unable to communicate with me / us at my / our registered address, I / we authorize UTI MF to correspond with the following person to ascertain my/our undated contact details.
Name
Address
Relationship with the applicant (optional)
Mobile
Email
Account Type Please () Current Savings NRE NRO DD issued from abroad Cash
ARN Name of Financial Advisor Sub ARN Code Sub Code/ Bank Branch Code M O Code EUI NO.* UTI RM No.
Signature of 1st Applicant / Guardian Signature of 2nd Applicant Signature of 3rd Applicant
Upfront Commission shall be paid directly by the investor to the AMFI / NISM certified UTI MF registered Distributors based on the investors’ assessment of various factors including the service rendered by the distributor. *I/We confirm that the EUIN box is intentionally left blank by me/us as this is an “execution-only” transaction without any interaction or advice by the distributor personnel concerned or notwithstanding the advice of in-appropriateness, if any, provided by such distributor personnel and the distributor has not charged any advisory fees for this transaction. (Please tick only when EUIN box is left blank).
Signature of 3rd Applicant
Name of the 3rd Authorised Signatory
Designation
* Applicable to NRI’s
Notes:
1. If the application is incomplete and any other requirement is not fulfilled, the application is liable to be rejected.
2. In case the applicant does not receive the Statement of Account within 10 days from the date of acceptance of the application, he/she may please write to the Registrar quoting serial number, date of acknowledgement and the name of the accepting authority to the Registrar.
3. Please ensure that all PAN details/ copy of KYC Acknowledgement provided by service provider are given, failing which your application will be rejected.
4. All communications relating to issue of Statement of Account, Change in Name, Address or Bank Particulars, Nomination, Redemption, Death Claims, etc., may please be addressed to the Registrar :
M/s. Karvy Computershare Pvt. Ltd.
Narayani Mansion, H. No. 1-90-2/10/E, Vittalrao Nagar, Madhapur, Hyderabad - 500 081.
Tel.: 040 - 23312454, Fax: 040 - 23115503,
Email:uti [at] karvy [dot] com
INVESTMENT DETAILS (Please ) (* Please check the opening and closing date of the Plan before selecting your choice)
NOMINATION DETAILS (Please ) (please sign if you do no wish to nominate)
Name and Address of Nominee
To be furnished in case nominee is a minor
Name
Date of Birth D D M M Y Y Y Y
(in case of nominee is a minor)
Name of the guardian
Address of guardian
Address
Signature of Nominee / guardian
(for minor) I/We hereby nominate the undermentioned Nominee to receive the amounts to my / our credit in the event of my / our death. I/We also understand that all payments and settlements made to such Nominee and signature of the Nominee acknowledging receipt thereof, shall be a valid discharge by the AMC / Mutual Fund / Trustee. I/We do not wish to nominate
Signature of 1st Applicant / Guardian Signature of 2nd Applicant Signature of 3rd Applicant
First Applicant Details
Mobile Number
Tel. (R) STD CODE
No. (O) STD CODE
*E mail
Alternate E-mail
Investors who wish to nominate two or three persons may fill in the separate form prescribed for the same and attach it with this application form.
Signature of 2nd Applicant
Name of the 2nd Authorised Signatory
Designation
Signature of 1st Applicant / Guardian
Name of the 1st Authorised Signatory
Designation
DECLARATION AND SIGNATURES OF APPLICANT/s
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 confirm that this investment has been duly authorised by appropriate authorities in terms of all relevant documents and procedural requirements. l I/We have not received nor been induced by any rebate or gifts, directly or indirectly in making investments. l 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. l I/We hereby authorize UTI MF/UTI AMC to share my data furnished in the Form to my distributor and other service providers of the UTI MF for the purpose of servicing, issue of account statement/consolidated statement of account etc and cross selling of products/schemes of the UTI MF. l *I/We confirm that we are Non-Residents of Indian Nationality/Origin and that the funds are remitted from abroad through approved banking channels or from my / our NRE / NRO Account. I/We undertake to provide further details of source of funds and any such other relevant documents, if called for by UTI Mutual Fund. l I hereby solemnly declare that I am the father/mother/guardian of the minor child in whose name the application is made. The date of birth stated by me is true and correct. I do not have any documents in support of the date of birth and relationship with minor child. (Strike out if this declaration is not applicable)
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DEMAT ACCOUNT DETAILS - (Please ensure that the sequence of names as mentioned in the application form matches with that of the account held with any one of the the Depository Participant. Demat Account details are compulsary if demat mode is opted above)
National Securities Depository Limited
Depository Name
DP ID No.
Beneficiary
Account No.
Central Depository
Securities
Limited
Depository Name
Target ID No.
Unitholding Option Demat Mode Physical Mode
GENERAL INFORMATION - Please () wherever applicable
Status
Resident Individual
Minor through guardian
HUF
Partnership
Trust
BOI
FII
Company
Sole Proprietorship
Society
Body Corporate
AOP
NRI
Others
Mode of Holding
Single
Anyone or survivor
Joint
Occupation
Business
Student
Agriculture
Self-employed
Professional
Housewife
Retired
Service
Others (Specify)
Marital Status
Unmarried
Married
Wedding Anniversary
D
M
D
M
Enclosures : Client Master List (CM) Transaction cum Holding Statement Delivery Instruction Slip (DIS)
*Denotes Mandatory Fields
BANK PARTICULARS OF 1ST APPLICANT (Mandatory as per SEBI Guidelines)
Bank Name Branch
Address MICR Code
(this is a 9-digit number next to your cheque number)
City Pin*
IFS Code
Account No.
(this is a 11 digit number)
Account type (please ) Savings Current NRO NRE
Annual Income of First Individual Applicant (Please () < 5 Lacs > 5 Lacs - < 15 Lacs
> 15 Lacs - < 25 Lacs
> 25 Lacs
Sign
Here
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Sign
Here
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*Please send the Account Statement, Abridged Annual Report, Transaction Confirmation, Communication of change of address, change of bank details etc. through email only at the below email ID. (If you wish to receive in physical form please tick
)
Regular Plan
Direct Plan
(Refer Instruction ‘u’)
UTI - FIXED TERM INCOME FUND SERIES – XV - *
Scheme Name
PLAN (Please )
OPTIONS (Please ) Growth Quarterly Dividend Payout Quarterly Dividend Reinvestment
Annual Dividend Payout Annual Dividend Reinvestment Maturity Dividend Option with payout facility (Defualt Growth option.)
For above plan