ANNEXURE XIII

Application for Transmission of Units
Please go through the instructions given at the end before filling up this form.

1. I/Wecam/are the nominee/legalheir/Executor/Administrator (strike off whicheveris not applicable) to the estate of
_________________________________________,the holder of the followingunits whohas expired on
Unit Certificate/Membership/Folio No. Number of Units
2. I/We tender herewith the above Unit Certificates/Membership Advice/Statement of Account and request you to issue
units in my/our names.
1. The date of birth (if claimant is minor) is ________________________. My relationship with him/her is that of (1)
Father (2) Mother (3) Court Guardian (Strike off whichever is not applicable).
2. I/We wish to hold these units on (1) Singly (2) Jointly (3) Either or survivor (Strike off whichever is not applicable)
3. Mode of payment of dividend (if units are held under ‘income’ option):
(1) Pay out option – by issue of warrants (2) Pay out option – through ECS to my bank
(3) Reinvestment Option
4. Name and address of my bank
Account Number : __________________________ Account Type : NRO / NRE / Savings / Current
Name of the Bank :
_________________________________________________________________________________________
Address of the Bank :
_________________________________________________________________________________________
Pin: ___________________________________________
MICR Bank Code Number ( 9 digits) :
5. Tax Payer’s PAN/GIR No.:_____________________ Tax circle/ward No._______________________
6. Name of the First Unit Holder (Minor) Sri / Smt/Kum
7. Address :
Pin :
8. Second Holder’s (Guardian’s) Name : Shri / Smt / Kum.
9. Third Holder’s (Guardian’s)Name: Shri / Smt / Kum
PTO
Guardian of
Minor nominee ________________
Name :
Date of Birth (if minor)
The above signatures are attested (with seal)
__________________________________________________________________________________________
FOR OFFICE USE ONLY
10. I/We do hereby nominate the following person to receive the amount payable on my/our death. (person applying
on behalf of minor/power of attorney holder/partnership firm/karta of HUF & Non-Individuals cannot nominate)
________________________________
Signature of first holder Signature of second holder Signature of third holder
Date : ________________________________ Place :
New Folio No. No. of Units
Date of Acceptance Inward number/case number
_________________________________________
INSTRUCTIONS :
6. Other Chief Representatives upto Rs.5000 face value.
2. Manager or above of UTI Mutual Fund (with name and code number)
II. Thumb impression of the claimant should be attested by anyone of the following persons:
Judicial/Stipendary Magistrare or Manager of scheduled commeiracl bank (upto Rs.10000 f ace value)
III. Nomination can be made by the sole holder or joint holders upto two persons.
I. Signature of the claimant should be attested by anyone of the following persons:
1. Manager of scheduled commercial bank (with name and code number)
3. Judicial/Stipendary Magistrate
4. UTI’s Chief Representa tive with FO upto Rs.20000 f ace value
5. UTI’s Chief Representa tive with CC upto Rs.10000 f ace value
SIGNATURE AND STAMP OF UTI
______________________________________
IV. It is mandatory for furnishing the bank account particulars.
________________________________________________________________________________________________
ACKNOWLEDGEMENT
Folio/Certificate/Membership Advice/Investor ID No. _____________________________
Received from ________________________________________ an application for death claim admission
alongwith _______________ Certificates/MA/SOA for _______________ units.