April 11, 2013
July 1, 2013
COMMON APPLICATION FORM FOR OPEN-ENDED
EQUITY AND BALANCED SCHEMES
UTI Asset Management Co. Ltd.
UTI - Balanced Fund (An open-ended Balanced Fund)
This product is suitable for investors who are seeking*:
l Long term capital growth
l Investment in equity instruments (maximum-75%) and fixed income securities (debt and money market securities)
l High risk
(Brown)
UTI - Banking Sector Fund (An open-ended equity scheme)
This product is suitable for investors who are seeking*:
l Long term capital growth
l Investment primarily in equity instruments of companies engaged in banking and financial services activities
l High risk
(Brown)
UTI - Contra Fund (An open-ended equity scheme)
This product is suitable for investors who are seeking*:
l Long term capital growth
l Investment in undervalued equity instruments based on insights from behavioral finance
l High risk
(Brown)
UTI - Dividend Yield Fund (An open-ended equity scheme)
This product is suitable for investors who are seeking*:
l Long term capital growth
l Investment predominantly in high dividend yielding equity instruments
l High risk
(Brown)
UTI - Energy Fund (An open-ended equity scheme)
This product is suitable for investors who are seeking*:
l Long term capital growth
l Investment in equity instruments of the energy sectors
l High risk
(Brown)
UTI - Equity Fund (An open-ended equity scheme)
This product is suitable for investors who are seeking*:
l Long term capital growth
l Investment in equity instruments of companies with good growth prospects
l High risk
(Brown)
UTI - India Lifestyle Fund (An open-ended equity scheme)
This product is suitable for investors who are seeking*:
l Long term capital growth
l Investment in equity instruments of companies that are expected to benefit from changing Indian demographics and indian lifestyles
l High risk
(Brown)
UTI - Infrastructure Fund (An open-ended equity scheme)
This product is suitable for investors who are seeking*:
l Long term capital growth
l Investment predominantly in equity instruments of companies the infrastructure sector
l High risk
(Brown)
UTI - Leadership Equity Fund (An open-ended equity scheme)
This product is suitable for investors who are seeking*:
l Long term capital growth
l Investment in equity instruments of companies that are “Leaders” in their respective industries/sectors / sub-sectors.
l High risk
(Brown)
UTI - Master Plus Unit Scheme (An open-ended equity scheme)
This product is suitable for investors who are seeking*:
l Long term capital growth
l Investment in high growth equity instruments comprised in S&P BSE 100
l High risk
(Brown)
Please read overleaf
UTI - Mastershare Unit Scheme (An open-ended equity scheme)
This product is suitable for investors who are seeking*:
l Long term capital growth
l Investment in equity instruments of fundamentally strong companies
l High risk (Brown)
UTI - Master Value Fund (An open-ended equity oriented value fund)
This product is suitable for investors who are seeking*:
l Long term capital growth
l Investment in equity instruments of companies that are undervalued to their expected
long term earnings growth.
l High risk (Brown)
UTI - Mid Cap Fund (An open-ended equity scheme)
This product is suitable for investors who are seeking*:
l Long term capital growth
l Investment primarily in mid cap equity instruments
l High risk (Brown)
UTI - MNC Fund (An open-ended equity scheme)
This product is suitable for investors who are seeking*:
l Long term capital growth
l Investment predominantly in equity instruments of Multinational companies and
other liquid stocks.
l High risk (Brown)
UTI - Nifty Index Fund (An open-ended passive Index Fund tracking the CNX Nifty Index)
This product is suitable for investors who are seeking*:
l Capital growth in tune with the index returns
l Passive investment in equity instruments comprised in CNX Nifty Index
l High risk (Brown)
UTI - Opportunities Fund (An open-ended equity scheme)
This product is suitable for investors who are seeking*:
l Long term capital growth
l Investment in equity instruments by capitalizing on opportunities arising in the market
dynamically
l High risk (Brown)
UTI - Pharma & Healthcare Fund (An open-ended equity scheme)
This product is suitable for investors who are seeking*:
l Long term capital growth
l Investment in equity instruments of companies in the Pharma & Healthcare sector
l High risk (Brown)
UTI - Services Industries Fund (An open-ended equity scheme)
This product is suitable for investors who are seeking*:
l Long term capital growth
l Investment in equity instruments of companies in the Services Industries sector
l High risk (Brown)
UTI - Top 100 Fund (An open-ended equity scheme)
This product is suitable for investors who are seeking*:
l Long term capital growth
l Investment predominantly in equity instruments of Top 100 companies by market
capitalisation
l High risk (Brown)
UTI-Transportation and Logistics Fund (An open-ended equity scheme)
This product is suitable for investors who are seeking*:
l Long term capital growth
l Investment in equity instruments of the companies engaged in the transportation and
logistics sector
l High risk (Brown)
UTI-Wealth Builder Fund Series II (An open-ended equity scheme)
This product is suitable for investors who are seeking*:
l Long term capital growth
l Investment in equity instruments/ Gold ETFs
l High risk (Brown)
* Investors should consult their financial advisers if in doubt about whether the product is
suitable for them.
Note: Risk is 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
Sr.No. 2013/
Registrar Sr. No.
OPTION FOR DESPATCH OF STATEMENT OF ACCOUNT
OVERSEAS ADDRESS (Overseas address is mandatory for NRI / FII applicants in addition to mailing address in India)
City*
State
Country*
Zip/Pin*
NAME IN FULL OF THE FATHER (OR) MOTHER / GUARDIAN (IN CASE OF MINOR)$ / CONTACT PERSON FOR INSTITUTIONAL APPLICANTS Mr. Ms. Mrs.
$ Proof of date of birth and proof of relationship with minor to be attached or else sign the declaration on the reverse (Refer instruction ‘f ’).
F I R S T
M I D D L E
L A S T
TRANSACTION CHARGES TO BE PAID TO THE DISTRIBUTOR (Please tick any one of the below) (Refer Instruction ‘i’) 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 Subscription of ` 10,000 and above ` 100 will be deducted as transaction charges per Subscription of ` 10,000 and above
Existing Unit Holder information Scheme Name: Folio Number:
COMMON APPLICATION FORM FOR OPEN-ENDED
EQUITY AND BALANCED SCHEMES
PLEASE USE SEPARATE FORM FOR EACH SCHEME
PLEASE FILL IN ALL COLUMNS IN CAPITAL LETTERS ONLY
(PLEASE READ INSTRUCTIONS CAREFULLY TO HELP US SERVE YOU BETTER)
Applicant’s address (for NRIs) At my Overseas address as mentioned above / To be despatched to my resident relative’s address in India as given above
ACKNOWLEDGEMENT
(To be filled in by the Applicant)
Stamp of UTI AMC Office/
Authorised Collection Centre
dated
(scheme name)
Sr. No. 2013/
Received from Mr / Ms / M/s
An application under
along with Cheque / DD No.$ /Cash
Drawn on (Bank)
for ` (in figures)


$ Cheques and drafts are subject to realisation.
DISTRIBUTOR INFORMATION (only empanelled Distributors/Brokers will be permitted to distribute Units) (refer instruction ‘h’)
BDA / CA Code
Amt. in words
PAYMENT DETAILS
Account No.
Date
Bank
Branch
Amt. of investment (i)
DD Charges if any (ii)
Net amount paid (i-ii)
# Please mention the application No. on the reverse of the cheque / DD, NEFT / RTGS advice. Cheque / DD must be drawn in favour of “The Name of the Scheme” & crossed “A/c Payee Only”
 Investment amount shall be Rs. 2 lacs and above in case of payments through NEFT / RTGS.
#Cheque/DD/NEFT/RTGS Ref. No.
/ Unique Serial No. (For Cash)
Account type Savings Current NRE
(please
) NRO DD issued from abroad Cash
*PAN of 3rd Applicant
Name of 2nd Applicant Mr. Ms. Mrs.
Date of Birth of 2nd Applicant
d d m m y y y y
*PAN of 2nd Applicant
Name of 3rd Applicant Mr. Ms. Mrs.
Date of Birth of 3rd Applicant
d d m m y y y y
F I R S T
M I D D L E
L A S T
Enclosed
PAN Card Copy Know Your Customer (KYC)* Acknowledgement Copy Please ()
F I R S T
M I D D L E
L A S T
Enclosed
PAN Card Copy Know Your Customer (KYC)* Acknowledgement Copy Please ()
DETAILS OF OTHER APPLICANTS
AADHAR CARD NO.
AADHAR CARD NO.
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 and sign below when EUIN box is left blank) (refer instruction ‘v’).
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)
Village/Flat/Bldg./Plot*
City/Town*
State
Pin*
Street/Road/Area/Post
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
Enclosed
PAN Card Copy Know Your Customer (KYC)* Acknowledgement Copy Please ()
APPLICANT’S PERSONAL DETAILS Mr. Ms. Mrs. * Denotes Mandatory Fields
*PAN OF 1ST APPLICANT/FATHER/MOTHER/GUARDIAN (whose particulars are furnished in the form) AADHAR CARD NO.
Ê
Ê
Signature of 1st Applicant / Guardian
Name of 1st Authorised Signatory
Signature of 2nd Applicant
Name of 2nd Authorised Signatory
Signature of 3rd Applicant
Name of 3rd Authorised Signatory
ARN Name of Financial Advisor Sub ARN Code Sub Code/ M O Code EUI No.@ UTI RM No.
Bank Branch Code
INVESTMENT DETAILS (For “DIRECT PLAN” Please tick here & tick Scheme, Plan / Option given below) (Refer instruction ‘j’)
Notes :
1. If the application is incomplete and any other requirement is not fulfilled, the application is liable to be rejected.
2. Consolidated Account Statement (CAS) will be sent within 10 days of the following month of the transaction.
3. Please ensure that all KYC Compliance Proof and PAN details are given, failing which your application will be rejected. PAN not applicable for Micro SIP.
4. All communication 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 Private Limited, Narayani Mansion, H.No.1-90-2/10/E, Vittalrao Nagar, Madhapur, Hyderabad – 500 081. Tel. 040-23312454, Fax: 040-23115503,
E-mail: uti [at] karvy [dot] com
Unitholding Option Demat Mode Physical Mode (if Demat account details are provided below, units will be allotted by default in Electronic Mode only)
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 Depository Participant. Demat Account details are compulsory if demat mode is opted above
National Securities
Depository Limited
Depository Name _______________________________________
Central Depository
Securities Limited
Depository Name ______________________________________________________
DP ID No.
Beneficiary
Account No.
Target ID No.
Enclosures : Client Master List (CMl) Transaction cum Holding Statement Delivery Instruction Slip (DIS)
Sign.
here
Ê
Sign.
here
Ê
Signature of 1st Applicant / Guardian
Name of 1st Authorised Signatory
______________________________________
Designation ___________________________
Signature of 2nd Applicant
Name of 2nd Authorised Signatory
______________________________________
Designation ___________________________
Signature of 3rd Applicant
Name of 3rd Authorised Signatory
______________________________________
Designation ___________________________
Ê
Annual Income of First Individual Applicant (Please () < 5 Lacs > 5 Lacs - < 15 Lacs > 15 Lacs - < 25 Lacs > 25 Lacs
GENERAL INFORMATION - Please () wherever applicable Resident Individual Minor through guardian HUF Partnership Trust Company Sole Proprietorship Society Body Corporate Others AOP BOI FII NRI
STATUS Business Student Agriculture Self-employed Others Professional Housewife Retired Service
OCCUPATION Single Anyone or survivor Joint
MODE OF HOLDING Unmarried
MARITAL STATUS Married Wedding
Anniversary
D
D
M
M
NOMINATION DETAILS (Please ) (please sign if you do not wish to nominate) 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.
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 with pin code
Signature of Nominee / guardian (for minor)
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.
I/We do not wish to nominate
Signature of 1st Applicant / Guardian
Signature of 2nd Applicant
Signature of 3rd Applicant
DECLARATION AND SIGNATURE OF APPLICANT/s
l 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 (Applicable to NRI’s). 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).
* 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 )
First Applicant Details
Mobile Number
Tel.
No.
(R)
STD CODE
(O)
STD CODE
*E mail _____________________________________________
Alternate E-mail ________________________________________


FRIEND IN NEED DETAILS (refer instruction - k) 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 updated contact details.
Email
Name
Address:
Relationship with the applicant (optional)
Mobile
F I R S T
M I D D L E
L A S T UTI-Infrastructure Fund UTI-Leadership Equity Fund UTI-Master Plus Unit Scheme UTI-Mastershare Unit Scheme UTI-Master Value Fund UTI-Mid Cap Fund UTI-MNC Fund
OPTION (for all schemes) Growth Dividend Payout Dividend Reinvestment (Default is growth option)
IFS Code
(this is a 11-digit number)
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*
Account type (please ) Savings Current NRO NRE
Account No. UTI-Balanced Fund UTI-Banking Sector Fund UTI-Contra Fund UTI-Dividend Yield Fund UTI-Energy Fund UTI-Equity Fund UTI-India Lifestyle Fund UTI-Nifty Index Fund UTI-Opportunities Fund UTI-Pharma & Healthcare Fund UTI-Services Industries Fund UTI-Top 100 Fund UTI-Transportation & Logistics Fund UTI-Wealth Builder Fund Series II