ANNEXURE V

UTI MUTUAL FUND/SPECIFIED UNDERTAKING OF UTI
FORM FOR REQUESTING AFTER SALES SERVICE
as under)
Signature of Major Attested by
Signature
to my Bank through ECS (details
Reinvested
_____________________________ ______________________________
Minor attaining Majority Major (i.e. former minor)’s
(Kindly tick appropriate box/es and fill in details)
Services requested :
Change in mode of payment to my Banker
To my address by IDW

Guardian/Bank Manager
Issue of Statement of Account
_____________________________________ _____________________________________
(Old Signature)
Name of Bank
Address of Bank
Change in holding Joint to Anyone or Survivor Anyone or Survivor to Joint
(9 digit MICR code as on cheque)
Change in status Resident to Non resident Non resident to Resident
Change in name Old Name
Change in name due to marriage New Name
(New Signature)
Change in address
Pin Code :
Phone Email :
Change in Bank details/Bank Address
Nomination Nomineename:
Date of birth (if minor)
Nameandaddress
of Guardian/Nominee
Repurchase Repurchase Value/Units (Rs)
Repurchase rate/date
Switchover Option From :________________ Scheme to____________ Scheme_____________
Value/Amount: Rs
Inclusion of alternate child: Name of Child
Date of birth :
(CGGF/RUP/CCCF)
Confirmation of non-revocation of Power of Attorney that it is still valid
Name of donee Signature of donor
Signature of donee
Inclusion of spouse name under SCUP
2nd holders
Signature
Tel. Nos.
E-Mail
Address
ACKNOWLEDGEMENT
Received an application from ___________________________________for ________________________________
service
Folio/Memb/Investor ID No.---------------------------------------------------
_______________________
Name of spouse DOB of spouse Signature of Spouse
1st holders Signature