Sr. No. 2013/
Transaction Slip
Folio No.:
Name:
Financial Advisor Sub ARN Code Sub Code EUI No.* RM Code
*“I/We hereby confirm that the EUIN box has been intentionally left blank by me/us as this is an “execution-only” transaction without any interaction or advice
by the employee/relationship manager/sales person of the above distributor or notwithstanding the advice of in-appropriateness, if any, provided by the
employee/relationship manager/sales person of the distributor and the distributor has not charged any advisory fees on this transaction”
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.
*PAN of 1st Applicant / Beneficiary Child/Fat her/Mother/Guardian (whose particulars are furnished in the form)
Enclosed copy of PAN Card KYC Complied Yes No
Scheme Name :
Nature of Transactions : (Please tick & fill up relevant details)
Purchase / Additional Purchase :
I/we would like to purchase units of the above mentioned scheme for Amount Rs ` (In fig)
(in words)
Cheque / DD Number Dated
Drawn on Branch
Bank A/c type (Please tick) Savings Current NRO NRE
Switch :
I/We would like to switch All units or of Partial units units or
Rs ` (amount in rupees) (in words)
from above mentioned Scheme to Plan
Option Growth Dividend Payout Dividend Re-Investment
Redemption :
I/We would like to redeem All units or of Partial units units or
Rs ` (amount in rupees) (in words)
from above mentioned Scheme / Fund. I/we furnish MICR & IFS code to facilitate electronic payment.
MICR No. IFSC
Declarati on
“I/We have read and understood the contents of the Offer document” and 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 the applicant/unit holder is
empowered to invest/disinvest and the signatories have necessary authorization to invest / disinvest on behalf of applicant/unit holder. I/We undertake to confirm that this
investment has been duly authorized by appropriate authorities in terms of all relevant documents and procedural requirements. I/We have not received nor been induced
by any rebate or gifts, directly or indirectly in making investment, details of source of funds and any such other relevant document, if called by UTI Mutual Fund.
* Applicable to NRIs
The ARN holder has disclosed to me/us all the commission (in the form of trial commission or any other made), payable to him for the different competing Schemes of
various Mutual Funds from amongst which the Scheme is being recommended to me/us.
Email ID:
Mobile No.:
SIGNATURE(S)
First Account Holder Second Account Holder Third Account Holder
UTI Mutual Fund - Acknowledgement for submission of Purchase / Redemption / Switch request (to be filled by the unitholder)
Received, subject to verification, Request for Purchase Redemption Switch
from Mr/ Mrs/ Ms : _____________________________________________________________
Folio No : _____________________________________________________________________
Receiving UFC/ Registrar’s official stamp
with date and signature
Registrar: Karvy Computershare Pvt. Ltd., Unit: UTI Mutual Fund, Narayani Mansion, H.No.1-90-2/10/E, Vittalrao Nagar, Madhapur, Hyderabad - 500 081 • E-mail: uti [at] karvy [dot] com
1. Please fill in the Form in CAPITAL LETTERS.
2. Please carry the original documents of the copies you wish
to submit towards the proof. The original will be returned
to you after verification, across the counter
3. Purchase, if any, are subject to realization of cheque(s) /
Draft(s).
4. W.e.f., 15.11.2010, third party cheques are not acceptable
for Mutual Fund investments.
5. W.e.f., 1.01.2012, SEBI has introduced uniform KYC
among all its intermediaries including mutual funds.
Accordingly, all investors, other than existing CVL KYC
compliant investors prior to 31-12-2011, are required to
follow the new KYC compliance procedure while making
any investment. The KYC forms are available on www.
utimf.com.
6. Please use the service request forms as specified by UTI MF
for the services like change of address (for non-KYC
complied folios) / bank mandate etc. For the KYC complied
Folios, request for change of address is to be updated with
KYC Registration Agency (KRA)The completed and duly
signed forms alongwith the necessary supporting
documents can be submitted at any of the UTI Financial
Centre.
Check list
 The form is complete in all respects.
 The form is signed by the holders as per the holding basis.
 Copy of PAN is attached.
 Units or Amount to redeem is clearly written
 Units or Amount to switch is clearly written
guidelines
7. All cheques and bank drafts must be drawn in the name of
the scheme or its abbreviation as specified in the SID/ and
crossed “A/c Payee Only” cheque /DD. A separate cheque
or draft must accompany each Application. In order to
avoid frauds and as a best practice, investors are advised to
make the payment instrument (cheque, DD, pay order etc)
favouring “UTI Mutual Fund Scheme A/c First Investor
name” or UTI Mutual Fund Scheme A/c Permanent
Account Number” or UTI Mutual Fund Scheme A/c Folio
Number”.
8. Please submit the unit certificate, wherever issued, along
with the request for redemption or transfer.
9. If the redemption request exceeds the balance in the
account or if the balance falls below the minimum balance
required, the account may be closed and the entire such
(lesser) balance may be paid by cheque / credit to your
bank account.
10. The additional purchase / redemption / switch request
must be signed by all joint holders in case the units are
held jointly.
11. For details and risk factors applicable to the scheme /
Plans, please refer to the SID/SAI. In case of any assistance,
please contact our nearest UTI Financial Centre / (UFC) /
Business Development Associate.