COMMON APPLICATION FORM

(PLEASE READ THE INSTRUCTIONS BEFORE FILLING UP THE FORM. All sections to be completed in ENGLISH in BLACK / BLUE COLOURED INK and in BLOCK LETTERS.)

Application No.

Collection Centre /

BSLAMC Stamp & Signature

Application No.

Received from Mr. / Ms. _____________________________________________________________________________ Date : _____/_____/___________

ENCLOSED

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ACKNOWLEDGEMENT SLIP (To be filled in by the Investor) COMMON APPLICATION FORM

Birla Sun Life Asset Management Company Limited

Toll Free : 1-800-270-7000/ 1-800-22-7000 | sms ‘GAIN’ to 567679 | Email: [email protected]

One India Bulls Centre , Tower 1, 17th Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone Road, Mumbai 400 013

COMMON APPLICATION FORM

For Resident Indians and NRIs/FIIs/FPIs

FIRST / SOLE APPLICANT INFORMATION (MANDATORY) (Refer Instruction No. 2,3,4) Fresh / New Investors fill in all the blocks. (1 to 10) In case of investment "On behalf of Minor", Please Refer Instruction no. 2(ii)

NAME OF FIRST / SOLE APPLICANT

PAN / PEKRN (Mandatory)

NAME OF THE SECOND APPLICANT

TRANSACTION CHARGES FOR APPLICATIONS ROUTED THROUGH DISTRIBUTORS/AGENTS ONLY (Refer Instruction 1 (viii))

In case the subscription (lumpsum) amount is ` 10,000/- or more and your Distributor has opted to receive Transaction Charges, 150/- (for first time mutual fund investor) or 100/- (for investor other than first

time mutual fund investor) will be deducted from the subscription amount and paid to the distributor. Units will be issued against the balance amount invested.

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Existing Folio No.

EXISTING UNITHOLDER please fill in your Folio No., Name & Email ID and then proceed to Section 5 (Applicable details and Mode of holding will be as per the existing Folio No.)

First Applicant / Authorised Signatory Second Applicant

Third Applicant

EUIN is mandatory for “Execution Only” transactions.

I/we hereby confirm that the EUIN box has been intentionally left blank my me/us as this transaction is executed without any interaction or advice by the employee/relationship manager/sales person of the above distributor/sub broker or notwithstanding the advice of

in-appropriateness, if any, provided by the employee/relationship manager/sales person of the distributor/sub broker.

Ref. Instruction No. 9

Mr.

Ms.

M/s.

Mr.

Ms.

M/s.

PAN / PEKRN (Mandatory)

NAME OF THE THIRD APPLICANT

Mr.

Ms.

M/s.

PAN / PEKRN (Mandatory)

Date of Birth**

D D M M YYYY

KYC

Date of Birth**

D D M M YYYY

KYC

Date of Birth**

D D M M YYYY

KYC

Resident Individual

NRI - NRO

FIIs

PIO

HUF

Club / Society

Body Corporate

Minor

Government Body

Trust

Others

(Please Specify)

Partnership Firm

NRI - NRE

Bank & FI

Sole Proprietor

TAX STATUS

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QFI

MAILING ADDRESS OF FIRST / SOLE APPLICANT

(P.O.Box Address is not sufficient. Please provide full address.) (Indian Address in case of NRIs/FIIs)

PIN CODE

MODE OF HOLDING

)] (Please Refer Instruction No. 2(v))[ (

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Anyone or Survivor (Default option is Anyone or survivor)

Joint

Single

ISD CODE

NAME OF THE GUARDIAN (In case First / Sole Applicant is minor) / CONTACT PERSON - DESIGNATION / PoA HOLDER (In case of Non-individual Investors)

RELATIONSHIP OF GUARDIAN (Refer Instruction No. 2(ii))

** Mandatory in case the First / Sole Applicant is Minor

Proof of the Relationship with Minor**

(Applicable for First / Sole Applicant)

Mr.

Ms.

M/s.

PAN / PEKRN (Mandatory)

Date of Birth**

D D M M YYYY

KYC

TEL: OFF.

TEL: RESI

CITY

STATE

Distributor Name / ARN No.

Sub Broker Name / ARN No. Sub Broker Code

Employee Unique ID. No. (EUIN)

AADHAR Card Number

PAN/PEKRN Proof

Complied

KYC

NECS Form

Yes No

No.

Scheme Name Plan / Option

Net Amount Paid (`)

Payment Details

Cheque/DD No./UTR No.

(in case of NEFT/RTGS)

Bank and Branch

BSL

Private Service Sector Public Service Sector Government Service Business Professional Agriculturist Retired Housewife

Student Forex Dealer Others .............................................................................................. (please specify)

Below 1 Lac 1-5 Lacs 10-25 Lacs

> 25 Lacs - 1 Crore > 1 Crore

Net worth (Mandatory for Non - Individuals Rs. ______________________________________ as on

D D M M YYYY

[Not older than 1 year]

5-10 Lacs

SECOND APPLICANT

Below 1 Lac 1-5 Lacs 10-25 Lacs

> 25 Lacs - 1 Crore

> 1 Crore OR Net Worth ______________________________________

5-10 Lacs

THIRD APPLICANT

Below 1 Lac 1-5 Lacs 10-25 Lacs

> 25 Lacs - 1 Crore

> 1 Crore OR Net Worth ______________________________________

5-10 Lacs

INVESTMENT DETAILS

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(Refer Instruction No. 5, 9 & 14) (If this section is left blank, only folio will be created)

# (Type of Account : Saving / Current / NRE / NRO / FCNR / NRSR) *All purchases are subject to realization of funds ^Refer to Instruction No. 5 (vi)

No.

*Cheque / DD Favouring

Scheme Name (refer Instruction 5)

Plan / Option

Sweep to

(applicable only for Dividend option)

Amount

Invested (`)

^DD

Charges

Net Amount

Paid (`)

Cheque/DD No./UTR No.

(in case of NEFT/RTGS)

Bank and Branch and Account Number

BSL

Scheme Name

Plan / Option

Seperate cheque/ demand draft must be issued for each investment drawn in favour of respective scheme name and the instrument should be crossed “A/c Payee Only”.

Please write appropriate scheme name as well as the Plan/Option/Sub Option

BANK ACCOUNT DETAILS (Please note that as per SEBI Regulations it is mandatory for investors to provide their bank account details) Refer Instruction No. 3(A)

(please specify)

SAVINGS CURRENT NRE NRO FCNR OTHERS

Name of the Bank

Branch Address

Pin Code

City

Account No.

11 Digit IFSC Code

9 Digit MICR Code

OCCUPATION

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FIRST APPLICANT

GROSS ANNUAL INCOME

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I am Politically Exposed Person

For Individuals

I am Related to Politically Exposed Person

Not Applicable

For Non-Individual Investors (Companies, Trust, Partnership etc.)

Yes

Is the company a Listed Company or Subsidiary of Listed Company or Controlled by a Listed Company:

(If No, please attach mandatory UBO Declaration)

Foreign Exchange / Money Charger Services

Gaming / Gambling / Lottery / Casino Services

Money Lending / Pawning

KYC DETAILS (Mandatory)

FIRST APPLICANT

Account Type

)]

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GO GREEN

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(Refer Instruction No. 10)

Annual Report

Account Statement

Other Statutory Information

SMS Transact Online Access

I/ We would like to register for my/our SMS Transact and/ or Online Access

Mobile No.

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Default Communication mode is E-mail only, if you wish to receive following document(s) via physical mode:

Email Id

+91

Facebook Id Twitter Id

Private Service Sector Public Service Sector Government Service Business Professional Agriculturist Retired Housewife

Student Forex Dealer Others .............................................................................................. (please specify)

SECOND APPLICANT

Private Service Sector Public Service Sector Government Service Business Professional Agriculturist Retired Housewife

Student Forex Dealer Others .............................................................................................. (please specify)

THIRD APPLICANT

I/We wish to nominate

I/We DO NOT wish to nominate and sign here ................................................................................................. 1st Applicant Signature (Mandatory)

DEMAT ACCOUNT DETAILS (OPTIONAL) (Please ensure that the sequence of names as mentioned in the application form matches with that of the A/c. held with the depository participant.) Refer Instruction No. 3(B)

NSDL:

Depository Participant Name: _______________________________

DPID No.:

I N

Beneficiary A/c No.

CDSL:

Depository Participant Name: _______________________________________

Beneficiary A/c No.

Enclosed: Client Master Transaction/ Statement Copy/ DIS Copy

NOMINATION DETAILS (Mandatory)

(Refer Instruction No. 7)

Nominee Name and Address

Guardian Name (in case of Minor)

Allocation %

Nominee/ Guardian Signature

Nominee 1

100%

To register multiple nominee please fill separate Multiple nomination Form.

DECLARATION(S) & SIGNATURE(S)

(Refer Instruction No. 1)

To,

The Trustee,

Birla Sun Life Mutual Fund

Having read and understood the contents of the Statement of Additional Information / Scheme Information Document of the Scheme, I/We hereby apply for units of the scheme and agree to abide by the terms,

conditions, rules and regulations governing the scheme. I/We hereby declare that the amount invested in the scheme is through legitimate sources only and does not involve and is not designed for the purpose of the

contravention of any Act, Rules, Regulations, Notifications or Directions of the provisions of the Income Tax Act, Anti Money Laundering Laws, Anti Corruption Laws or any other applicable laws enacted by the

government of India from time to time. I/We have understood the details of the scheme & I/we have not received nor have been induced by any rebate or gifts, directly or indirectly in making this investment.

For Non-Individual Investors: I/We hereby confirm that the object clause of the constitution document of the entity (viz. MOA / AOA / Trust Deed, etc.), allows us to apply for investment in this scheme of Birla Sun Life

Mutual fund and the application is being made within the limits for the same. I/We are complying with all requirements / conditions of the entity while applying for the investments and I/We, including the entity, if the

case may arise so, hereby agree to indemnify BSLAMC / BSLMF in case of any dispute regarding the eligibility, validity and authorization of the entity and/or the applicants who have applied on behalf of the entity.

For NRIs only: I/We confirm that I am/we are Non Residents of Indian Nationality/Origin and that I/we have remitted funds from abroad through approved banking channels or from funds in my/our Non-Resident

External /Non-Resident Ordinary /FCNR account. (Refer Inst. No. 6)

I/We confirm that details provided by me/us are true and correct.

**I have voluntarily subscribed to the on-line access for transacting through the internet facility provided by Birla Sun Life Asset Management Company Ltd. (Investment Manager of Birla Sun Life Mutual Fund) and

confirm of having read, understood and agree to abide the terms and conditions for availing of the internet facility more particularly mentioned on the website www.birlasunlife.com and hereby undertake to be

bound by the same. I further undertake to discharge the obligations cast on me and shall not at any time deny or repudiate the on-line transactions effected by me and I shall be solely liable for all the costs and

consequences thereof.

(Refer Inst. No. 14)

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.

FATCA & CRS Declaration: I/ We have understood the information requirements of this Form (read along with FATCA & CRS Instructions) and hereby confirm that the information provided by me/ us on this Form is

true, correct, and complete. I/ We also confirm that I/ We have read and understood the FATCA & CRS Terms and Conditions and hereby accept the same.

D D M M Y Y Y Y

Date

Signature of First Applicant / Authorised Signatory

Signature of Second Applicant

Signature of Third Applicant

FATCA & CRS INFORMATION For Individuals & HUF (Mandatory) Non Individual investors should mandatorily fill seperate FATCA detail form[Please tick (✓)]

If Yes, please provide the following information [mandatory]