Fillable Common Application Form (Page 2 of 2) in pdf

3. Investment and Payment Details

Refer Scheme Ready Reckoner on page no. 23

(Cheque / DD should be drawn in favour of the Scheme. Investors applying under direct plan must mention “Direct” against Scheme name.)

Scheme Name

Option

Dividend Frequency

For Lumpsum Investment

For SIP / Micro SIP

(Refer instruction no. 7 on page no. 20)

SIP

Micro SIP

Investment Amt. (Rs.)

Mode of Payment (3)

Chq.

Fund Transfer

SIP through Auto-Debit (ECS / Direct Debit) OR

SIP through Post Dated Cheques

Pls. fill up the SIP Auto Debit Facility Form

Subsequent Installment Details

Investment Amount

No. of Installments

Total Amount

Net Amt. (Rs.)

Investment amt. - DD charges

DD charges,

(Rs.)

if any

Rs.

= Rs.

First SIP Installment Cheque Details :

Cheque / DD No.

Date

D D M M Y Y Y Y

Cheque No.

Amount

Dated

D D M M Y Y Y Y

Drawn on Bank

Bank / Branch

Branch

SIP Date ( 3)

3rd

10th

15th

20th or

25th

Frequency (3)

Monthly or

Quarterly

A/c. No.

SIP through Post Dated Cheques (Use CTS Cheques only)

M M Y Y Y Y

Period From

Account Type (3)

Current

Savings

Chq. Nos. From

NRI Investors only (3)

NRE

NRO

FCNR

SPNR

CTS : Cheque Truncation System

Applicable in case of Third Party Payment: Payment on behalf of Please ( 3)

Minor

Client

Employee

Distributor

Name of the Person making Payment

PAN

( Please refer instruction no. 8 )

Enclosed copy of KYC Compliance Proof

4. Bank Account Details (Mandatory As Per SEBI Guidelines)

Refer instruction no. 4 on page no. 20

Account No.

Account Type (please 3)

Current

Savings

NRE

NRO

FCNR

Bank Name

City

Branch Address

MICR Code

NEFT/RTGS/IFSC Code

(9 digit No. next to your Cheque No.)

(11 digit character code appearing on cheque leaf)

We credit the redemption/dividend proceeds directly into investors’ account through electronic means if the details provided by the investors are sufficient for the same. Please provide a cancelled cheque

leaf of the same bank account as mentioned above. Mentioning your IFSC will help us transfer the amount to your bank account faster. To receive cheque payout, please tick here ( 3)

Unit holders who have opted to hold Units in dematerialised form must provide Bank Account details linked with the Demat account, as mentioned under section 4 above. In case of discrepancy, bank

details as per depository records will be final.

5. Nomination Details

(Mandatory only for investors who opt to hold units in non-demat form. )

Refer instruction no. 11 on page no. 21

If you wish to register a single nominee for your investments, please fill in the nomination details below. In case you wish to register multiple nominees, please download nomination form available on our

website or at any Religare Invesco Investor Service Centers.

Name and Address of Nominee

Name and Address of the Guardian (if Nominee is a Minor)

Name

Address

City

State

Signature of

Date of Birth

D D M M Y Y Y Y

Guardian’s relation

Relationship with Applicant

(in case nominee is a minor)

the Guardian

with the Minor Nominee

nate)

I do not intend to nominate ( Please tick the box , in case you do not wish to nomi

6. Personal Identification Number (PIN)

Refer instruction no. 13 on page no. 22

I would like to apply for a PIN (This will enable you to access your account via the internet and phone). Please tick here ( 3)

7. Declaration & Signature(s)

The Trustees, Religare Invesco Mutual Fund

Sole / First

Having read and understood the contents of the Statement of Additional Information / Scheme Information Document(s) of the respective schemes , I / We hereby apply to the Trustees of

Religare Invesco Mutual Fund for units of the Scheme / Option as indicated above and agree to abide by the terms, conditions, rules and regulations of the Scheme. I / We have understood

Applicant /

the details of the Scheme and I / We have not received nor have been induced by any rebate or gifts, directly or indirectly, in making this investment. I/We do not have any existing Micro

Investments which together with the current Micro Investment application will result in aggregate investments exceeding Rs. 50, 0 00/- in a year (applicable to Micro Investment investors

Guardian / POA

only). The Distributor 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. I / We hereby authorise Religare Invesco Mutual Fund, its Investment Manager and its Agents to disclose

details of my / our investment to my / our bank(s) / Religare Invesco Mutual Fund’s Bank(s) and / or Distributor / Broker/ Investment Advisor and to verify my / our bank details provided by

me / us. I / We hereby declare that the particulars given above are correct. If the transaction is delayed or not effected at all for reasons of incomplete or incorrect information, I/We would

not hold Religare Invesco Asset Management Company Pvt. Ltd. (Investment Manager to Religare Invesco Mutual Fund), their appointed service providers or representatives responsible.

Second

I/We will also inform Religare Invesco Asset Management Company Pvt. Ltd., about any changes in my/ our bank account. I / We hereby declare that the amount being invested by me/us in

the Scheme of Religare Invesco Mutual Fund is derived through legitimate sources and is not held or designed for the purpose of contravention of any Act, Rules, Regulations or any statute

Applicant / POA

or legislation or any other applicable laws or any Notifications, Directions issued by any governmental or statutory authority from time to time.

Applicable to KRN holders :

I, the first / sole holder hereby declare that I do not hold a Permanent Account Number and hold only a single ‘PAN exempt KRN’ issued by KRA and that my existing investment in schemes of

Religare Invesco Mutual Fund together with current application will not result in aggregate investments exceeding Rs. 50, 0 00 / - in a rolling 12 months period or in a financial year i.e. April to March.

Applicable to NRIs only :

I/We confirm that I am / 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 /

Third

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

(Please 3)

Yes

If NRI (Please 3)

Repatriation basis

Non-Repatriation basis

Applicant / POA

Date

D D

M M

Y Y Y Y