Essel Mutual Fund

New Purchase

Applicant Details

Category*

Resident India

NRI

Status*

First holder investor name*

Email ID*

Mobile number*

First Applicant FATCA Details

Occupation*

Annual Income*

Politically Exposed*

Yes

Related to Politically Exposed*

Yes

Country of Birth*

Country of Citizenship/Nationality*

Tax Resident of any country other than India*

Foreign Tax id No

Second Applicant FATCA Details

Occupation*

Annual Income*

Politically Exposed*

Yes

Related to Politically Exposed*

Yes

Country of Birth*

Country of Citizenship/Nationality*

Tax Resident of any country other than india*

Foreign Tax id No

Third Applicant FATCA Details

Occupation*

Annual Income*

Politically Exposed*

Yes

Related to Politically Exposed*

Yes

Country of Birth*

Country of Citizenship/Nationality*

Tax Resident of any country other than india*

Foreign Tax id No

Contact Details

Address Line1*

Address Line2*

Address Line3

Country*

State*

City*

PIN Code*

Do you want to share your Residence &office Telephone Numbers?*

Yes

Scheme details

Category*

Plan

Scheme*

Option*

Sub Option*

"Please select Direct Plan if you are investing without Financial Advisor code" and "Please select Existing Plan if you are investing with Financial Advisor code"

Investment details

LUMP SUM

ISIP

Scheme minimum amount

0.00

Investment amount*

Please note that the amount you wish to invest using internet banking should be within the limit specified by you for your account/your broker code *

Broker Code*

RIA Code

Ex : INA013568978 (3 alphabets + 9 numerics)

SIP First Instalment

SIP Date*

Frequency*

No.of minimum Instalments

No.of Instalments

Enrollment Period From*

To*

Perpetual

I/We hereby confirm that the EUIN box has been intentionally left blank by 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. 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. Rs.150/ for new investors and Rs.100/- for existing MF investors will be deducted as transaction charges per subscription of Rs.10,000 and above.

Bank details

IFSC Code*

Bank name*

Branch name

Bank A/C Number*

Bank A/C Type*

Mode of Payment*

Nomination

I do not wish to nominate

Total Number of Nominee's*

Nominee's Name*

Nominee's Percentage*

Date of Birth of Nominee*

Guardian (for Minor Nominee)

Address of Nominee / Guardian same as above?*

Yes

Address Line 1

Address Line 2

Address Line 3

City

PIN Code

Nominee's Name*

Nominee's Percentage*

Date of Birth of Nominee*

Guardian (for Minor Nominee)

Address of Nominee / Guardian same as above?*

Yes

Address Line 1

Address Line 2

Address Line 3

City

PIN Code

Nominee's Name*

Nominee's Percentage*

Date of Birth of Nominee*

Guardian (for Minor Nominee)

Address of Nominee / Guardian same as above?*

Yes

Address Line 1

Address Line 2

Address Line 3

City

PIN Code

Please be informed that the Units will be created based on the receipt in the mutual fund scheme account as per applicable SEBI guidelines, and not based on the date of debit from investors bank account.

I accept all the above mentioned declarations and terms and conditions.

Transaction Date & Time
Transaction Reference Number
Scheme Name
Investment Amount
Payment Mode
Broker Code
EUIN

Investment Summary