IDBI Dividend Yield Fund ASBA Form
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IDBI Dividend Yield Fund An open ended equity scheme predominantly investing in dividend yielding stocks. 4th Floor, IDBI Tower, WTC Complex, Cuffe Parade, Colaba, Mumbai - 400 005. APPLICATION SUPPORTED BY BLOCKED AMOUNT (ASBA) FORM Investors must read the Key Information Memorandum and Instructions before completing this Form. New Fund Offer Opens on: 3rd December, 2018 • New Fund Offer Closes on: 17th December, 2018 Scheme re-opens for continuous sale and repurchase from: Within 5 business days from the date of allotment Offer for Units of Rs. 10 each (at par) during the New Fund Offer period and continuous offer for Units of NAV based prices. This product is suitable for investors who are seeking*: • Long term capital growth Riskometer • Investment in predominantly in dividend yielding equity and equity related instruments Investors understand that their principal will be at Moderately High risk *Investors should consult their financial advisors if in doubt about whether the product is suitable for them. (The Application Form should be completed in English and in BLOCK LETTERS only.) ASBA Application No. KEY PARTNER / AGENT INFORMATION FOR OFFICE USE ONLY Name and AMFI Reg. No. Date of Receipt Folio No. SCSB Branch Stamp & Code SCSB Branch Sr. No. Sub Agent’s Name and Code / EUIN@ (ARN) Bank Branch Code Upfront commission shall be paid directly by the investor to the ARN Holder (AMFI registered Distributor) based on the investors’ assessment of various factors including the service rendered by the distributor. @ 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. 1a. UNIT HOLDER INFORMATION (Names should be in the same sequence as appearing in your demat account. In case of discrepancies, the Application is liable to get rejected) NAME OF FIRST / SOLE APPLICANT Resident Individual NRI [Mandatory Please tick (ü)] Mr. Ms. M/s. PAN# / PEKRN CKYC No. Gender (Please ü) Male Female Other Date of Birth D D / M M / Y Y Y Y Below 1 Lac 1-5 Lacs >5-10 Lacs >10-25 Lacs >25-1 Crore >1 Crore Gross Annual Income Details (Please ü) Net-worth in ` (* Net worth should not be older than 1 year) as on (date) D D / M M / Y Y Y Y (Not older than 1 year) Politically Exposed Person (PEP) Status(Also applicable for authorised signatories/Promoters/Karta/Trustee/Whole time Directors) I am PEP I am Related to PEP Not Applicable NAME OF GUARDIAN (in case of First / Sole Applicant is a Minor. Should be in the same sequence as appearing in your demat account.) / NAME OF CONTACT PERSON – DESIGNATION (in case of non-individual Investors) Mr. M/s. Nationality Designation Contact No. PAN# / PEKRN CKYC No. Gender (Please ü) Male Female Other Date of Birth D D / M M / Y Y Y Y Below 1 Lac 1-5 Lacs >5-10 Lacs >10-25 Lacs >25-1 Crore >1 Crore Gross Annual Income Details (Please ü) Net-worth in ` (* Net worth should not be older than 1 year) as on (date) D D / M M / Y Y Y Y (Not older than 1 year) Politically Exposed Person (PEP) Status(Also applicable for authorised signatories/Promoters/Karta/Trustee/Whole time Directors) I am PEP I am Related to PEP Not Applicable NAME OF THE SECOND APPLICANT Resident Individual NRI [Mandatory Please tick (ü)] Mr. Ms. M/s. PAN# / PEKRN CKYC No. Gender (Please ü) Male Female Other Date of Birth D D / M M / Y Y Y Y Below 1 Lac 1-5 Lacs >5-10 Lacs >10-25 Lacs >25-1 Crore >1 Crore Gross Annual Income Details (Please ü) Net-worth in ` (* Net worth should not be older than 1 year) as on (date) D D / M M / Y Y Y Y (Not older than 1 year) Politically Exposed Person (PEP) Status(Also applicable for authorised signatories/Promoters/Karta/Trustee/Whole time Directors) I am PEP I am Related to PEP Not Applicable ACKNOWLEDGEMENT SLIP FOR SCSB (Self Certified Syndicate Bank) IDBI Dividend Yield Fund Date________________________ to BE retained by THE SCSB ASBA 4th Floor, IDBI Tower, WTC Complex, Cuffe Parade, Application No. Colaba, Mumbai - 400 005. (To be filled by the Sole/First Applicant) Received from Mr./Ms. _________________________________________ SCSB Account Details Total Amount to be blocked Address _____________________________________________________ Bank Account No. ____________________________ (Rs. in figures) ___________________________ Tele./Fax Mobile No. Bank Name & Address ________________________ (Rs. in words) ____________________________ E-mail: ___________________________________________ _______________________________________ __________________________________ __________________________________ __________________________________ First / Sole Applicant / Guardian / PoA Second Applicant Third Applicant ACKNOWLEDGEMENT SLIP FOR APPLICANT Date________________________ IDBI Dividend Yield Fund ASBA 4th Floor, IDBI Tower, WTC Complex, Cuffe Parade, (To be filled by the Sole/First Applicant) Application No. Colaba, Mumbai - 400 005. Received from Mr./Ms. _____________________________________ SCSB Account Details Total Amount to be blocked SCSB Stamp, Signature, Date & Time of Form Submission Address _________________________________________________ Bank Account No. _______________________ (Rs. in figures) ______________________ Tele./Fax Mobile No. Bank Name & Address ____________________ (Rs. in words) _______________________ E-mail: _______________________________________ _________________________________ NAME OF THE THIRD APPLICANT Resident Individual NRI [Mandatory Please tick (ü)] Mr. Ms. M/s. PAN# / PEKRN CKYC No. Gender (Please ü) Male Female Other Date of Birth D D / M M / Y Y Y Y Below 1 Lac 1-5 Lacs >5-10 Lacs >10-25 Lacs >25-1 Crore >1 Crore Gross Annual Income Details (Please ü) Net-worth in ` (* Net worth should not be older than 1 year) as on (date) D D / M M / Y Y Y Y (Not older than 1 year) Politically Exposed Person (PEP) Status(Also applicable for authorised signatories/Promoters/Karta/Trustee/Whole time Directors) I am PEP I am Related to PEP Not Applicable MAILING ADDRESS OF FIRST / SOLE APPLICANT CONTACT DETAILS OF FIRST / SOLE APPLICANT STD Code Telephone : Off. Res. Mobile Fax Email # Please attach PAN Proof. 1b. POWER OF ATTORNEY (PoA) HOLDER DETAILS NAME OF PoA Mr. Ms. M/s. PAN# [Please tick ü( )] 2. FATCA and CRS DETAILS For Individuals (Mandatory) (Non-Individuals are required to submit separate FATCA & CRS information (for non-individuals / Legal entity) and UBO Declaration Form available at www.idbimutual.co.in) First Applicant (including Minor) Second Applicant/Guardian/POA Third Applicant Place of Birth Country of Birth Nationality Indian U.S. Others, please specify ___________ Indian U.S. Others, please specify ___________ Indian U.S. Others, please specify ___________ Tax Residence Address Type (as per KYC records) Residential Registered Office Business Residential Registered Office Business Residential Registered Office Business Are you a tax resident (i.e., are Yes No Yes No Yes No you assessed for Tax) in any other If ‘YES’, please fill below for ALL countries (other than India) in which you are a Resident for tax purposes i.e., where you are a Citizen / Resident / country outside India? Green Card Holder / Tax Resident in the Respective countries. (1) (1) (1) Country of Tax Residency (2) (2) (2) (3) (3) (3) (1) (1) (1) Tax Identification Number OR (2) (2) (2) Functional Equivalent (3) (3) (3) (1) (1) (1) Identification Type (2) (2) (2) (TIN of other, Please specify) (3) (3) (3) If TIN is not available, please tick the 1 2 3 1 2 3 1 2 3 reason A, B, or C (as defined below) A B C A B C A B C A B C A B C A B C A B C A B C A B C Reason A The country where the Account Holder is liable to pay tax does not issue Tax Identification Numbers to its residents. Reason B No TIN required. (Select this reason Only if the authorities of the respective country of tax residence do not require the TIN to be collected). Reason C Others; please state the reason thereof______________________________________________________________________________________ 3. INVESTMENT DETAILS Name of Scheme: IDBI Dividend Yield Fund - Plan Regular Direct - Option Growth Dividend - Mode of Dividend Payout Re-investment Sweep Dividend Sweep: To Scheme Plan Option Subscription Amount Rs. in figures Rs. in words 4. SCSB / ASBA ACCOUNT DETAILS OF THE APPLICANT (Application Money to be blocked from this Account) Account No. Name of the Bank Branch Bank City Account Type [Please tick ü( )] SAVINGS CURRENT NRE NRO FCNR OTHERS_______________ (please specify) Total Amount to be blocked Amount in figures ( ` ) ______________________________ in words (Rupees) _____________________________________________________________ IFSC Code The 9 digit MICR Code number of my/our Bank & Branch is 5. BANK ACCOUNT DETAILS OF FIRST / SOLE APPLICANT Fill in these details only if the ASBA Account details provided in Section 3 are different from the Bank Account details linked with the Demat Account as mentioned under Section 5 below. Account No. Name of the Bank Branch Bank City Account Type [Please tick ü( )] SAVINGS CURRENT NRE NRO FCNR OTHERS_______________ (please specify) Total Amount to be blocked Amount in figures ( ` ) ___________________________________ in words (Rupees) _________________________________________________________________________________ IFSC Code The 9 digit MICR Code number of my/our Bank & Branch is (Please note that as per SEBI Regulations it is mandatory for investors to provide their bank account details) 6. DEMAT ACCOUNT DETAILS Please (ü) NSDL CDSL DP ID Beneficiary Account No./Client ID DP Name The details of the Bank Account linked with the Demat account as mentioned above be provided under Section 4. 7. Nomination Details [Minor / HUF / Poa Holder / Non Individuals Cannot Nominate] Please register MY/OUR NOMINEE AS PER below details OR I/WE DO not wish to nominatION No.