APPLICATION FORM

Please read Product labeling details

available on cover page and instructions before filling this Form
Application No.:
Distributor/RIA name and ARN/Code Sub Broker ARN & Name Sub Broker/Branch/RM Internal Code EUIN (Refer note below) For Office use only

I/We confirm that the EUIN box is intentionally left blank by me/us as this is an “execution-only”
transaction without any interaction or advice by the distributor personnel concerned.
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.
I am a First Time Investor in Mutual Fund Industry. I am an Existing Investor in Mutual Fund Industry. Sole / First Applicant's Signature Mandatory

1. FIRST APPLICANT’S DETAILS

Name of First Applicant (Should match with PAN/Aadhar Card) Date of Birth (1st Appl / Minor) (attach proof)
D D M M Y Y Y Y

Name of Guardian (if minor)/POA/Contact Person PAN (1st Appl / Guardian) Date of Birth (Guardian)
D D M M Y Y Y Y

AADHAAR No. (1st Appl / Guardian) Attach copy (mandatory) CKYC - KIN Guardian is:
Father Mother Court Appointed

Existing Folio PAN of POA KYC AADHAAR No. of POA Attach copy (mandatory)

2. CONTACT DETAILS AND CORRESPONDENCE ADDRESS (As per KYC records)

Email ID Address Type (Mandatory)
(in capital)
a. Residential & Business
Mobile +91 Tel (STD Code)
b. Residential
Address c. Business
d. Registered Office

Landmark
City Pin Code
(Mandatory) State
3. KYC DETAILS (Mandatory)
3a. Status of Sole/1st Applicant (Please tick ) Indian Resident Individual Minor (Resident) Minor (Repatriable) Minor
D D(Non Repatriable) Y Y Y Y
NRI (Repatriable) NRI (Non-Repatriable) PIO Sole Proprietorship HUF - Indian HUF - NR Partnership Firm Limited Partnership (LLP) Public Ltd. Co. Private Ltd. Co.
Body Corporate Bank FIs Insurance Companies Government Body AOP/BOI Trust Society Provident Fund Superannuation/Pension Fund Gratuity Fund Mutual Fund
FII FPI-Category I/II/III FCRA GDN Defence Establishment NPS Trust Others _____________________________________________________________ (Please specify)
Are you a Non-Profit Organization [NPO] or Company u/s 25 (Companies Act 1956) or u/s 8 of Companies, Act, 2013: Yes No
3b. Occupation Details (Please tick ) Private Sector Service Public Sector Service Government Service Business Professional
Agriculturist Retired Housewife Student Forex Dealer Others (Please specify)
3c. Gross Annual Income (Please tick ) Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs >25 Lacs-1 crore >1 crore
Net-worth in (Mandatory for Non-Individuals) ` as on D D M M Y Y Y Y (Not older than 1 year)
3d. For Individuals (Please tick ) Not Applicable I am Politically Exposed Person I am Related to Politically Exposed Person
4. JOINT APPLICANTS (IF ANY) DETAILS
Mode of Holding (Please tick ) Joint (Default) Anyone or Survivor Date of Birth
2nd Applicant D D M M Y Y Y Y
(Should match with PAN/Aadhar Card)
PAN AADHAR NO. Attach copy (mandatory) CKYC - KIN

a. Occupation Details (Please tick ) Private Sector Service Public Sector Service Government Service Business Professional
Agriculturist Retired Housewife Student Forex Dealer Others (Please specify)
b. Gross Annual Income (Please tick ) Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs >25 Lacs-1 crore >1 crore
c. Others (Please tick ) Not Applicable Politically Exposed Person (PEP) Related to a Politically Exposed Person (PEP)

3rd Applicant Date of Birth D D M M Y Y Y Y

(Should match with PAN/Aadhar Card)
PAN AADHAR NO. Attach copy (mandatory) CKYC - KIN

a. Occupation Details (Please tick ) Private Sector Service Public Sector Service Government Service Business Professional
Agriculturist Retired Housewife Student Forex Dealer Others (Please specify)
b. Gross Annual Income (Please tick ) Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs >25 Lacs-1 crore >1 crore
c. Others (Please tick ) Not Applicable Politically Exposed Person (PEP) Related to a Politically Exposed Person (PEP)

ACKNOWLEDGEMENT SLIP (To be filled in by the investor) DSP BLACKROCK MUTUAL FUND
Received, subject to realisation and verification an application for purchase of Units as mentionedin the application form.
Application No.
From
Scheme Cheque no. Amount
DSPBR
5. FATCA and CRS DETAILS For Individuals (Mandatory) Non Individual investors including HUF should mandatorily fill separate FATCA/CRS details form
Sole/First Applicant/Guardian 2nd Applicant 3rd Applicant POA

Place & Country of Birth PLACE COUNTRY Place & Country of Birth PLACE COUNTRY Place & Country of Birth PLACE COUNTRY

Nationality Indian U.S. Other Nationality Indian U.S. Other Nationality Indian U.S. Other
# Please indicate all Countries, other than India, in which you are a resident for tax purpose, associated Taxpayer Identification Number and it's Identification type eg. TIN etc.
*If TIN is not available or mentioned, please mention reason as: 'A' if the country does not issue TINs to its residents; 'B' & mention why you are unable to obtain a TIN; 'C' if the authorities of the country
of tax residence entered above do not require the TIN to be disclosed.

Country # Tax Identification Identification Country # Tax Identification Identification Country # Tax Identification Identification
Number Type/Reason* Number Type/Reason* Number Type/Reason*
1 1 1

2 2 2

3 3 3

6. BANK ACCOUNT DETAILS (Avail Multiple Bank Registration Facility)

Bank Name
Bank A/C No. A/C Type Savings Current NRE NRO FCNR Others

Branch Address
City Pin
IFSC code: (11 digit) MICR code (9 digit) (This is a 9 digit number next to your cheque number)

7. INVESTMENT AND
PAYMENT
DETAILS (Default
plan/option/sub option will be applied incase of no information, ambiguity or discrepancy)
Cheque/DD should be in favour of: “DSP BlackRock Mutual Fund” if single cheque with multiple schemes OR “Scheme Name”, in case of single scheme / scheme wise cheques.

One time Lumpsum Investment SIP: Systematic Investment Plan. Attach OTM form, if not already registered. Mention First SIP Cheque Details below
and in SIP form.
Full Scheme/Plan/Option/Sub Option Amount (`)
Payment Mode: Cheque DD
1. DSPBR - Scheme Plan Option/Sub Option
RTGS NEFT Funds transfer
2. DSPBR - Scheme Plan Option/Sub Option Cheque/DD/RTGS/NEFT Details:
Ref. No.
3. DSPBR - Scheme Plan Option/Sub Option
Date D D M M Y Y Y Y
Total Amount in words Amount in Figures
DD charges, if any

Payment from Bank A/c No. Pay In A/c No. A/c. Type Savings Current NRE NRO FCNR Others

Bank Name & Branch

Documents Attached to avoid Third Party Payment Rejection, where applicable: Bank Certificate, for DD Third Party Declarations
8. NOMINATION DETAILS Individuals (single or joint applicants) are advised to avail Nomination facility.
I/We wish to nominate. I/We DO NOT wish to nominate and sign here 1st Applicant Signature (Mandatory)
Relationship with Guardian Name Nominee/ Guardian
Nominee Name applicant (In case of Minor) Allocation % Signature
Nominee 1
Nominee 2
Nominee 3
Address Total = 100%
9. UNIT HOLDING OPTION:
In Account Statement In Demat mode: NSDL: I N Depository Participant (DP) ID (NSDL only) Enclose for demat option:
Mode (default): Client Master List
Beneficiary Account Number (NSDL only)
Transaction/Holding Statement
CDSL: DIS Copy

10. DECLARATION & SIGNATURES

Having read and understood the contents of the Scheme Information Document and Statement of Additional Information, Key Information Memorandum, Instructions and addenda issued by DSP BlackRock Mutual
Fund form time to time, I / We, hereby apply to the Trustee of DSP BlackRock Mutual Fund for Units of the relevant Scheme/Plan/Option and agree to abide by the terms and conditions, rules and regulations. I /
We have understood the information requirements of the application form, including FATCA and CRS requirements, terms and conditions (read along with instructions and scheme related documents) and hereby
accept the same and further confirm that the information provided by me/us on this form is true, correct, and complete. I / We declare that the amount invested in the Scheme is through legitimate sources only
and is not designed for the purpose of contravention or evasion of any Act, Regulation, Rule, Notification, Directions or any other applicable laws enacted by the Government of India or any Statutory Authority. I
hereby provide my consent in accordance with Aadhaar Act, 2016 and regulations made thereunder, for (i) collecting, storing and usage (ii) validating/authenticating and (ii) updating my Aadhaar number(s) in
accordance with the Aadhaar Act, 2016 (and regulations made thereunder) and PMLA. I hereby provide my consent for sharing/disclose of the Aadhaar number(s) including demographic information with the asset
management companies of SEBI registered intermediaries, their Registrar and Transfer Agents (RTA)/Service Providers for the purpose of updating the same in all my/our folios.

Sole / First Applicant / Guardian Second Applicant Third Applicant POA holder, if any

Email: [email protected] Website: www.dspblackrock.com Contact Centre: 1800 200 4499

Quick Name, Address are correctly mentioned Full scheme name, plan, option is mentioned Additional documents provided if investor name is
Checklist not pre-printed on payment cheque or if
Email ID / Mobile number are mentioned Pay-In bank details and supportings are attached
KYC information provided for each applicant Nomination facility opted Demand Draft is used.
FATCA/CRS details provided for each applicant Form is signed by all applicants Non Individual investors should attach
Aadhaar No. and copy is attached for each applicant FATCA Details and Declaration Form
UBO Declaration Form