BOI AXA SIP Shield

Application Form
PLEASE FILL ALL FIELDS WITH BLACK BALL POINT, IN BLOCK LETTERS AND ALL FIELDS ARE MANDATORY
Investors must read the KIM, Instructions and Product Labeling on front page before completing this Form. Application No:

1 DISTRIBUTOR INFORMATION* FOR OFFICE USE ONLY

Bank Branch Code/ Date/Time
Distributor ARN/ RIA Sub Agent ARN Code EUIN No. CO Code MO Code Sales Code
RIA Registration Number of Receipt

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/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 Sole/1st applicant/Guardian/ 2nd applicant/Authorised 3rd applicant/Authorised
above distributor/sub broker or notwithstanding the advice of in-appropriateness, if any, provided by the Authorised Signatory/POA Signatory Signatory
employee/relationship manager/sales person of the distributor/sub broker.

2 TRANSACTION CHARGES FOR APPLICATIONS THROUGH DISTRIBUTORS/AGENTS ONLY*

In case the purchase / subscription amount is ` 10,000 or more and your Distributor has opted to receive Transaction Charges, the same are deductible I confirm that I am a First time investor across Mutual Funds.
as applicable from the purchase/ subscription amount and payable to the Distributor. Units will be issued against the balance amount invested. I confirm that I am an existing investor in Mutual Funds.

3 MODE OF HOLDING & KIN/ KYC DETAILS*

Single Joint Anyone or Survivor (Default)
Permanent Account Number (PAN) KYC Identification Number (KIN)
First Applicant PAN/ KYC Proof Enclosed
Second Applicant PAN/ KYC Proof Enclosed
Third Applicant PAN/ KYC Proof Enclosed
Guardian (in case Minor) PAN/ KYC Proof Enclosed

4 APPLICANT'S DETAILS (Refer Terms & Conditions)

FIRST/ SOLE APPLICANT'S DETAILS Mr. Ms.

Name (1st)

Date of Birth D D M M Y Y Y Y Nationality Country of Birth

Legal Entity Identifier (LEI) (Refer Instruction No. 18)

Status of First/ Sole Applicant [Please tick (P)] (The insurance facility is available only for First/ Sole Applicant ) Resident Individual NRI-Repatriation NRI-Non Repatriation

Please note that your address and contact details will be updated as per your KYC/ CKYC records.
Mailing address

Landmark
City State Pin Code

Email ID Mobile +91 Tel.

Overseas address (for FPIs/ NRIs/ PIOs)

Mailing address

Landmark City
State Country Zip Code

SECOND APPLICANT'S DETAILS Mr. Ms. Nationality Country of Birth

nd
Name (2 )

Mobile +91 Email ID

THIRD APPLICANT'S DETAILS Mr. Ms. Nationality Country of Birth

rd
Name (3 )

Mobile +91 Email ID

(*Please refer Scheme Information Document (SID) and Key Information Memorandum (KIM) for further details)

ACKNOWLEDGEMENT SLIP FOR SIP SHIELD (To be filled in by the investor) Application No:
Received from: Mr. Ms.
an application for allotment of units under Scheme Cheque/DD No.
Date D D M M Y Y Y Y Amount (`) Drawn on Bank and Branch
Checklist Investment Details Bank Mandate Attested PAN Card Copy KYC Details
Collection Centre’s Stamp &
Please note: All purchases are subject to realization of cheques/Demand Drafts and subject to the terms and conditions of relevant Receipt Date and Time
Scheme Information Document and Statement of Additional Information.
5 ADDITIONAL KYC DETAILS*
Occupation details for 1st Applicant 2nd Applicant 3rd Applicant
Private Sector Service Politically Exposed Person (PEP) details: Is a PEP Related to PEP Not Applicable
Public Sector Service
Government Service
Business 1st Applicant
Professional
Agriculturist
Retired 2nd Applicant
Housewife
Student
Proprietorship 3rd Applicant
Others (Please specify)
Gross Annual Income Range (in `) 1st Applicant 2nd Applicant 3rd Applicant Gross Annual Income Range (in `) 1st Applicant 2nd Applicant 3rd Applicant
Below 1 lac 10-25 lac
1-5 lac 25 lac- 1 cr
5-10 lac > 1 cr

EMAIL COMMUNICATION INFORMATION*

I/We wish to receive the following document(s) physically in lieu of Email. Account Statement News Letter Annual Report Other Statutory Information

6 FATCA & CRS INFORMATION (Self Certification)*

The below information is required for all applicant(s)

Address Type: Residential or Business Residential Business Registered Office (for address mentioned in form/existing address appearing in Folio)
Please indicate all countries in which you are resident for tax purposes and the associated Tax Reference Numbers below.

Category First Applicant Second Applicant Third Applicant

Is the applicant(s) Country of Yes No Yes No Yes No

Birth/ Citizenship/ Nationality/ If Yes, please provide the If Yes, please provide the If Yes, please provide the
Tax Residency other than India? following information [mandatory] following information [mandatory] following information [mandatory]

Place/ City of Birth

Country of Birth

Country of Tax Residency

Tax Payer Ref. ID No^

Identification Type
[TIN or other, please specify]

Country of Tax Residency 2

Tax Payer Ref. ID No. 2

Identification Type
[TIN or other, please specify]

Country of Tax Residency 3

Tax Payer Ref. ID No. 3

Identification Type
[TIN or other, please specify]

^In case Tax Identification Number is not available, kindly provide its functional equivalent.

7 BANK ACCOUNT DETAILS - Mandatory (Payout Bank - If left blank, application will be rejected)*

Name of the Bank

Account Number A/C Type (Please ü) Savings Current NRE NRO FCNR Others ___
SIP SHIELD/25032019

Branch Address
City State PIN Code

MICR Code (Please enter the 9 digit number that appears after your cheque number) Cancelled copy of a cheque required in case of
investments not through cheque
IFSC Code (RTGS/NEFT) (11 Character code appearing on your cheque leaf)

(*Please refer Scheme Information Document (SID) and Key Information Memorandum (KIM) for further details)

FOR MORE INFORMATION

BOI AXA Mutual Fund
Add: B/204, Tower 1, Peninsula Corporate Park, Ganpatrao Kadam Marg, Lower Parel, Mumbai 400013
Call us at (Toll Free) Email us at Website
1800-266-2676 & 1800-103-2263 [email protected] www.boiaxamf.in
8 SCHEME, INVESTMENT & PAYMENT DETAILS (Refer Instruction No. 15 (1))

Scheme Name

Plan/ Option/ Sub Option (Please tick the appropriate boxes Regular Plan IDCW Option - Reinvestment Payout
only if applicable to the scheme in which you plan to invest) Growth Option OR
#
Direct Plan IDCW Frequency - Regular Quarterly

SIP Through ECS/ Standing Instruction / Direct Debit SIP Date 1st 7th 10th* 15th 20th 25th (*Default date is 10th)

Payment Details for First Cheque/ DD Mode of Payment Cheque DD Funds Transfer NEFT RTGS

Investment Amount DD Charges Net Amount

Cheque/DD No. Cheque/DD Date Drawn on Bank
A/c Type Savings Current NRO FCNR NRE Account No.
Applications with Third Party Cheques, prefunded instruments etc. and in circumstances as detailed in AMFI Circular No.135/BP/16/10-11 shall be processed in accordance with the said circular. Third Party Payment
Declaration form is available on www.boiaxamf.in or at BOI AXA Mutual Fund branch offices.
#w.e.f. January 1, 2013 or such other date as may prescribed by the Regulator. The terms and conditions will be subject to Regulatory approval and will be issued by way of an addendum after necessary approval(s).
REDEMPTION / DIVIDEND REMITTANCE*

Electronic Payment (It is the responsibility of the Investor to ensure the correctness of the IFSC code/ MICR code for Electronic Payout at recipient/destination branch corresponding to the Bank details.)
Cheque Payment

9 DEMAT ACCOUNT DETAILS* – (Please ensure that the sequence of names as mentioned in the application form matches with that of the account held with the Depository Participant).
(If Demat Account details are provided below, units will be allotted by default in electronic mode only)

DP Name
National Securities Depository Limited (NSDL)
DP ID No. I N Beneficiary Account No.

DP Name
Central Depository Services (India) Limited (CDSL)
Target ID No.

10 DECLARATION OF GOOD HEALTH (Mandatory Requirement) (Refer Instruction no. 15 (11))

Please tick (3) For Either Yes or No – Otherwise The Application Will Be Invalid
1. Have you ever been treated for symptoms of high blood pressure, diabetes, heart attack or heart disease, stroke, chest pain, kidney disease, AIDS or AIDS related complex, Yes No
cancer or tumor, asthma or respiratory disease, mental or nervous disease, liver disease, blood disease, digestive and bowel disorder, disorder of the bones, spine or muscle?
2. Have you within the last 2 years taken any form of medication for more than 14 consecutive days to treat an illness or disease? Yes No
3. Have you within the last two years consulted any medical practitioner for any condition other than minor impairment such as cold or flu? Yes No
I understand and agree that the answers to the questions in this Declaration of Good Health are true and complete to the best of my
knowledge and belief. I authorize any medical practitioner, hospital, employer, institution or any other person, to disclose to Star Union Dai-
ichi Life Insurance Company Limited any information relating to my health or my employment now or at any time in the future.
I understand and agree that failure to answer any question in this declaration truthfully will render the insurance cover invalid and void.
Date of Birth D D M M Y Y Y Y Date D D M M Y Y Y Y
Signature of Life Assured
Gender Male Female Place

11 NOMINATION DETAILS (Mandatory Requirement)*

I/ We hereby nominate the under mentioned nominee to receive the amounts to my/ our credit in event of my/ our death.
I/ We also understand that all the payments and settlements made to such nominee and signature of the nominee acknowledging receipt thereof, shall be valid discharge by the AMC/ Mutual Fund/ Trustee.
Date of Birth Name & Address of the Guardian Signature of Nominee/ Guardian
Name & Address of Nominee(s) Relationship with Nominee
(Mandatory) (To be furnished in case the Nominee is a Minor) (If nominee is minor)

The holder of a policy of life insurance on his own life, may, when effecting the policy or any time before the policy matures for payment, nominate the person or persons to whom the money secured by the policy
shall be paid in the event of his death. Where such nominee is a minor, the policy holder may also appoint any person who is a major, to receive the Death benefit during the minority of the nominee.
Please note that this nomination will be register for insurance also.

12 DECLARATION AND SIGNATURE(S)

I/We have read and understood the contents of the Scheme Information Document and Statement of Additional Information of BOI AXA Mutual Fund including the section on “Who cannot invest” and “Prevention of
Money Laundering”. I/We hereby apply for Allotment/Purchase of Units in the Scheme and agree to abide by the terms and conditions applicable thereto. I/We hereby declare that I/We am / are authorised to make
this investment and that the amount invested in the Scheme is through legitimate sources only and does not involve and is not designed for the purpose of any contravention or evasion of any Act, Rules,
Regulations, Notifications or Directions issued by any regulatory authority in India. I/We hereby authorise BOI AXA Mutual Fund, its Investment Manager and its agents to disclose details of my investment to my
bank(s)/BOI AXA Mutual Fund’s bank(s) and /or Distributor /Broker / Investment Advisor. I/We have neither received nor been induced by any rebate or gifts, directly or indirectly, in making this investment. I/We
declare that the information given in this application form is correct, complete and truly stated.
I/We are aware that the information provided/collected in this application form is necessary in relation to operation of my/our investment account. I/We hereby give consent for sharing my/our data/information with
any third party as may be required by BOI AXA Mutual Fund for the purpose of providing services to me/us or for opening, continuing and operating my/our investment account/folio.
I am informed about the arrangement between BOI AXA Mutual Fund and the Insurance company and about the Master Policy Document. I understand that i am eligible to avail cover under such arrangement; and
hereby wish to avail the insurance cover.
I/ We hereby declare that I/ We do not have any existing Micro SIP which together with the current application will result in a total investments exceeding ` 50,000 in a year.
Applicable to NRI only: I /We confirm that I am/we are Non-Resident Indian/Person of Indian Origin and that I/We have remitted funds from abroad through approved banking channels or from funds in my/our
NRE/NRO/FCNR Account. I/We undertake that all SIP installment made under this Folio will also be from funds received from abroad through approved banking channels or from funds in my/our NRE/NRO/FCNR
Account.
Applicable to citizen of USA/ Canada: I/We hereby confirm that I/We am/are not restricted persons resident in Canada or in Countries which are non-compliant with FATF Agreements or in the United States of
America (USA), or corporations, or partnerships or any other entity created or organised in or under the laws of USA or any person/entity falling within the definition of the term 'US Person' under the US Securities
Act of 1933, (as amended). I/We hereby confirm that I/We are not giving a false confirmation and/or disguising my/our country of residence. I/We confirm that BOI AXA Investment Managers Pvt. Ltd. is relying
upon this confirmation and in no event shall members of the BOI AXA Group and / or their directors, officers and employees be liable for any direct, indirect, special, incidental or consequential damages arising out
of false confirmation/information.
I/ We confirm that the ARN holder has disclosed to me/us all the commissions (in the form of trail commission or any other mode), payable to him by the different competing Schemes of various Mutual Funds from
amongst which the Scheme is being recommended to me/us.
I/we authorize BOI AXA Mutual Fund, BOI AXA Investment Managers Pvt. Ltd./ Registrars to refer these details to any of the appropriate authorities including KYC Registration Agency/Authentication Agencies etc.
and also authorize such agencies / service providers to share the data as per their records, for verification purpose.
Date D D M M Y Y Y Y

1st Applicant 2nd Applicant 3rd Applicant

(*Please refer Scheme Information Document (SID) and Key Information Memorandum (KIM) for further details)
 TERMS AND CONDITIONS FOR SIP SHIELD AUTO DEBIT FACILITY true, accurate and correct. The User(s) acknowledge their responsibility for information provided in the
SIP Registration cum Debit Mandate, SMS sessions or otherwise solely rests with the User(s). As such
1. New investors who wish to enroll for the Systematic Investment should fill up SIP Form in addition to the AMC / Registrar will not be responsible or liable for any loss, claims, liability which may arise on
the Common SIP SHIELD Form, with or without the initial investment amount i.e. the first installment account of any incorrect and/or erroneous information provided by the User(s) in such form,
can be without the cheque. However in lines with SEBI and AMFI guidelines the requirement of documents or mediums.
submission of documents for subscription/ transaction is modified from time to time. Therefore, for 16. The User(s) agree and confirm that if at any stage the information provided is found to be incorrect /
such additional requirements the investor is required to refer the "Instruction For Completing The false / erroneous, the AMC / Registrar reserves the right to, at its sole discretion, reject the
Application Form" (as provided in the main application form) and submit such additional Registration cum Mandate and refund the Purchase amount or if Units have been allotted, freeze the
documentation for the same. folio or Redeem the Units at Applicable NAV (at applicable Exit Load, if any) and in such a cases the
2. The cheque may be drawn in favour of “Full name of the Scheme” followed by the name of the sole or decision of the AMC / Registrar shall be final and binding on the User(s) and the Mutual Fund / AMC
1st joint holder/ his PAN/folio number. For e.g. “XYZ Scheme A/c – Sole / First Investor name” or “XYZ will not be responsible for any consequence there from.
Scheme A/c -Permanent Account Number” or “XYZ Scheme A/c -Folio Number”.
3. If the investment is without a first investment cheque then the cancelled cheque copy is mandatory for
submission and, if such cancelled cheque is without any name a bankers attestation is required on the OTHER TERMS & CONDITIONS
SIP form.
1. This facility is available presently only for Systematic Investment Plan.
4. Monthly SIP facility is available only on specific dates of the month viz - 1st/or 7th/or 10th/or 15th/or
20th/or 25th and minimum duration is 3 years. 2. NACH debit facility is offered at various banks. For a detailed list of banks please refer the website
www.npci.org.in
5. During ongoing purchase in monthly SIP your first SIP can be for any day of the month. Your second and
subsequent SIPs are available only on the above specified dates of the month with a minimum gap of 3. This facility is offered only to the investors having bank accounts with above mentioned Banks.
atleast 30 calendar days between first and second SIP installment. In case the chosen date turns out Above list is subject to modification/updation at any time in future at the sole discretion of BOI AXA
to be a non working day for the scheme; the SIP will be processed on the immediate following working Investment Managers Pvt Ltd, without assigning any reason or prior notice. If any bank is removed, SIP
day. instructions of investors for such banks via NACH will be discontinued without any prior notice.
6. The SIP cheque (where the investment is made by cheque) should be drawn on the same bank account 4. By signing the NACH mandate form the investor agrees to abide by the terms and conditions of NACH
which is to be registered for Auto Debit. The bank account provided for Auto Debit should participate in facility through NPCI (www.npci.org.in).
local MICR clearing. 5. New/Existing investors who wish to enroll for SIP through NACH should fill the SIP Application Form
7. The first investment cheque while applying for Monthly SIP should be same as SIP amount. and the Registration cum Mandate Form for NACH.
8. If two consecutive SIP’s fail, the SIP will automatically stand terminated and a communication to the 6. New Investors should mandatorily give a cheque for the first transaction.
effect will be sent to the investor. a. First SIP Cheque should be dated current day. All subsequent Installments through NACH to be
9. The investor has the right to discontinue SIP at any time he/she so desires by sending a written either 1st/7th/10th/15th/20th/25th of the month.
request, at least 7 working days prior to the due date of next SIP for Monthly SIP, to any of the offices of b. The Registration cum Mandate Form for NACH should be submitted at least 30 Calendar days
BOI AXA Mutual Fund or its Investor Service Centres. prior to next sip cycle date through NACH.
10. Investors availing the Micro SIP facility shall be exempted from submission of requirement of PAN. c. *Unique Mandate Registration Number (UMRN) is auto generated by NPCI during the mandate
Micro SIP shall be applicable where aggregate of installments in a rolling 12 months period or in a creation for the first time. Investors, who do not have the UMRN, please leave it blank. UMRN
financial year i.e. April-March does not exceed ` 50,000/- per year. Micro SIP benefit is available to would be linked to the folio and maximum length is 20 characters comprising of Alpha Numeric
individuals, NRI's are not eligible. The AMC will reject the application where they find that documents Character allotted by NPCI.
are deficient or where the installment total will exceed ` 50,000/- per year. d. Investors who already have UMRN registered under the folio can fill up the SIP Registration cum
11. Investor will not hold BOI AXA Investment Managers Pvt. Ltd., its registrars and other service providers Mandate Form for NACH and should be submitted at least 30 Calendar days before the date of
responsible if the transaction is delayed or not effected, the investor bank account is debited in the first debit through NACH.
advance or after the specific SIP date due to various clearing cycles of Auto Debit / local holidays / 7. Please provide the cancelled cheque leaf of the Bank A/c no. for which NACH facility is registered.
incomplete or incorrect instructions from the applicant.
8. Investors need to mandatorily fill the SIP Registration Cum Mandate form for NACH for any
12. BOI AXA Investment Managers Pvt. Ltd., its registrars and other service providers shall not be amendment and cancellation quoting their UMRN by giving 7 working days prior notice to any of the
responsible and liable for any transaction failures, due to rejection of the transaction by your bank / investor service centre.
branch or its refusal to register the SIP mandate.
9. Investor can choose to discontinue the SIP facility under folio without cancelling the UMRN by giving 7
13. Please refer the Scheme Information Documents/ Statement of Additional Information of the scheme working days prior notice to any of the Investor Service Centre. Investor can choose to register any
for the Applicable NAV, Redemptions, Risk Factors, Load and other information before investing. future SIP by simply filling up the Registration cum mandate form for NACH quoting their UMRN.
14. The responsibility of the information provided in this SIP Registration cum Debit Mandate or any other 10. Please enter IFSC Code (maximum length-11 Alpha Numeric Characters) and MICR Code (maximum
application form for this facility solely rests with the User(s) and the AMC / Mutual Fund / Registrar will length – 9 Numeric Characters) of investor bank.
not be responsible or liable for any loss, claims, liability that may arise on account of any incorrect and
/ or erroneous data / information supplied by the User(s). 11. In case of existing investor, if application is received without existing UMRN then the first UMRN
registered in the folio would be considered
15. The User(s) confirm that the information provided in the SIP Registration cum Debit Mandate,
KYC/CKYC Application Form and all other documentation provided / communicated to the AMC is

15. SIP Shield Terms and Conditions

1. BOI AXA SIP Shield is an add-on, optional feature available only with BOI AXA Large & Mid Cap Equity 12. The Group Life Insurance Cover will be governed by the terms and conditions of the insurance policy with
Fund, BOI AXA Tax Advantage Fund, BOI AXA Mid & Small Cap Equity & Debt fund, BOI AXA Small cap the relevant Insurance Company as determined by the AMC.
Fund, BOI AXA Equity Debt Rebalance Fund and BOI AXA Manufacturing & Infrastructure Fund. 13. In case of death of the applicant, his / her legal representatives may file a claim directly with the
2. The minimum SIP tenure for BOI AXA SIP Shield is 3 years. designated branch of the Insurance Company supported by all relevant documents as required by the
3. Frequency for SIP Shield is only monthly. Insurer and the payment of the claim may be made to the legal representatives by the insurance
4. Minimum application amount = ` 1500 and in multiples of ` 100 thereafter company. The AMC will not entertain any request for claims for the insurance covered.
5. The AMC may provide a Group Life Insurance Cover to all Resident Individual/NRI applicants and fund 14. All insurance claims will be settled in India and shall be payable in Indian Rupees only. Settlement
the premium towards such cover. Non-individuals as well as Citizens / Residents of USA/ Canada/ and procedure will be as stipulated by the Insurance Company. Insurance claims will be directly settled by
Persons not of Indian Origin/ Sole Proprietorship will not be covered under the SIP Shield Facility. the Insurance Company.
6. The insurance cover will be available for individuals with a minimum age of 18 years and maximum age 15. The AMC will not be responsible or liable for maintaining service levels and/or any delay in processing
of 54 years as on last birthday. claims arising out of this facility.
7. Only the First / Sole unit holder will be covered under the insurance. No insurance cover will be provided 16. The Mutual Fund, Trustees, AMC, or their Directors, officers or employees shall not be liable for any
for the second / third unit holder. claims (including but not limited to rejection of any claim, non-settlement, delays etc, by the insurer)
arising out of the insurance cover provided to the unit holder.
8. For the purpose of availing insurance cover the eligibility of the applicant is that he / she is in good 17. All the terms and conditions pertaining to Monthly SIP will be applicable on SIP Shield.
health.
9. The insurance cover will commence from the date of first allotment of units under SIP Shield. 18. The AMC is bringing this offer to the investors of the Scheme only as an additional facility and is not
acting as an agent for marketing/sales of insurance policies nor soliciting any business.
10. Amount of Insurance Cover is as follows: 19. Subject to what has been stated above, the AMC reserves a right to modify / annul the said Group
If SIP continues, the insurance cover would be as follows: Insurance Cover. The AMC also reserves the right to change the insurance company from time to time.
• Year 1 : 10 times the monthly SIP SHIELD installment 20. The Group Life Insurance cover will be subject to the following exclusions and such other terms and
• Year 2 : 50 times the monthly SIP SHIELD installment conditions as may be prescribed by the insurance certificate governing the cover:
• Year 3 onwards : 120 times the monthly SIP SHIELD installment a. The Group Life Insurance Cover shall not extend to cover instances of death due to suicide in the first
All the above mentioned limits are subject to a maximum cover of ` 50 lacs per investor across all year of cover.
schemes/plans/folios covered under SIP SHIELD. b. Death within 45 days from the commencement of the SIP installments except for death due to
If SIP SHIELD is discontinued, the insurance cover would be as follows: accident.
• SIP SHIELD discontinues before 3 years : Insurance cover stops immediately 21. The provision for the Group Life Insurance Policy does not have any bearing on the performance of the
scheme.
• SIP SHIELD discontinues after 3 years : Insurance cover equivalent to the value of units allotted
under SIP SHIELD investment at the start of the each policy year, subject to a maximum of 120 times 22. For the purpose of availing of the SIP Shield facility, a unique folio will be created.
the monthly installment, capped at the maximum of ` 50 lacs. 23. If any transaction such as, switchout,/redemption/ STP out/ folio consolidation request is made under
The insurance cover will also cease: this unique folio, the Insurance cover will be cancelled with immediate effect. In case of additional
purchase/switch ins/STP in, a separate folio will be created.
• At the end of the tenure. i.e., upon completion of 60 years of age.
SIP SHIELD/04062019

24. First installment payment made through cheque should be the same as SIP amount and the same shall
• Redemption / switch-out (fully or partly) of units purchased under the scheme in which SIP SHIELD be considered as the first SIP installment.
facility is taken.
25. In the event insurance cover is rejected/ not granted the SIP investment shall continue in the selected
• Incase of two consecutive SIP failures. scheme.
• The first SIP installment cheque/first SIP debit towards SIP Shield is dishonoured. 26. The Trustee/AMC reserves the right to change/modify the terms and conditions of SIP Shield or
11. The investor will necessarily be required to furnish his / her date of birth, gender and details of the withdraw the SIP Shield at a later date. All the other provisions of the Scheme Information
nominee to whom the money secured by the policy shall be paid in the event of his death in the Documents/addendums except as specifically modified herein above remain unchanged till further
application form and sign the declaration of Good Health, in absence of which, no insurance cover can notice.
be availed by the investor. Where the nominee is a minor, the policy holder may also appoint any person 27. First nominee will be considered for SIP Shield.
who is a major, to receive the Death benefit during the minority of the nominee.

FOR MORE INFORMATION

BOI AXA Mutual Fund
Add: B/204, Tower 1, Peninsula Corporate Park, Ganpatrao Kadam Marg, Lower Parel, Mumbai 400013
Call us at (Toll Free) Email us at Website
1800-266-2676 & 1800-103-2263 [email protected] www.boiaxamf.in
 SIP SHIELD AUTO DEBIT/ NACH FACILITY :
REGISTRATION CUM MANDATE
INVESTORS SUBSCRIBING TO THE SCHEME THROUGH SIP AUTO DEBIT FACILITY TO COMPLETE THIS FORM COMPULSORILY ALONGWITH COMMON SIP SHIELD FORM
Application should be submitted atleast 30 days before processing of Monthly SIP SHIELD
For terms & conditions refer overleaf
Application No:
1 DISTRIBUTOR INFORMATION FOR OFFICE USE ONLY
Bank Branch Code/ Date/Time
Distributor ARN/ RIA Sub Agent ARN Code EUIN No. CO Code MO Code Sales Code
RIA Registration Number of Receipt

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/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 Sole/1st applicant/Guardian/ 2nd applicant/Authorised 3rd applicant/Authorised
broker or notwithstanding the advice of in-appropriateness, if any, provided by the employee/relationship Authorised Signatory/POA Signatory Signatory
manager/sales person of the distributor/sub broker.

2 INVESTOR DETAILS (Please refer Point No. 10 for Micro SIP)

Folio No. / Application No.
Name of 1st Applicant
Name of 2nd Applicant
Name of 3rd Applicant
3 SIP DETAILS
Scheme Name
Plan Option
Sub Option IDCW Frequency
Please refer the scheme specific SID and SAI to know the Plan, Option & Sub-Options related information.
Frequency (Please ü) ü Monthly SIP Date 1st 7th 10th# 15th 20th 25th (#Default date is 10th)
Instalment Amount (In figures) Drawn on Bank /Branch Name
Mandatory Enclosures (Please ü) If the first installment is not by cheque Blank Cancelled Cheque
From To Enrolment period has to be for a minimum period of 3 years and can
Enrolment Period D D M M Y Y Y Y D D M M Y Y Y Y be extended upto age of 54 years of the first applicant.
DECLARATION & SIGNATURE: I/We hereby declare that the particulars given above are correct and express my willingness to make payments referred above to debit my/our account directly or through participation in
Auto Debit/ NACH Facility. If the transaction is delayed or not effected at all for reasons of incomplete or incorrect information, I / We would not hold the user institution responsible. I / We will also inform AMC, about any
changes in my/our bank account. I/We have read and agreed to the terms and conditions mentioned overleaf.
I/ We confirm that 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. Applicable to NRI only: I /We confirm that I am/we are Non-Resident Indian/Person of Indian Origin and that I/We have remitted funds from abroad through approved
banking channels or from funds in my/our NRE/NRO/FCNR Account. I/We undertake that all SIP Installments made under this Folio will also be from funds received from abroad through approved banking channels or from
funds in my/our NRE/ NRO/FCNR Account. We are not citizens/ residents of USA or Canada.
SIGNATURE (S) (as in our records)

1st Applicant 2nd Applicant 3rd Applicant

DEBIT MANDATE FORM NACH / DIRECT DEBIT

UMRN F O R O F F I C E U S E O N L Y Date D D M M Y Y Y Y

Tick ) ) Sponsor Bank Code For Office use only Utility Code For Office use only
CREATE I/We hereby authorize to debit (tick ) SB/CA/CC/SB-NRE/SB-NRO/Other
BOI AXA Mutual Fund
MODIFY
Bank a/c number
CANCEL

with Bank Name of customers bank IFSC or MICR

an amount of Rupees Amount in words `

FREQUENCY Mthly Qtly H -Yrly Yrly As & when presented DEBIT TYPE Fixed Amount Maximum Amount

Reference 1 Phone No.

Reference 2 Email ID
I agree for the debit of mandate processing charges by the bank whom I am authorizing to debit my account as per latest schedule of charges of the bank
PERIOD
From D D M M Y Y Y Y Signature Primary Account holder Signature of Account holder Signature of Account holder
To D D M M Y Y Y Y
Name as in bank records Name as in bank records Name as in bank records
Or Until Cancelled 1. 2. 3.

• This is to confirm that the declaration has been carefully read, understood & made by me/us. I am authorizing the user entity/Corporate to debit my account, based on the instruction as agreed and signed by me.
• I have understood that I am authorized to cancel/amend this mandate by appropriately communicating the cancellation/amendment request to the User entity/Corporate of the bank where I have authorized the debit.

ACKNOWLEDGMENT SLIP (To be filled by the investor)

Folio No. Investor Name
Scheme Name (Scheme Name)
Plan Option
SIP Period From D D M M Y Y to D D M M Y Y Till further Notice Stamp & Signature
 4 BANKER'S ATTESTATION
Signature of authorised Official from Bank (Bank stamp and date)

Certified that the signature of account holder and the details of Bank Account mentioned in Debit Mandate form
for NACH/ Direct Debit are correct as per our records.

TERMS AND CONDITIONS FOR SIP SHIELD AUTO DEBIT FACILITY KYC/CKYC Application Form and all other documentation provided / communicated to the AMC is
true, accurate and correct. The User(s) acknowledge their responsibility for information provided in the
SIP Registration cum Debit Mandate, SMS sessions or otherwise solely rests with the User(s). As such
1. New investors who wish to enroll for the Systematic Investment should fill up SIP Form in addition to the AMC / Registrar will not be responsible or liable for any loss, claims, liability which may arise on
the Common SIP SHIELD Form, with or without the initial investment amount i.e. the first installment account of any incorrect and/or erroneous information provided by the User(s) in such form,
can be without the cheque. However in lines with SEBI and AMFI guidelines the requirement of documents or mediums.
submission of documents for subscription/ transaction is modified from time to time. Therefore, for 16. The User(s) agree and confirm that if at any stage the information provided is found to be incorrect/
such additional requirements the investor is required to refer the "Instruction For Completing The false/ erroneous, the AMC/ Registrar reserves the right to, at its sole discretion, reject the
Application Form" (as provided in the main application form) and submit such additional Registration cum Mandate and refund the Purchase amount or if Units have been allotted, freeze the
documentation for the same. folio or Redeem the Units at Applicable NAV (at applicable Exit Load, if any) and in such a cases the
2. The cheque may be drawn in favour of “Full name of the Scheme” followed by the name of the sole or decision of the AMC / Registrar shall be final and binding on the User(s) and the Mutual Fund / AMC
1st joint holder/ his PAN/folio number. For e.g. “XYZ Scheme A/c – Sole / First Investor name” or “XYZ will not be responsible for any consequence there from.
Scheme A/c -Permanent Account Number” or “XYZ Scheme A/c -Folio Number”.
3. If the investment is without a first investment cheque then the cancelled cheque copy is mandatory for
submission and, if such cancelled cheque is without any name a bankers attestation is required on the OTHER TERMS & CONDITIONS
SIP form.
4. Monthly SIP facility is available only on specific dates of the month viz - 1st/or 7th/or 10th/or 15th/or 1. This facility is available presently only for Systematic Investment Plan.
20th/or 25th and minimum duration is 3 years. 2. NACH debit facility is offered at various banks. For a detailed list of banks please refer the website
5. During ongoing purchase in monthly SIP your first SIP can be for any day of the month. Your second and www.npci.org.in
subsequent SIPs are available only on the above specified dates of the month with a minimum gap of 3. This facility is offered only to the investors having bank accounts with above mentioned Banks.
atleast 30 calendar days between first and second SIP installment. In case the chosen date turns out Above list is subject to modification/updation at any time in future at the sole discretion of BOI AXA
to be a non working day for the scheme; the SIP will be processed on the immediate following working Investment Managers Pvt Ltd, without assigning any reason or prior notice. If any bank is removed, SIP
day. instructions of investors for such banks via NACH will be discontinued without any prior notice.
6. The SIP cheque (where the investment is made by cheque) should be drawn on the same bank account 4. By signing the NACH mandate form the investor agrees to abide by the terms and conditions of NACH
which is to be registered for Auto Debit. The bank account provided for Auto Debit should participate in facility through NPCI (www.npci.org.in).
local MICR clearing. 5. New/Existing investors who wish to enroll for SIP through NACH should fill the SIP Application Form
7. The first investment cheque while applying for Monthly SIP should be same as SIP amount. and the Registration cum Mandate Form for NACH.
8. If two consecutive SIP’s fail, the SIP will automatically stand terminated and a communication to the 6. New Investors should mandatorily give a cheque for the first transaction.
effect will be sent to the investor. a. First SIP Cheque should be dated current day. All subsequent Installments through NACH to be
9. The investor has the right to discontinue SIP at any time he/she so desires by sending a written either 1st/7th/10th/15th/20th/25th of the month.
request, at least 7 working days prior to the due date of next SIP for Monthly SIP, to any of the offices of b. The Registration cum Mandate Form for NACH should be submitted at least 30 Calendar days
BOI AXA Mutual Fund or its Investor Service Centres. prior to next sip cycle date through NACH.
10. Investors availing the Micro SIP facility shall be exempted from submission of requirement of PAN. c. *Unique Mandate Registration Number (UMRN) is auto generated by NPCI during the mandate
Micro SIP shall be applicable where aggregate of installments in a rolling 12 months period or in a creation for the first time. Investors, who do not have the UMRN, please leave it blank. UMRN
financial year i.e. April-March does not exceed ` 50,000/- per year. Micro SIP benefit is available to would be linked to the folio and maximum length is 20 characters comprising of Alpha Numeric
individuals, NRI's are not eligible. The AMC will reject the application where they find that documents Character allotted by NPCI.
are deficient or where the installment total will exceed ` 50,000/- per year. d. Investors who already have UMRN registered under the folio can fill up the SIP Registration cum
11. Investor will not hold BOI AXA Investment Managers Pvt. Ltd., its registrars and other service providers Mandate Form for NACH and should be submitted at least 30 Calendar days before the date of
responsible if the transaction is delayed or not effected, the investor bank account is debited in the first debit through NACH.
advance or after the specific SIP date due to various clearing cycles of Auto Debit / local holidays / 7. Please provide the cancelled cheque leaf of the Bank A/c no. for which NACH facility is registered.
incomplete or incorrect instructions from the applicant. 8. Investors need to mandatorily fill the SIP Registration Cum Mandate form for NACH for any
12. BOI AXA Investment Managers Pvt. Ltd., its registrars and other service providers shall not be amendment and cancellation quoting their UMRN by giving 7 working days prior notice to any of the
responsible and liable for any transaction failures, due to rejection of the transaction by your bank / investor service centre.
branch or its refusal to register the SIP mandate. 9. Investor can choose to discontinue the SIP facility under folio without cancelling the UMRN by giving 7
13. Please refer the Scheme Information Documents/ Statement of Additional Information of the scheme working days prior notice to any of the Investor Service Centre. Investor can choose to register any
for the Applicable NAV, Redemptions, Risk Factors, Load and other information before investing. future SIP by simply filling up the Registration cum mandate form for NACH quoting their UMRN.
10. Please enter IFSC Code (maximum length-11 Alpha Numeric Characters) and MICR Code (maximum
14. The responsibility of the information provided in this SIP Registration cum Debit Mandate or any other length – 9 Numeric Characters) of investor bank.
application form for this facility solely rests with the User(s) and the AMC / Mutual Fund / Registrar will 11. In case of existing investor, if application is received without existing UMRN then the first UMRN
not be responsible or liable for any loss, claims, liability that may arise on account of any incorrect registered in the folio would be considered
and/ or erroneous data / information supplied by the User(s).
15. The User(s) confirm that the information provided in the SIP Registration cum Debit Mandate,

15. SIP Shield Terms and Conditions

1. BOI AXA SIP Shield is an add-on, optional feature available only with BOI AXA Large & Mid Cap Equity 13. In case of death of the applicant, his / her legal representatives may file a claim directly with the
Fund, BOI AXA Tax Advantage Fund, BOI AXA Mid & Small Cap Equity & Debt fund, BOI AXA Small cap designated branch of the Insurance Company supported by all relevant documents as required by the
Fund, BOI AXA Equity Debt Rebalance Fund and BOI AXA Manufacturing & Infrastructure Fund. Insurer and the payment of the claim may be made to the legal representatives by the insurance
2. The minimum SIP tenure for BOI AXA SIP Shield is 3 years. company. The AMC will not entertain any request for claims for the insurance covered.
3. Frequency for SIP Shield is only monthly. 14. All insurance claims will be settled in India and shall be payable in Indian Rupees only. Settlement
4. Minimum application amount = ` 1500 and in multiples of ` 100 thereafter procedure will be as stipulated by the Insurance Company. Insurance claims will be directly settled by
5. The AMC may provide a Group Life Insurance Cover to all Resident Individual/NRI applicants and fund the Insurance Company.
the premium towards such cover. Non-individuals as well as Citizens / Residents of USA/ Canada/ and 15. The AMC will not be responsible or liable for maintaining service levels and/or any delay in processing
Persons not of Indian Origin/ Sole Proprietorship will not be covered under the SIP Shield Facility. claims arising out of this facility.
6. The insurance cover will be available for individuals with a minimum age of 18 years and maximum age 16. The Mutual Fund, Trustees, AMC, or their Directors, officers or employees shall not be liable for any
of 54 years as on last birthday. claims (including but not limited to rejection of any claim, non-settlement, delays etc, by the insurer)
7. Only the First / Sole unit holder will be covered under the insurance. No insurance cover will be provided arising out of the insurance cover provided to the unit holder.
for the second / third unit holder. 17. All the terms and conditions pertaining to Monthly SIP will be applicable on SIP Shield.
8. For the purpose of availing insurance cover the eligibility of the applicant is that he / she is in good 18. The AMC is bringing this offer to the investors of the Scheme only as an additional facility and is not
health. acting as an agent for marketing/sales of insurance policies nor soliciting any business.
9. The insurance cover will commence from the date of first allotment of units under SIP Shield. 19. Subject to what has been stated above, the AMC reserves a right to modify / annul the said Group
10. Amount of Insurance Cover is as follows: Insurance Cover. The AMC also reserves the right to change the insurance company from time to time.
If SIP continues, the insurance cover would be as follows: 20. The Group Life Insurance cover will be subject to the following exclusions and such other terms and
• Year 1 : 10 times the monthly SIP SHIELD installment conditions as may be prescribed by the insurance certificate governing the cover:
• Year 2 : 50 times the monthly SIP SHIELD installment a. The Group Life Insurance Cover shall not extend to cover instances of death due to suicide in the first
• Year 3 onwards : 120 times the monthly SIP SHIELD installment year of cover.
All the above mentioned limits are subject to a maximum cover of ` 50 lacs per investor across all b. Death within 45 days from the commencement of the SIP installments except for death due to
schemes/plans/folios covered under SIP SHIELD. accident.
If SIP SHIELD is discontinued, the insurance cover would be as follows: 21. The provision for the Group Life Insurance Policy does not have any bearing on the performance of the
• SIP SHIELD discontinues before 3 years : Insurance cover stops immediately scheme.
• SIP SHIELD discontinues after 3 years : Insurance cover equivalent to the value of units allotted 22. For the purpose of availing of the SIP Shield facility, a unique folio will be created.
under SIP SHIELD investment at the start of the each policy year, subject to a maximum of 120 times 23. If any transaction such as, switchout,/redemption/ STP out/ folio consolidation request is made under
this unique folio, the Insurance cover will be cancelled with immediate effect. In case of additional
SIP AUTO DEBIT/04062019

the monthly installment, capped at the maximum of ` 50 lacs.

The insurance cover will also cease: purchase/switch ins/STP in, a separate folio will be created.
• At the end of the tenure. i.e., upon completion of 60 years of age. 24. First installment payment made through cheque should be the same as SIP amount and the same shall
• Redemption / switch-out (fully or partly) of units purchased under the scheme in which SIP SHIELD be considered as the first SIP installment.
facility is taken. 25. In the event insurance cover is rejected/ not granted the SIP investment shall continue in the selected
• Incase of two consecutive SIP failures. scheme.
• The first SIP installment cheque/first SIP debit towards SIP Shield is dishonoured. 26. The Trustee/AMC reserves the right to change/modify the terms and conditions of SIP Shield or
withdraw the SIP Shield at a later date. All the other provisions of the Scheme Information
11. The investor will necessarily be required to furnish his / her date of birth, gender and details of the Documents/addendums except as specifically modified herein above remain unchanged till further
nominee to whom the money secured by the policy shall be paid in the event of his death in the notice.
application form and sign the declaration of Good Health, in absence of which, no insurance cover can 27. First nominee will be considered for SIP Shield.
be availed by the investor. Where the nominee is a minor, the policy holder may also appoint any person
who is a major, to receive the Death benefit during the minority of the nominee.
12. The Group Life Insurance Cover will be governed by the terms and conditions of the insurance policy with
the relevant Insurance Company as determined by the AMC.

FOR MORE INFORMATION

BOI AXA Mutual Fund
Add: B/204, Tower 1, Peninsula Corporate Park, Ganpatrao Kadam Marg, Lower Parel, Mumbai 400013
Call us at (Toll Free) Email us at Website
1800-266-2676 & 1800-103-2263 [email protected]
[email protected] www.boiaxamf.com
www.boiaxamf.in