COMMON 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 (Refer Instruction No. 1) 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

ARN-118251
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 TRANSACTION CHARGES FOR APPLICATIONS THROUGH DISTRIBUTORS/AGENTS ONLY (Refer Instruction No. 1(a))
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 EXISTING UNIT HOLDER INFORMATION [Please fill in your Folio Number and proceed to Scheme and Payment Details] (Refer Instruction No. 2(a))
Folio No.

4 MODE OF HOLDING & KIN/ KYC DETAILS (Refer Instruction No. 9(a & b))
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

5 APPLICANT'S DETAILS (Refer Instruction No. 2(b)) (#Refer Instruction No. 2(b)9) (* Mandatory)

FIRST/ SOLE APPLICANT'S DETAILS Mr. Ms. M/s

st
Name (1 )

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

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

Status of First/ Sole Applicant [Please tick (P)] Individual Non - Individual [For Non - individual - please attach FATCA, CRS & Ultimate Beneficial Ownership (UBO)
Self Certification Form] (Refer Instruction No. 14 & 15) (Mandatory)
Resident Individual NRI-Repatriation NRI-Non Repatriation Partnership Trust HUF AOP PIO Company Minor through guardian BOI OCI
Body Corporate LLP Society / Club Foreign National Resident in India
FPI Sole Proprietorship Non Profit Organisation (please specify)
Others____________________________
For Investments "On behalf of Minor" Birth Certificate School Certificate Passport Other Relationship with minor Father Mother Legal Guardian
NAME OF GUARDIAN (in case of First/ Sole Applicant is a Minor)/ NAME OF CONTACT PERSON - DESIGNATION (in case of non-individual Investors)/ POA HOLDER/ SOLE PROPRIETOR DETAILS
Mr. Ms. M/s
Designation Mobile +91
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.

*I/We hereby declare that the email address and the mobile number provided on the application form belongs to (Please tick (P) any one from the below options)
Self Spouse My Dependents My Childrens
Please note: In the event that the mobile number or the email id provided herein above does not appear to be the unit holder's, then the AMC shall send suitable communication in this regard to the unit holder.
Overseas address (for FPIs/ NRIs/ PIOs)
Mailing address

Landmark City
State Country Zip Code

SECOND APPLICANT'S DETAILS Mr. Ms. Nationality Country of Birth Mobile* +91

Name (2nd)

Email ID*

THIRD APPLICANT'S DETAILS Mr. Ms. Nationality Country of Birth Mobile* +91
rd
Name (3 )

Email ID*

ACKNOWLEDGEMENT SLIP (TO BE FILLED IN BY THE SOLE/FIRST APPLICANT) Application No:

Received from: Mr. / Ms. / M/s_______________________________________________________ an application for allotment of units

under Scheme________________________________, Plan_________________________, Option _________________________
Cheque/DD No______________________Dated____/____/________ Amount (`) _________________________________ Drawn
on Bank and Branch ________________________________________________.
Please note: All unit allotments are subject to realization of cheques/Demand Drafts and subject to the terms and conditions of relevant Scheme Information Document and Stamp, Signature & Date
Statement of Additional Information.
6 ADDITIONAL KYC DETAILS (Refer Instruction No. 2(c))
st nd rd
Occupation details for 1 Applicant 2 Applicant 3 Applicant Guardian
Politically Exposed Person (PEP) details: Is a PEP Related to PEP Not Applicable
Private Sector Service
Public Sector Service
Government Service 1st Applicant
Business
Professional 2nd Applicant
Agriculturist
3rd Applicant
Retired
Housewife
Guardian
Student
Proprietorship
Authorised Signatory/ Partners/ Directors/ Others
Others (Please specify)
Foreign Exchange / Money Changer Services Gaming / Gambling / Lottery / Casino Services
Non-Individual Investors involved/ providing any of the mentioned services
Money Lending / Pawning None of the above
Gross Annual Income Range (in `) 1st Applicant 2nd Applicant 3rd Applicant Guardian Gross Annual Income Range (in `) 1st Applicant 2nd Applicant 3rd Applicant Guardian
Below 1 lac 10-25 lac
1-5 lac 25 lac- 1 cr
5-10 lac > 1 cr

OR Networth in ` (Mandatory as on
for Non Individual) (not older
than 1 year) DD MM YYYY

EMAIL COMMUNICATION INFORMATION (Refer Instruction No. 7)

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

7 FATCA & CRS INFORMATION (for Individual including Sole Proprietor) (Self Certification) (Refer Instruction No. 14)

The below information is required for all applicant(s)/ guardian

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 (including Minor) Second Applicant/ Guardian Third Applicant

Is the applicant(s)/ guardian's Yes No Yes No Yes No

Country of Birth/ Citizenship/
Nationality/ Tax Residency other If Yes, please provide the If Yes, please provide the If Yes, please provide the
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.

8 BANK ACCOUNT DETAILS - Mandatory (Payout Bank - If left blank, application will be rejected) (Refer Instruction No. 3)

Name of the Bank

EQUITY-KIM/04062019

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

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)

FOR MORE INFORMATION

Bank of India Mutual Fund (Formerly 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.boimf.in
9 SCHEME AND PAYMENT DETAILS (Payment through Cash/Non-MICR Cheques/Outstation Cheques not accepted) (Refer Instruction No.4 & 8)

Scheme Name

Plan Option

Sub Option IDCW Frequency

Investment Amount (`) DD Charges if any (`) Net Amount (`)

Cheque/ DD No. Drawn Bank Branch/City

Account Type* S/B NRE* Current NRO FCNR* *Kindly provide photocopy of the payment Instrument or Foreign Inward remittance Certificate (FIRC) evidencing source of funds
Please (ü) RTGS Fund Transfer Letter dated Bank A/c No.

UTR/ Reference no.

REDEMPTION / DIVIDEND REMITTANCE (Refer Instruction No. 5)

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

10 DIVIDEND TRANSFER FACILITY (Please tick to select this facility) (Refer Instruction No.4(e)(4))

This facility is available only under Transfer of Income Distribution cum capital withdrawal plan (IDCW Transfer) if the unit holder chooses to transfer the amount of the dividend receivable by
them into any of the open ended scheme - Target Scheme ___________________________________________________________________
11 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) (Refer Instruction No. 10)

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.

12 NOMINATION DETAILS for Individuals [Minor / HUF / POA Holder / Non Individuals cannot Nominate] (Mandatory) (Refer Instruction No. 6)
I/We wish to nominate as under: OR I / We hereby confirm that I / We do not wish to appoint any nominee(s) for my mutual fund units held in my / our mutual fund folio and understand the issues
involved in non appointment of nominee(s) and further are aware that in case of death of all the account holder(s), my / our legal heirs would need to submit all the
requisite documents issued by Court or other such competent authority, based on the value of assets held in the mutual fund folio.
Name and Address of Nominee(s) PAN Relationship of Date of Birth Signature of Nominee Proportion (%) in which
(IN CAPITALS) Nominee with (Birth proof to Name and Address of Guardian (Optional)/ Guardian of the units will be shared
Unitholder be attached)* Nominee (Mandatory) by each Nominee (should
aggregate to 100%)
(to be furnished in case the Nominee is a minor)

Nominee 1

Nominee 2

Nominee 3

*Proof of Relationship of Guardian with Minor: Birth Certificate School Leaving Certificate Passport Others _________________________
I/We have read and understood the instructions on nomination and I/We hereby undertake to abide by the same. The instructions contained herein supercedes all previous nominations made by me/us
in respect of the folio(s) mentioned above.

POA holder cannot

nominate.
First / Sole Applicant Second Applicant Third Applicant

13 DECLARATION
I/We have read and understood the contents of the Scheme Information Document and Statement of SIGN HERE
Additional Information of Bank of India Mutual Fund (Formerly BOI AXA Mutual Fund) including the
section on Who cannot invest and Prevention of Money Laundering. I/We hereby apply for (Please write Application Form No. / Folio No.
Allotment/Purchase of Units in the Scheme and agree to abide by the terms and conditions applicable on the reverse of the Cheque / Demand Draft /
thereto. I/We hereby declare that I/We am /are authorised to make this investment and that the amount Payment Instrument.)
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 Bank of India Mutual Fund (Formerly
BOI AXA Mutual Fund) its Investment Manager and its agents to disclose details of my investment to my First/ Sole Applicant/
bank(s)/Bank of India Mutual Fund (Formerly BOI AXA Mutual Fund) and /or Distributor /Broker /
Investment Advisor. I/We have neither received nor been induced by any rebate or gifts, directly or Guardian/ PoA/
indirectly, in making this investment. I/We declare that the information given in this application form is Authorised Signatory
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 SIGN
with any third party as may be required by Bank of India Mutual Fund (Formerly 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/ 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 request Bank of India Mutual Fund (Formerly BOI AXA Mutual Fund) to update my/our following Second Applicant/
details for the above Folios. I/we authorize Bank of India Investment Managers Pvt. Ltd. (Formerly BOI Authorised Signatory
Star Investment Managers Pvt. Ltd.) (Formerly BOI AXA Investment Managers Pvt. Ltd.) Registrars to
refer these details to any of the appropriate authorities including Unique Identification Authority of India
SIGNATURE(S)

(UIDAI)/ KYC Registration Agency/Authentication Agencies etc. and also authorize such agencies / SIGN
service providers including UIDAI to share the data as per their records, for verification purpose. In case
of any correction/change in name/address/mobile number/date of birth etc. recorded with UIDAI, please
update the change with UIDAI’s Aadhaar Self Ser vice Update Por tal, cur rently,
https://ssup.uidai.gov.in/web/guest/update and also with Bank of India MF (Formerly BOI AXA MF).
I/WE HEREBY CONFIRM THAT I/WE HAVE NOT BEEN OFFERED/ COMMUNICATED ANY INDICATIVE
PORTFOLIO AND/ OR ANY INDICATIVE YIELD BY THE FUND/ AMC/ ITS DISTRIBUTOR FOR THIS
INVESTMENT.
Applicable to NRI only: I /We confirm that I am/we are Non-Resident Indian/Person of Indian Origin and Third Applicant/
that I/We have remitted funds from abroad through approved banking channels or from funds in my/our Authorised Signatory
NRE/NRO/FCNR Account. I/We undertake that all additional purchases 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.
SIGN
CERTIFICATION: I / We have understood the information requirements of this Form (read along with the
FATCA & CRS Instructions) and hereby confirm that the information provided by me/us on this Form is
true, correct, and complete. I / We also confirm that I / We have read and understood the FATCA & CRS
Terms and Conditions above and hereby accept the same.