Common Application Form

Investors must read the Key Information Memorandum, the instructions and Product Labeling on cover page before completing this Form.
The Application Form should be completed in English and in BLOCK LETTERS only.

1 KEY PARTNER/AGENT INFORMATION (Investors applying under Direct Plan must mention “Direct” in ARN column.)

ARN / RIA Code ARN / RIA Name Sub Agent’s ARN EUIN No.
I/We hereby confirm that the EUIN box has been intentionally left blank by me/us as this is an “execution-only”
transaction without any interaction or advice by the employee/relationship manager/sales person of the above
distributor or notwithstanding the advice of in-appropriateness, if any, provided by the employee/relationship
manager/sales person of the distributor and the distributor has not charged any advisory fees on this transaction. First Holder Second Holder Third Holder

2 TRANSACTION CHARGES FOR APPLICATIONS THROUGH DISTRIBUTORS ONLY (refer Instruction B)

In case the subscription (lumpsum) amount is Rs. 10,000/- or more and your distributor has opted to receive Transaction Charges, Rs. 150/- (for the first time mutual fund investor) or Rs. 100/-
(for the investor other than first time mutual fund investor) will be deducted from the subscription amount and paid to the distributor. Units will be issued against the balance amount invested.

3 EXISTING INVESTOR DETAILS (If you have existing folio, please provide Folio No. and proceed to section 11 (Refer instruction C)

Folio No. The details in our records under the folio no. mentioned alongside will apply for this application.

Anyone or
4 MODE OF HOLDING / OPERATION Single
Survivor
(Default option) Joint

5 APPLICANT’S DETAILS (Please refer to the Instruction No. A, C, D, R) All fields are mandatory. Gender Male Female

1st APPLICANT Mr Ms M/s P. S. JAGDISH Date of Birth** D 22

D 1
M 1
M 6
Y 6
Y
Ensure that name is as per Pan / Aadhaar card.
PAN/PEKRN* Nationality CKYC Number/KIN Proof Attached
A A B P J 0 5 3 2 B I N D I A N
GUARDIAN NAME IF MINOR/CONTACT PERSON Gender Male Female
(FOR NON INDIVIDUAL) /POA HOLDER
Mr Ms
Date of Birth D D M M Y Y
PAN/PEKRN* Nationality CKYC Number/KIN Proof Attached

Relationship with Minor applicant Natural guardian Court appointed guardian Proof of relationship with minor

2nd APPLICANT Resident Individual NRI (Second Applicant is not allowed in case of minor as first/sole applicant.) Gender Male Female

Mr Ms M/s Date of Birth D D M M Y Y

PAN/PEKRN* Nationality CKYC Number/KIN Proof Attached

3rd APPLICANT Resident Individual NRI (Third Applicant is not allowed in case of minor as first/sole applicant.) Gender Male Female
Mr Ms M/s Date of Birth D D M M Y Y
Nationality CKYC Number/KIN Proof Attached

POA HOLDER Resident Individual NRI Gender Male Female

Mr Ms M/s Date of Birth D D M M Y Y
Nationality CKYC Number/KIN Proof Attached

*Mandatory information - If left blank, the application is liable to be rejected.**Mandatory in case the Sole/First applicant is minor. Individual client who has registered under KYC Records Registry (CKYCR) can fill
the 14 digit KYC Identification Number (KIN)

6 CORRESPONDENCE DETAILS OF SOLE/FIRST APPLICANT (AS PER KYC RECORDS)

Correspondence Address Overseas Address (Mandatory for NRI / Fll Applicants)

No. 31, North Mada Street,

HOUSE / FLAT NO. HOUSE / FLAT NO.

Srinagar Colony, STREET ADDRESS STREET ADDRESS

ChennaiCITY / TOWN Tamilnadu

STATE CITY / TOWN STATE

India COUNTRY 6 0 PIN

0 CODE
0 1 5 COUNTRY PIN CODE

Country Code. STD Code.

Tel. No. Office Residence Mobile No. 9 8 4 0 0 2 7 2 7 0

Email ID j a g d i s h f a m i l y o f f i c e @ g m a i l . c o m
Default Communication mode is E-mail only, if you wish to receive following document(s) via physical mode: (please here) Account Annual Other Statutory
Statement Report Information

I/We hereby confirm that the primary email address provided in the application belongs to self

I/We hereby confirm that the primary email address provided in the application belongs to a family member (Refer Instruction No. 5 )

7 TAX STATUS (Please ) (For First / Sole Applicant)

Resident Individual LLP Public Limited Company Government Body AOP/BOI Defence Establishment
On behalf of Minor Sole Proprietorship Private Limited Company Financial Institution Trust / Society / NGO Other Specify
HUF Partnership Firm Body Corporate Fll Non Profit Organization/Charities
NRI-NRE NRI-NRO Bank Foreign Portfolio Investor QFI
PIO OCI Foreign National Resident In India

8 KYC DETAILS (Mandatory)

OCCUPATION [Please tick ( )]
Private Sector Public Sector Government Business Non Profit Professional Agriculturist Retired Housewife Proprietorship Others
Service Service Service Organisation
First Applicant/Guardian
Second Applicant
Third Applicant
POA Holder
GROSS ANNUAL INCOME [Please tick ( )]

First Applicant/ Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs >25 Lacs-1 crore >1 crore
Guardian OR Net worth (Mandatory for Non-Individuals) ` as on D D M M Y Y Y Y (Not older than 1 year)
Second Applicant Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs >25 Lacs-1 crore >1 crore OR Net worth `
Third Applicant Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs >25 Lacs-1 crore >1 crore OR Net worth `
POA Holder Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs >25 Lacs-1 crore >1 crore OR Net worth `
OTHERS[Please tick ( )]
For Individuals Please tick ( ) I am Politically Exposed Person (PEP)^ I am Related to Politically Exposed Person (RPEP) Not applicable
First Applicant/
For Non-Individuals Please tick ( ) (Please attach mandatory Ultimate Beneficial Ownership (UBO) declaration form - Refer instruction no. IV (h)):
Guardian
(i)Foreign Exchange / Money Changer Services Y N (ii) Gaming / Gambling / Lottery / Casino Services Y N (iii) Money Lending / Pawning Y N
Second Applicant Politically Exposed Person (PEP)^ Related to Politically Exposed Person (RPEP) Not applicable
Third Applicant Politically Exposed Person (PEP)^ Related to Politically Exposed Person (RPEP) Not applicable
POA Holder Politically Exposed Person (PEP)^ Related to Politically Exposed Person (RPEP) Not applicable

9 DEMAT ACCOUNT DETAILS (Optional - Refer Instruction k) (Nomination Provided in Demat Account shall be considered)
NSDL

CDSL

DP Name DP Name

NSDL: Depository Participant (DP) ID (NSDL only) Beneficiary Account Number (NSDL only) CDSL: Beneficiary ID (CDSL only)

10 BANK DETAILS (The name of the Sole/First applicant must be pre printed on the cheque.)
Mandatory information - If left blank, the application is liable to be rejected.( Mandatory to attach proof, in case the pay-out bank account is different from the bank account mentioned under Section 11 Below.)
For unit holder opting to hold units in demat form, please ensure that the bank account linked with the demat account is mentioned here.Redemption/Dividend/Refund Payout will be credited into
this bank account.
Account Number 4 3 6 1 0 1 7 2 9 6 9 Account Type Savings Current NRO NRE FCNR Others (please specify)

Bank Name & Branch S T A N D A R D C H A R T E R E D B A N K

Branch City C H E N A I IFSC Code S C B L 0 0 11 digit3 6 0 8 3 MICR Code 6 0 0 0 9 3digit6 0 0 8
11 MODE OF PAYMENT OF REDEMPTION / DIVIDEND VIA DIRECT CREDIT / NEFT / ECS (refer instruction I )

Unitholders will receive redemption / dividend proceeds directly into their bank account (as furnished in Section 9) via Direct credit / NEFT / ECS facility
I wish to receive a cheque instead of direct credit into my account.
12 INVESTMENT & PAYMENT DETAILS (refer instruction F) Please write Cheque/DD in favour of the Scheme name only.
Scheme Parag Parikh Flexi Cap Fund Parag Parikh Liquid Fund Parag Parikh Tax Saver Fund

Plan Direct (Default Plan) Regular

Option Growth (Default Plan) Dividend (N/A for Parag Parikh Flexi Cap Fund (PPFCF) and Parag Parikh Tax Saver Fund (PPTSF) )

Sub-Option Div - Reinvest Div - Monthly Payout

Daily Weekly Monthly

(Default Option)
Mode of Payment Self Third Party Payment (please fill the ‘Third Party Payment Declaration Form)

Payment mode Cheque DD Common CAMS OTM / PPFAS OTM Fund Transfer RTGS/NEFT Transfer Letter DD Charges

S. *Cheque / DD Favouring Cheque Amount DD Net Amount Cheque/DD No./UTR No.

No. Scheme Name Date Invested (`) Charges Paid (`) (in case of NEFT/RTGS) Bank and Branch and Account Number

A/c No. 43610172969

1. Parag Parikh Flexi Cap Fund 20/01/22 2,00,00,000/- 2,00,00,000/- Cheque No. 002383 STANDARD CHARTERED BANK , G. N. Chetty Road, T. Nagar, Chennai - 17

2. Parag Parikh Liquid Fund

3. Parag Parikh Tax Saver Fund

*All purchases are subject to realization of funds

13 NOMINATION DETAILS Individuals (single or joint applicant) are advised to avail Nomination facility.
I/We DO NOT wish to nominate and sign here

First/Sole Applicant Second Applicant Third Applicant

I/We wish to nominate

In case of Minor Relationship Nominee/Guardian
Nominee Name & Address Allocation % sign
Guardian Name & Address Date of birth with Investor
Nominee 1 MEERA JAGDISH 171273 100% WIFE
Nominee 2

Nominee 3

14 FATCA and CRS Information/Foreign Tax Law (Self Certification) (Required for all applicant(s)/Guardians, Sole Proprietor & POA Holder)
For Non-Individual investor : You are required to submit separate FATCA/CRS/UBO declaration form.
Place/City of Birth Country of Birth Country of Citizenship / Nationality
First Applicant / Guardian KERALA INDIA Indian U.S. Others Please specify

Second Applicant Indian U.S. Others Please specify

Third Applicant Indian U.S. Others Please specify

POA Holder Indian U.S. Others Please specify

Are you a tax resident (i.e. are you assessed for tax) in any other country outside India? YES No (please tick )
If “YES” please fill for ALL countries (other than Indian in which you are a Resident for tax purpose i.e. where you are a Citizen/ Resident/ Green Card holder/ Tax Resident in the respective countries.)

Country of Tax Residency# Tax Identification Number Identification Type* Identification Type
or Functional Equivalent (TIN or other please specify) (TIN or other please specify)
First Applicant / Guardian Reasons A B C
Second Applicant Reasons A B C
Third Applicant Reasons A B C
POA Holder Reasons A B C
# To also include USA, where the individual is a citizen/ green card holder of USA. *In case Tax Identification Number is Not available, kindly provide its functional equivalent.

Reason A The country where the Account Holder is liable to pay tax does not issue Tax Identification Number to its residents.

Reason B No TIN required (Select this reasons Only if the authorities of the country of tax residence do not require the TIN to be collected ) Reason C Others please state the reasons there of:

Address Type of Sole / 1st Holder Address Type of 2nd Holder Address Type of 3rd Holder
Residential Registered Office Business Residential Registered Office Business Residential Registered Office Business

Instructions
1. ‘If the Name given in the application does not match the name as appearing on the PAN Card/Aadhaar card, authentication, application may be liable to get rejected or further transactions may
be liable to get rejected’

2. I /We have understood the information requirement 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 below and hereby accept the same.

3. Politically Exposed Persons (PEP) are defined as individuals who are or have been entrusted with prominent public function in a foreign country, e.g., Heads of States or of Governments, senior
politicians, senior government/judicial/military officers, senior executive of state-owned corporations, important political party officials, etc.

4. Country of Tax Residence and Tax ID number: Tax Regulations require us to collect information about each investor’s tax residency. In certain circumstances (including if we do not receive a valid
self-certification from you) we may be obliged to share information on your account with relevant tax authorities. If you have any questions about tax residency, please contact your tax advisor.
Should any information provided change in the future, please ensure you advise us of the change. If you are a US citizen or resident, please include United States in this related field along with
your US Tax Identification Number.

5. As per AMFI Circular No. 135/BP/77/2018-19, please provide email id and Mobile Number of the Primary Unit Holder of the Folio. In cases where the email address/mobile No. is not provided in the
application form, the email address/mobile no. of the first applicant as per the KYC data will be taken as the email address/mobile No. The email address of one investor should not be allowed/updated
against folios of other/multiple investors, unless a specific written request is received in this regard, duly signed by the investors or the investors in such folios belong to the same family (applicable in
respect of individual investors only).
‘Family’ for this purpose shall mean self, spouse, dependent children, dependent parents as specified in SEBI Circular No.CIR/MIRSD/15/2011 dated Aug 02, 2011, addressed to all Stock Exchanges.

DECLARATION

I/We am/are not prohibited from accessing capital markets under any order/ruling/judgment etc. of any regulation, including SEBI. I/We confirm that my application is in compliance with applicable
Indian and foreign laws. I/We hereby confirm and declare as under:-

1. For Non-Individual Investor: I/We hereby confirm that the object clause of the constitution document of the entity (viz. MOA / AOA / Trust Deed, etc.), allows us to apply for investment in this scheme of
PPFAS Mutual Fund and the application is being made within the limits for the same. I/We are complying with all requirements / conditions of the entity while applying for the investments and I/We,
including the entity, if the case may arise so, hereby agree to indemnify PPFAS AMC / PPFAS Mutual Fund in case of any dispute regarding the eligibility, validity and authorization of the entity and/or the
applicants who have applied on behalf of the entity.
2. For NRIs only: I/We confirm that I am/we are Non Residents of Indian Nationality/Origin and that I/we have remitted funds from abroad through approved banking channels or from funds in my/our Non-
Resident External/Non-Resident Ordinary/FCNR account. (Refer Inst. No. F)

3. Applicable to PEKRN Holders: I, the first / sole holder, also hereby declare that I do not hold a permanent Account Number and hold only a single PAN Exempt KYC Reference No. (PEKRN) issued by KYC
Registration Authority and that my existing investments together with the current application will not result in aggregate investments exceeding Rs. 50,000/-in a rolling 12 months period or in a financial
year.

4. I have voluntarily subscribed to the online access for transacting the internet facility provided by PPFAS Asset Management Private Ltd. (Investment Manager of PPFAS Mutual Fund) and confirm of
having read, understood and agree to abide the terms and conditions for availing of the internet facility more particularly mentioned on the website www.amc.ppfas.com and hereby undertake to
be bound by the same. I further undertake to discharge the obligations cast on me and shall not at any time deny or repudiate the online transactions effected by me and I shall be solely liable for
all the costs and consequences there of.

5. I/We have read, understood and hereby agree to comply with the terms and conditions of the scheme related documents and apply for allotment of Units of the Scheme(s) of PPFAS Mutual Fund
(’Fund’) indicated above.

6. I/We am/are eligible Investor(s) as per the scheme related documents and am/are authorised to make this investment as per the Constitutive documents/authorization(s). The amount invested in
the Scheme(s) is through legitimate sources only and is not for the purpose of contravention and/or evasion of any act, rules, regulations, notifications or directions issued by any regulatory
authority in India.

7. The information given in/ with this application form is true and correct and further agree to furnish such other further/additional information as may be required by the PPFAS Asset Management
Private Limited (AMC)/Fund and undertake to inform the AMC/Fund/Registrars and Transfer Agent (RTA) in writing about any change in the information furnished from time to time.

8. That in the event, the above information and/or any part of it is/are found to be false/untrue/misleading, I/We will be liable for the consequences arising there from.

9. I/We hereby authorize you to disclose, share, remit in any form/manner/mode the above information and/or any part of it including the changes/updates that may be provided by me/us to the
Mutual Fund, its Sponsor/s, Trustees, Asset Management Company, its employees, agents and third party service providers, SEBI registered intermediaries for single updation/ submission, any
Indian or foreign statutory, regulatory, judicial, quasi- judicial authorities/agencies including but not limited to Financial Intelligence Unit-India (FIU-IND) etc without any intimation/advice to me/us.

10. I/We will indemnify the Fund, AMC, Trustee, RTA and other intermediaries in case of any dispute regarding the eligibility, validity and authorization of my/our transactions.

11. The ARN holder (AMFI registered Distributor) has disclosed to me/us all the commissions (in the form of trail commission or any other mode), payable to him/them for the different competing
Schemes of various Mutual Funds from amongst which the Scheme is being recommended to me/us.

12. 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.

13. Preferred mode of payment Electronic Credit. RTGS IFSC/NEFT code will help us transfer the amount to your bank account quicker, electronically. In case the bank does not credit my /our bank
account with / without assigning any reason thereof, or if the transaction is delayed or not effected at all or credited into the wrong account for reasons of incomplete or incorrect information, I /
We would not hold PPFAS Mutual Fund responsible. Further the Mutual Fund reserves the right to issue a demand draft / payable at par cheque in case it is not possible to make payment by
DC/NEFT/ECS.

14. I/We acknowledge that in case any of the above specified information is found to be false or untrue or misleading or misrepresenting, I/We am/are aware that I/We may liable for it. I/We hereby
authorize you [Fund/AMC/RTA/Other participating entities] to disclose, share, remit in any form, mode or manner, all / any of the information provided by me, including all changes, updates to
such information as and when provided by me to Mutual Fund, its Sponsor, Asset Management Company, trustees, their employees / RTAs ('the Authorized Parties') or any Indian or foreign
governmental or statutory or judicial authorities / agencies including but not limited to the Financial Intelligence Unit-India (FIU-IND), the tax / revenue authorities in India or outside India wherever it
is legally required and other investigation agencies without any obligation of advising me/us of the same. Further, I/We authorize to share the given information to other SEBI Registered
Intermediaries /or any regulated intermediaries registered with SEBI / RBI / IRDA / PFRDA to facilitate single submission / update & for other relevant purposes. I/We also undertake to keep you
informed in writing about any changes / modification to the above information in future and also undertake to provide any other additional information as may be required at your / Fund’s end. As
may be required by domestic or overseas regulators/ tax authorities, I/We authorize Fund/AMC/RTA to withhold and pay out any sums from your account or close or suspend your account(s)
without any obligation of advising me of the same

15. Consent for Telemarketing: I/We hereby accord my/our consent to PPFAS AMC for receiving the promotional information/ material via email, SMS, telemarketing calls etc. on the mobile number
and email provided by me/us in this Application Form.

16. For Foreign National Resident in India only: I/We will redeem my/our entire investment/s before I/We change my/our Indian residency status. I/We shall be fully liable for all consequences
(including taxation) arising out of the failure to redeem on account of change in residential status.

17. For NRIs/PIO/OCIs only: I/We comfirm that my application is in compliance with applicable Indian and foreign laws.
Please ( ) Yes No If Yes, ( ) Repatriation basis Non-repatriation basis

DECLARATION
I declare that the information is to the best of my knowledge and belief, accurate and complete.
I agree to notify PPFAS Mutual Fund/PPFAS Asset Management Private Limited immediately in the event the information in the self-certification changes.

SIGN HERE SIGN HERE SIGN HERE

FIRST OR SOLE APPLICANT/ GUARDIAN/POA SECOND APPLICANT THIRD APPLICANT

ACKNOWLEDGMENT SLIP (To be filled in by the Investor)

Application No. ISC Stamp & Signature
PPFAS MUTUAL FUND
Corporate Office : 81/82, 8th Floor, Sakhar Bhavan, Ramnath Goenka Marg, 230, Nariman Point, Mumbai - 400 021.
Received, subject to realisation, verification and conditions, an application for purchase of Units as mentioned in the application form.

From
Cheque No. Dated Amount (Rs) Scheme
 One Time Mandate Instruction Form (OTM/NACH Form) * Mandatory Fields

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

Sponsor Bank Code HDFC0999999 Utility Code HDFC00070000003309

Tick ( )
CREATE PPFAS Mutual Fund to debit (tick )* SB CA CC SB-NR0 Other
I/We hereby authorize SB-NRE
MODIFY
CANCEL Bank a/c number

with Bank Name of customers bank IFSC or MICR

an amount of Rupees
FREQUENCY Monthly Quarterly Half Yearly Yearly As & when presented DEBIT TYPE Fixed Amount Maximum Amount
Reference 1 PAN No. Mobile No.

Reference 2 Folio No. Email ID

I agree for the debit mandate processing charges by the bank whom I am authorizing to debit my account as per latest schedule for charges of the bank.
PERIOD
From* Signature Primary Account holder Signature of Account holder Signature of Account holder
To
Or 1. Name as in bank records 2. Name as in bank records 3. Name as in bank records
Until Cancelled
• 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 instructions as agreed & signed by me.
• I have understood that I am authorised to cancel/amend this mandate by a appropriately communicating the cancellation/amendment request to the user entity/corporate or the bank where I have authorised the debit.

SIP Registration/Renewal Form (for OTM registered investors only)

Please tick a as applicable:
OTM Debit Mandate is already registered in the folio. [No need to submit again].
OTM Debit Mandate is attached and to be registered in the folio. SIP Auto debit will start after mandate registration (usually within Thirty days depending on OTM or NACH modalities).
The total of all installments in a day should be less than or equal to the amount as mentioned in One Time Mandate already registered or submitted, if not registered.
Investors must read the SID / SAI and Key Information Memorandum and the instructions before completing this Form.
The Application Form should be completed in English and in BLOCK LETTERS only. Note: No need to attach One Time Mandate again, if already registered/submitted earlier.

Scheme Parag Parikh Flexi Cap Fund Parag Parikh Liquid Fund *>À>}Ê*>ÀˆŽ Ê/>ÝÊ->ÛiÀÊ՘`

Plan Direct (Default Plan) Regular

Option Growth (Default Plan) Dividend (N/A for Parag Parikh Flexi Cap Fund (PPFCF)Ê>˜`Ê*>À>}Ê*>ÀˆŽ Ê/>ÝÊ->ÛiÀÊ՘`Ê­**/-®
Sub-Option Div - Reinvest Div - Monthly Payout
Daily Weekly Monthly
(Default Option)

CKYC details (KIN):

FOR OFFICE USE ONLY (TIME STAMP)
Distributor Name/ARN No. Sub-broker Name/ Code EUIN No.

I/We hereby confirm that the EUIN box has been intentionally left blank by me/us as this is an “execution-only” transaction without any interaction or advice by
the employee/relationship manager/sales person of the above distributor or notwithstanding the advice of in-appropriateness, if any, provided by the First Holder Second Holder Third Holder
employee/relationship manager/sales person of the distributor and the distributor has not charged any advisory fees on this transaction.

Transaction charges for applications through Distributors

I confirm that I am a first time investor (`150 deductible as transaction charge & payable to distributor) I confirm that I am a existing investor (`100 deductible as transaction charge & payable to distributor)

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 ARN Holder.

EXISTING INVESTOR DETAILS (If you have existing folio)

Folio No. The details in our records under the folio number mentioned alongside will apply for this application.

NAME OF SOLE/FIRST APPLICANT Mr. Ms. M/s.

SIP DETAILS

Monthly SIP (Default Option, Minimum: ` 1,000, 6 months) Dates 1st 5th 10th (Default) SIP Amount
Quarterly SIP (NA for Parag Parikh Liquid Fund) 15th 20th 25th 1,000 5,000 10,000

Standard From M M Y Y Y Y To M M Y Y Y Y 50,000 100,000 500,000

Period

Default From To 1 2 2 0 9 9 Any Other Amount

M M Y Y Y Y
First SIP Cheque Date D D M M Y Y Y Y Cheque No.

SIP TOP UP (Optional) (Tick to avail this facility)

SIP TOP UP Start Month / Year M M Y Y Y Y SIP TOP UP Frequency: Half Yearly Yearly

TOP UP Amount*: (Minimum Rs. 500) Rs.

Note: Default Frequency is Yearly. It is mandatory to submit NACH (OTM). NACH mandate should be provided for maximum amount in line with your Top Up mandate & SIP tenure.

SIP TOP UP Amount-based Cap* (Optional) : Rs.

Please refer to point No. 7 under ’SIP Top Up Explained’

Continued to the next page

Declaration: I/We hereby declare that the particulars provided in this mandate are correct and complete and hereby agree to participate in the OTM/NACH/Direct Debit/Standing Instructions (SI) and make
payments through the NACH platform according to the terms and conditions thereof. I/We further hereby agree and acknowledge that I/we will not hold the AMC and/or responsible for any delay and/or
failure in debiting my bank account for reasons not attributable to the negligence and/or misconduct on the part of the AMC I/We hereby declare and confirm that, irrespective of my/our registration of the
above mobile number in the 'DO NOT DISTURB (DND)', 'or in any similar register maintained under applicable laws, now or subsequent to the date hereof, I/We hereby consent to the Bank / PPFAS AMC
communicating with me/us in any manner whatsoever on the said mobile number with respect to the transactions carried out in my/our aforementioned bank account(s). I/We hereby agree to abide by
the terms and conditions that may be intimated to me/us by the PPFAS AMC/Bank with respect to the OTM/NACH/Direct Debit/SI from time to time.

Authorisation to Bank: This is to inform that I/We have registered for OTM / NACH (Debit Clearing) / Direct Debit / SI facility and that the payment towards my/our investments in the Schemes of PPFAS
Mutual Fund shall be made from my/our above mentioned bank account with your Bank. I/We hereby authorize the representatives of PPFAS Asset Management Company Limited, Investment Manager to
PPFAS Mutual Fund carrying this mandate form to get it verified and executed. I/We authorize the Bank to debit my/our above-mentioned bank account for any charges towards mandate verification,
registration, transactions, returns, etc, as applicable for my/our participation in NACH/OTM/Direct Debit/SI.

Sole/First Unit Holder’s Signature Second Unit Holder ’s Signature Third Unit Holder ’s Signature

ACKNOWLEDGEMENT SLIP (To be filled in by the Applicant)

PPFAS MUTUAL FUND ISC Stamp & Signature
Date: Corporate office : 81/82, 8th Flr, Sakhar Bhavan, Ramnath Goenka Marg, 230, Nariman Point, Mumbai 400 021.

Folio No. Received from: Amount:

OTM DEBIT MANDATE FORM SIP FORM First SIP Cheque Date Cheque No.
SIP TOP UP FORM

INSTRUCTIONS TO FILL ONE TIME MANDATE (OTM)

1. Investors who have already submitted a One Time Mandate (OTM) form or 6. Utility Code of the Service Provider will be mentioned by PPFAS Mutual Fund
already registered for OTM facility should not submit OTM form again as OTM
registration is a one-time process only for each bank account. However, if such 7. Tick on the respective option to select your choice of action and instruction.
investors wish to add a new bank account towards OTM facility may fill the form.
8. The numeric data like Bank account number, Investors account number should
be left padded with zeroes.
2. Investors, who have not registered for OTM facility, may fill the OTM form and
submit duly signed with their name mentioned.
9. Please mention the Name of Bank and Branch, IFSC / MICR Code also provide an
Original Cancelled copy of the cheque of the same bank account registered in
3. Unit holder(s) need to provide along with the mandate form an original cancelled
One Time Mandate.
cheque (or a copy) with name and account number pre-printed of the bank
account to be registered or bank account verification letter for registration of the
10. The amount in figures should be same as the amount
mandate failing which registration may not be accepted. The Unit holder(s)
cheque/ bank account details are subject to third party verification. mentioned in words, in case of ambiguity the mandate will be rejected.

11. For the convenience of the investors the frequency of the mandate will be ”As and
4. Investors are deemed to have read and understood the terms and conditions of When Presented” (Any corrections in this will be subject to rejection)
OTM Facility, SIP registration through OTM facility, the Scheme Information
Document, Statement of Additional Information, Key Information Memorandum, 12. Please affix the Names of customer/s and signature/s as well as seal of Company

Instructions and Addenda issued from time to time of the respective Scheme(s) (where required) and sign the undertaking.
of PPFAS Mutual Fund.
13. As per NPCI, Mandate Maximum CAP amount is Rs.100,00,000/- (One Crore) with
effect from 1st Oct 2016, until further notice. .
5. In case of OTM, date and the validity of the mandate should be mentioned in
DD/MM/YYYY format and in case of SIP TOP UP it should be in MM/YYYY format. 14. If your OTM is registered, you can call and renew your SIP on the Toll Free Number:
1800 266 7790 based on the OTM limit and Expiry.