11

Signature & Stamp

*All SIP purchases are subject to realisation of Cheque / DD.

Acknowledgement Slip (To be filled in by the Investor)

FIRST APPLICANT

Received from Mr / Ms / M/s ______________________________________________________________________________

FOLIO NO. COMMON APPLICATION FORM NO.(For Existing Investor) (For New Investor)

REQUEST FOR SIP* SWP STP Start Date End Date

SYSTEMATIC TRANSFER PLAN (STP)

SYSTEMATIC WITHDRAWAL PLAN (SWP)

WITHDRAWAL FREQUENCY

(Applicable for fixed withdrawals only)

1ST OF EACH MONTH

10TH OF EACH MONTH

20TH OF EACH MONTH

FIXED WITHDRAWAL MONTHLY (Min. 6 Withdrawals)

QUARTERLY (Min. 4 Quarters)

OR

APPRECIATION WITHDRAWAL

MONTHLY (Distributed only on 1st

of the following month)

OR

OUARTERLY (Distributed only on 1st of

the following month)

SCHEME

PLAN OPTION

AMOUNT PER INSTALMENTRS. IN

RS. WORDS____________

_____________________________________________________

(Minimum Rs. 500/- and in multiples of Rs 1/- thereafter)

No. of SWP Total Amt. of SWP

AMOUNT PER TRANSFER

RS.

WORDS ____________________________

____________________________________________

No. of Transfers

Total Amt. of Transfer

SPECIMEN

SIGNATURES

SECOND APPLICANT THIRD APPLICANT

�

AND / OR

AND / OR

OR

Note : Please refer instruction overleaf for more details.

To,The Trustee, Birla Mutual FundI/We have read and understood the contents of the Offer Document of the respective Scheme(s) and the instruction overleaf. I/We hereby apply for enrolment forthe SIP / SWP / STP (please tick � your choice) of the following Scheme/Plan and agree to abide by the terms and conditions of the respective Scheme/Plan.

APPLICATION FORM FOR Sub-broker CodeDistributor Code

FOLIO NO. COMMON APPLICATION FORM NO.(For Existing Investors) (For New Investors)

Name of theFirst Applicant

Mr. Ms. M/s.

SYSTEMATIC INVESTMENT PLAN (SIP)*MINIMUM NO. OF CHEQUESA] Monthly SIP :(i) Birla MIP, Birla MIP II & Birla SunlifeMonthly Income : Minimum 6 chequesof Rs. 5000/- each and above.(ii) Other Schemes : Minimum 6Cheques of Rs. 1000/- each andabove OR Minimum 12 cheques ofRs. 500/- each and above.B] Quar terly SIP :(i) Birla MIP, Birla MIP II & BirlaSunlife Monthly Income : Minimum4 cheques of Rs. 7500/- each andabove(ii) Other Schemes : Minimum 4Cheques of Rs. 1500/- each andabove.

INSTRUMENT DETAILS

Cheque Nos.From

TO

From TO

Bank &Branch

Amount per Rs. inChq. Rs. Words

Total TotalCheques Amount

INVESTMENT FREQUENCY

MONTHLY

1st And/Or 7th And/Or 10th And/Or

14th And/Or 20th And/Or 21st And/Or

28th

QUARTERLY

1st Or 7th Or 10th Or

14th Or 20th Or 21st Or

28th

TOTALCHEQUES

TRANSFER FREQUENCY

MONTHLY OR QUARTERLY

1ST OF EACH MONTH 1ST OF EACH QUARTER

10TH OF EACH MONTH 10TH OF EACH QUARTER

20TH OF EACH MONTH 20TH OF EACH QUARTER

AND / OR

AND / OR

OR

OR

(Min. 4 quar ters)(Min. 12/6 transfers)

MINIMUM TRANSFER AMOUNT : A. Monthly Plan : Minimum of Rs. 500/- each and

above for 12 transfers OR Rs. 1000/- each and above for 6 transfers. B. QuarterlyPlan : Minimum of Rs. 1500/- each and above for minimum 4 quarters.

NOTE : In case the ‘End Date’ is not mentioned, for SWP / STP, same would continue till unit balance is available in the folio or request to discontinue thesame is received, whichever is earlier. As regards SIP, the ‘End Date’ must coincide with the date of the last cheque.

PAN DETAILS Second Applicant

Guardian(In case applicant is a minor)

First Applicant

Third Applicant(Mandatory if transaction amountis Rs. 50,000/- or above)

(Refer Instruction B-6)

STPSYSTEMATIC TRANSFER PLANSYSTEMATIC WITHDRAWAL PLAN

SWPSYSTEMATIC INVESTMENT PLAN

SIP

�START DATE : END DATE :

SCHEME NAME PLAN OPTION SUB OPTION

FREQUENCY 1st And/Or 7th And/Or 10th And/Or 14th And/Or 20th And/Or 21st And/Or 28th Monthly

Quarterly

D D / M M / Y Y Y Y D D / M M / Y Y Y Y

ARN-0032

13

Sub-broker CodeDistributor Code

REGISTRATION CUM MANDATE FORM FOR ECS (DEBIT CLEARING)

SIP through ECS facility

FOLIO NO. APPLICATION NO.(For Existing Investors) (For New Investor) Refer Inst. No. 1

Name of theFirst Applicant

Mr. Ms. M/s.

PAN DETAILS Second Applicant

Guardian(In case applicant is a minor)

First Applicant

Third Applicant(Mandatory if transaction amountis Rs. 50,000/- or above)

(Refer Instruction C-20)

To,The Trustee, Birla Mutual FundI/We have read and understood the contents of the Offer Document of the respective Scheme(s) and the instruction overleaf. I/We hereby apply for enrolment forthe SIP through ECS facility of the following Scheme/Plan and agree to abide by the terms and conditions of the respective Scheme/Plan.

Signature & Stamp

SYSTEMATIC INVESTMENT PLAN (SIP)*

I/We hereby declare that the particulars given above are correct and express my/our willingness to make payments referred above through participation in ECS. If the transaction is delayed or noteffected at all for reasons of incomplete or incorrect information, I/We would not hold Birla Mutual Fund responsible. I/We will also inform Birla Mutual Fund, about any changes in my/our bankaccount. I/We have read and agreed to the terms and conditions mentioned overleaf.

THIRD APPLICANT

�

THIRD APPLICANT

Bank Account Number

*All SIP purchases are subject to realisation of Cheque / DD / ECS Debit.

Acknowledgement Slip (To be filled in by the Investor)

Received from Mr / Ms / M/s ______________________________________________________________________________

Note : Please refer instructions mentioned overleaf before submitting the form.

Note:

ECS Debit for SIP investment, will be subject to availability of dates

offered by M/s. Tech Process Solutions Ltd (previously M/s. Bill Junction

Payments Ltd.) at the respective location.

INVESTMENT FREQUENCY

MONTHLY

1st And/Or 7th And/Or 10th And/Or

14th And/Or 20th And/Or 21st And/Or

28th (Maximum 3 SIPs in a month)

QUARTERLY

1st Or 7th Or 10th Or

14th Or 20th Or 21st Or

28th

Account holder Nameas in Bank Account

FIRST APPLICANTSPECIMENSIGNATURES

(As in your Bank Records)

SECOND APPLICANT

FIRST APPLICANTSPECIMENSIGNATURES

(As in Bank Records)

SECOND APPLICANT

Authorisation of the Bank Account Holder (To be signed by the Account Holder(s)

This is to inform I/We have registered for the RBI’s Electronic Clearing Service (Debit Clearing) andthat my payment towards our investment in Birla Mutual Fund shall be made from my/our mentionedbank account with your bank. I/We authorise the representative carrying this ECS mandate form toget it verified & executed.

(APPLICATION SHOULD BE SUBMITTED AT LEAST TWENTY DAYS BEFORE THE FIRST DEBIT THROUGH ECS)

�

NOTE : The ‘End Date’ must coincide with the date of the last Installment.

START DATE : END DATE : D D / M M / Y Y Y Y

Cheque No. (Note:Cheque should be drawn on bank as per details provided below)

Bank Name

Branch Address

Account No.

Account Type Saving Current NRI NRO

9 Digit MICR No. �

Each SIP Amount (Rs.) Total No. of SIP’s

Please enter the 9 digit number thatappears after your cheque number

(Excluding the 1st Cheque)

Start Date End Date

FREQUENCY 1st And/Or 7th And/Or 10th And/Or 14th And/Or 20th And/Or 21st And/Or 28th Monthly

Quarterly

FOLIO NO. APPLICATION NO.(For Existing Investor) (For New Investor)

SCHEME NAME PLAN OPTION SUB OPTION

with Pin Code

D D / M M / Y Y Y Y

ARN-0032