icici prudential banking and financial services fund

8/14/2019 ICICI Prudential Banking and Financial Services Fund

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Signature, Stamp & Date

Application No.

ACKNOWLEDGEMENT SLIP (To be filled in by the investor)

Address

Received from: Mr./Ms./M/s.

Bank Serial No. Date & Timeof Receipt

Sub-Broker CodeBroker Code

Application Form (for Resident Indians and NRIs/PIOs)

ICICI Prudential Banking and Financial Services Fund(New Fund Offer from ICICI Prudential Mutual Fund)

Application No.

New Fund Offer Opens On

July 09, 2008

1 FOR EXISTING UNITHOLDERS

2 ABOUT YOU

(Please read the instructions beforecompleting the application form)

New Fund Offer Closes On

August 07, 2008Earliest Closing On

August 07, 2008Date:

Folio No.If you have an existing folio with PAN validation & KYC validation (if applicable), pleasemention the folio number in the space provided and proceed to Step 5 . Please note thatthe applicable details and mode of holding will be as per the existing folio.

ARN-

Account Statement

3 E-MAIL COMMUNICATION I/We wish to receive the following via e-mail instead of physical document:

Quarterly Review & Annual Report Other statutory information

Name of Third Applicant

Mr. Ms.

Name of Second Applicant

Mr. Ms.

Mailing Address (Please provide full address) (Mandatory)

PI N

State Country

Designation of the Contact Person (In case of non-individual investors)

Name of Guardian (in case of minor) /Contact Person (In case of non-individual investors)

Mr. Ms.

Name of First Applicant

Mr. Ms. M/s.

1st Applicant

Guardian (in case 1stapplicant is minor)/POA

(Mandatory)

*NRIs/PIOs applications to besubmittedONLYat any of thedesignated ICICI Bank, Citibank,HDFC Bank Collection Centres orat AMC branches.

Status [Please tick ()]

Minor

NRI/PIO*

Resident Individual

HUF

Sole Proprietorship

Partnership Firm

Trust

Bank/FI

AOP/BoI

Club/Society

Company

Others (Please specify) _______

_______________________

City

Permanent Account Number (PAN) - Mandatory{Please submit a copy of PAN card. In case the 1st applicant is minor,please provide Guardians PAN. Refer to Instruction No. II-b(4) }

2nd Applicant

3rd Applicant

Copy of KYC acknowledgement enclosed




Know Your Customer (KYC)(Please refer to instruction no. IX) Please tick ()(Mandatory for investment of Rs.50,000 & above)

Mode of holding [Please tick ()]

Single

Anyone or Survivor

Joint

(Default option: Anyone or Survivor)

Occupation [Please tick ()]

Professional

Business

Retired

Housewife

Service

Student

Others (Please specify)_____________________________

_________________________

_________________________

Overseas Address (in case of NRIs/FIIs)

State

Communication

Tel.

E-Mail

Tel.(Off.) Mobile

City ZIP/PIN(Mandatory)(Mandatory)(Mandatory)(Mandatory)(Mandatory)Country

(Mandatory)(Mandatory)(Mandatory)(Mandatory)(Mandatory)

Date of Birth (Mandatory)

D D M M Y Y Y Y

0155 NJ IndiaInvest 54934


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Application for Units of ICICI Prudential Banking and Financial Services Fund

Option Retail Option

Sub-Options (Please tick) GrowthDividend

Dividend Payout Dividend Reinvestment

Application Amount Rs. Cheque/DD No. Dated

drawn on branch

5 YOUR INVESTMENT DETAILS

To the Trustee, ICICI Prudential Mutual Fund I/We have read andunderstood the Offer Document/Key Information Memorandum of ICICI Pru -dential Banking and Financial Services Fund. I/We apply for the units of ICICI Prudential Banking andFinancial Services Fund and I/we agree to abide b y the terms, conditions, rules and regulations of the scheme.I/We confirm to have understood the terms & conditions, investment objectives, investment pattern, funda-mental objectives and risk factors applicable to the Sc heme. I/We have understood the details of t he schemeand I/we have not received nor been induced by any rebate or gifts, directly or indirectly, in making thisinvestment. I/We agree to abide by the terms, conditions, rules, regulations and other statutory requirementsof SEBI, AMFI, Prevention of Money Laundering Act, 2002 and such other regulations as may be applicablefrom time to time. I/We declare that the amount invested in the Scheme is through legitimate sources only andis not designed for the purpose of contravention or evasion of any Act, Regulation, Rule, Notification, Direc-tions or any other applicable laws enacted by the Government of India or any Statutory Authority. I/We agreethat in case my/our investment in the Scheme is equal to or more than 25% of the corpus of the Sc heme, thenICICI Prudential Asset Management Co. Ltd., Investment Manager t o the Scheme, has full right to refund t heexcess to me/us to bring my/our investment below 25%.

D D M M Y Y Y Y7 YOUR CONFIRMATION

Address of Guardian

Name of the Nominee

Address of Nominee (Please provide full address)

PIN

PINCode

Name of the Guardian (If nominee is minor) - Mandatory

I/We hereby nominate the undermentioned Nominee to receive the amounts to my/our credit in event of my/our death. I/We also understand that all payments and settlements madeto such Nominee and signature of the Nominee acknowledging receipt thereof, shall be a valid discharge by the AMC/Mutual Fund/Trustees.

Signature of Guardian

Relationship with minor

6 NOMINATION DETAILS (Optional) For single nomination, please fill in the details below. For multiple nominations, please use the nomination form overleaf.

Date of Birth (If nominee isminor) (Mandatory)

Mr. Ms. M/s. D D M M Y Y Y Y

Amount Invested (C) = (A) + (B)

(Optional)

TOP UP Amount*:

Rs.___________________

Half Yearly Yearly

TOP UP Frequency:

* TOP UP amount has to bein multiples of Rs.500 only.

[Please refer to InstructionNo.X]

SIP TOP UP Half YearlyAmount (Rs.) _______________________________________ Frequency: Yearly

Please ensure that the following details are complete and accurate, in the absence of which the application will be rejected & refunded.

1. First applicants Bank name.2. First applicants Bank account number.

3. Cheque/DD date should be on or before the NFO closure date.4. PAN details and copy of PAN for all the holders.

5. KYC acknowledgement for all the holders, if applicable.6. Application amount should be equal to or greater than the

minimum subscription amount.The above mentioned cases are not an exhaustive list of situations in which therejection could happen.

SIP through:

Standing Instruction/

Direct Debit

E CS

Bank Particulars (Name of the Bank)

Account Number

Branch Address

Account Type

City

If Mandatory Details are not provided,your application is liable to be rejected.

4 BANK ACCOUNT DETAILS OF FIRST APPLICANT (Refer instruction No.III)

NRENROSavingsCurrent

9 DigitMICR code

IFSC Code(11 digit)

(a) Please quote 9 Digit Code No. of your Bank and Branch corresponding to Bank Account details. (This number appears on every leaf of your cheque book after your chequenumber). (b) Please attach a blank cancelled Cheque or a clear photocopy of a cheque issued by your bank verifying of the Code No. (c) The AMC reserves the right tomake dividend payments through ECS where MICR code is available.

MANDATORY

Retail Option: In case, the investor has not selected the sub-option for his investments or selected multiple sub-options, the default sub-option will be Dividend Reinvestment.

Institutional Option I : Please use a separate application form available on the website www.icicipruamc.com.

Retail OptionScheme Name:ICICI PRUDENTIAL BANKING &FINANCIAL SERVICES FUND Sub-Options (Please tick) Growth

Dividend

Dividend Payout Dividend Reinvestment

Option

AMOUNT INVESTED AND PAYMENT DETAILSAmount Paid (A)

Bank Name & Branch

City Account Type (For NRI Investors)Cheque/DD DateCheque/DD No.

DD Charges (B)

NRO NRE FCNR

Rs. Rs.Rs.

D D M M Y Y

FirstApplicant

SecondApplicant

ThirdApplicant

SIGNATURE(S)


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ICICI Prudential Banking and Financial Services Fund(New Fund Offer from ICICI Prudential Mutual Fund)

Sole/First Applicants Name

SYSTEMATIC INVESTMENT PLAN (SIP) AUTO DEBIT (ECS) INSTRUCTION FORM

List of Cities for SIP Auto Debit via ECS (Debit Clearing): Agra Ahmedabad Allahabad Amritsar Asansol Aurangabad Bangalore Baroda Bhilwara Bhopal Bhubaneshwar Burdwan Calicut Chandigarh Chennai Cochin Coimbatore Dehradun Delhi Dhanbad Durgapur Erode Gorakhpur Guwahati Gwalior Hubli Hyderabad Indore Jabalpur Jaipur Jalandhar Jammu Jamnagar Jamshedpur Jodhpur Kakinada Kanpur Kolhapur Kolkata Lucknow Ludhiana Madurai (SIP Dates: 1st, 7th & 25th only) Mangalore Mumbai Mysore Nagpur Nasik Nellore Panjim Patna Pondicherry (SIP Dates: 10th, 15th & 25th only) Pune Raipur Rajkot Ranchi Salem Shimla Sholapur Siliguri Surat Tirupati Tirupur Trichur Trichy (SIP Dates: 7th, 10th & 25thonly) Trivendrum Udaipur Udipi Varanasi Vijayawada (also covers Guntur, Tenali & Mangalgiri) Vishakhapatnam.

PARTICULARS OF BANK ACCOUNT (Mandatory)

Bank Account Holders Name

Bank Name Branch Name

Account Number Account Type Savings Current Cash Credit

Signatures as in Bank Records

Authorisation of the Bank Account Holder for Auto Debit (ECS)

This is to inform I/we have registered for the RBI's Electronic Clearing Service (Debit Clearing) and that mypayment towards my investment in ICICI Prudential Mutual Fund shall be made from my/our belowmentioned bank account with your bank. I/We authorise the representative carrying this ECS mandate Formto get it verified & executed.

I/We hereby declare that the particulars given above are correct and express my willingness to make payments referred above through participation in ECS. If the tr ansaction is delayed or not effected at allfor reasons of incomplete or incorrect information, I/We would not hold the user institution responsible. I/We will also inform ICICI Prudential Mutual Fund, about any changes in my bank account. I/We

have read and understood the Offer Document/Key Information Memorandum of ICICI Prudential Banking and Financial Services Fund. I/We apply for the units of ICICI Prudential Banking and FinancialServices Fund and I/we agree to abide by the terms, conditions, rules and regulations of the scheme.I/We hereby agree to avail the Top up facility for SIP and authorize my bank to auto debit a further increase in installment from my designated account.I/We agree that AMC/Mutual Fund (including its affiliates), and any of its officers directors, personnel and employees, shall not be held responsible for any delay/wrong debits on the part of the bank forexecuting the direct debit instructions of additional sum on a specified date from my account. If the transaction is not effected at all for reasons of incomplete or incorrect information, the user institutionwould not be held responsible.I/We agree to abide by the terms, conditions, rules and regulations of this facility. I/We confirm to have understood that the introduction of this facility may also give rise to operational risks and hereby takefull responsibilty.

We hereby authorise ICICI Prudential Mutual Fund and their authorised service providers to debit my/our following bank account by ECS (Debit Clearing) for collection of SIP payments.

Existing Folio No. Date:

AccountNumber

9 Digit MICR Code (Please enter the 9 digit number that appears in your cheque next to the cheque number)In case of At Par accounts, kindly provide the correct MICR number of the bank branch.

APPLICATION NO.:


The Manager, _______________________________________________________________________________________________________________ (Bank Name & Branch Address)

I/We, Mr./Ms./M/s. _____________________________________________________________________________________________ hereby authorise you to debit on a monthly basis (as a Standing

Instruction) from my/our Account No. mentioned below (hereinafter referred as funding account) for Rs.______________________ (Rupees ________________________________________________only) and remit the same on account of ICICI Prudential Mutual Fund.

STANDING INSTRUCTION/DIRECT DEBITFOR SYSTEMATIC INVESTMENT PLAN

2nd

Holder

3rdH

older

1stHolder

Name of the Beneficiary: ICICI Prudential Mutual Fund Account.I/We undertake to keep sufficient funds in the funding account on the date of execution of standing instruction. I/We hereby declare that the particulars given above are correct andcomplete. If the transaction is delayed or not effected at all for reasons of incomplete or incorrect information, I/we would not hold the Mutual Fund or the Bank responsible. If the d ateof debit to m y/our account happens to be a non banking/business day as defined in the Offer Document of the said Scheme of ICICI Prudential Mutual Fund, execution of the SIP w illhappen on the previous business day and allotment of units will happen as per the Terms and Conditions listed in the Offer Document of the Mutual Fund. I/We have read andunderstood the offer document(s) of the Fund. I/We apply for the units of the scheme and I/we agree to abide by the terms, conditions, rules and regulations of the scheme. I/We confirmto have understood the terms & conditions, investment objectives, investment pattern, fundamental objectives and risk factors applicable to the Plans and/or Options under theScheme(s). I/We agree to abide by the terms, conditions, rules and regulations of the Plan(s). I/We have understood the details of the scheme and I/we have not received nor beeninduced by any rebate or gifts, d irectly or indirectly, in making this investment. I/We hereby agree to avail the TOP UP facility for SIP and authorize my bank to execute the StandingInstruction for a further increase in installment from my designated account. I/We agree that AMC/Mutual Fund (including its affiliates), and any of its officers directors, personnel andemployees, shall not be held responsible for any delay / wrong debits on the part of the bank for executing the standing instructions of additional sum on a specified date from myaccount. If the transaction is not effected at all for reasons of incomplete or incorrect information, the user institution would not be held responsible. I/We agree to abide by the terms,conditions, rules and regulations of this facility. I/We confirm to have understood that the introduction of this facility may also give rise to operational risks and hereby take fullresponsibilty.

Yours faithfully,

APPLICATION NO.:ExistingFolio No.

I/We hereby apply to the Trustee of ICICI Prudential Mutual Fund for the Systematic InvestmentPlan (SIP) Enrolment under the following scheme and agree to abide by the terms and conditionsof the plan.

Please note: SIP dates would be the 1st or 7thor 10th or 15th or 25th of every month exceptfor Madurai, Trichy & Pondicherry.

SIP Date: 1st 7th 10th 15th 25th

SIP Start Month/Year : October 2008

SIP End Month/Year

Each SIP Amount: Rs. _____________________________

(Rupees ________________________________________

______________________________________________)

Scheme Name:

ICICI PRUDENTIAL BANKINGAND FINANCIAL SERVICESFUND

Option: Retail Option

Growth

Sub-Options (Please tick)

Dividend

Payout Reinvestment M M Y Y Y Y

TOP UP Amount*: Rs.___________________________________ TOP UP Frequency: Half Yearly Yearly

* TOP UP amount has to be in multiples of Rs.500 only. [Please refer to General Instruction No. 4]

SIP TOP UP(Optional)

(Tick to avail this facility)

1st

Holder

2nd

H

older

3rd

H

older


1st

Hold

er

2nd

Hold

er

3rd

Hold

er

Please note: SIP dates would be the 1stor 7th or 10th or 15th or 25th of everymonth except for Madurai, Trichy &Pondicherry.

SIP Date: 1st 7th 10th 15th 25th

SIP Start Month/Year: October2008SIP End Month/Year

Each SIP Amount: Rs. _____________________________

(Rupees ________________________________________

______________________________________________)

Scheme Name:

ICICI PRUDENTIAL BANKINGAND FINANCIAL SERVICESFUND

Option: Retail Option

Growth

Sub-Options (Please tick)

Dividend

Payout Reinvestment

TOP UP Amount*: Rs._____________________________TOP UP Frequency: Half Yearly Yearly

* TOP UP amount has to be in multiples of Rs.500 only. [Please refer to General Instruction No. 4]

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

Debit A/c. No._____________________________

M M Y Y Y Y

icici prudential banking and financial services fund

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