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1122016

UTI-NPS-

PRAN No.

UTI AMC COLLECTION A/c NPS TRUST

PRAN

(TIER I ONLY)

UTI-NPS-(TIER I ONLY)

NPS SUBSCRIBER’S SIGNATURE

3 1 1 2 2 0 4 9

PAN Number

Maximum Amount

PRAN NO.

Name of PRAN holder

PRAN HOLDER DETAILS :

Reference No. :

I/We hereby authorise UTI AMC Ltd., and their authorised service providers and my banker, to debit bank account using the Mandate form. If the transaction is delayed or not effected at all for reason of incorrect information or other reasons, I/we would not hold UTI AMC Ltd., responsible. I/We will also inform UTI AMC Ltd., above any changes in my bank account.

By signing this SIP enrolment form I / We understand, that the amount will be debited from the Bank account mentioned in SIP Mandate

0 1

0 7

1 5

2 5

(Multiples of Rs. 100/-)

1 2 4 9

UTI AMC Ltd., UTI Tower, Bandra-Kurla Complex, Bandra (East), Mumbai - 400 051.

* This contribution is eligible for Tax benefits under section 80C, and Sec. 80CCD (1B) of Income Tax act 1961.

Note : All purchases are subject to realisation of Cheques / receipt of fundsSignature and Stamp of POP-SP

✔

✔

CHECK LIST

1. The Form is complete in all respects.

2. The form is signed by the holders as per the holding basis of the Bank.

3. PRAN, Mobile Number, email ID, PAN details are submitted.

4. A Copy of cheque leaf is enclosed.

5. Please submit the NPS SIP Form duly filled & Signed at any of our nearest Financial Center.

GUIDELINES TO FILL UTI NPS FORM

1. Date In format DD/MM/YYYY

2. Bank A/c Type : Tick the relevant box

3. Provide CBS Account Number

4. Write name of the bank through which you wish to invest.

5. IFSC / MICR Code : Fill respective code

6. Mention Maximum Amount

7. Reference 1 : Mention PRAN Number

8. Reference 2 : Mention PAN Number

9. Period : Starting date of UTI NPS FORM registration (in format DD/MM/YYYY)

10. Telephone Number

11. Email ID

12. Specimen Signature as Submitted by you with your banker against the particular / given bank account

13. Name : Mention Holder Name as Per Bank Record

TERMS AND CONDITIONS

1. The Registration cum Mandate form for NACH should be submitted at least 30 calendar days before the date of the first debit date.

2. The Bank on which the mandate is provided should participate in NACH clearing as per the list provided by RBI.

3. The subscriber agrees to abide by the terms and conditions of NACH facility of RBI/NPCI.

4. The subscriber will not hold UTI AMC LTD/service provider responsible, if the registration/debit transaction is not honored/is rejected by the investors bank with/without assigning any reason or invalid reason. UTI AMC Ltd shall assist the subscriber in ascertaining the correct reason of rejection of the mandate or transaction on case to case basis on a best effort basis.

5. Units allotment in PRAN account is subject to the guidelines issue by PFRDA.

6. SIP facility is available only for contribution to Tier I account.

“In case there is any change in your KYC information please update the same by using the prescribed ‘KYC Change Request form’ and submit the same at the Point of Service of any KYC Registration Agency”

80 gsm