ICICI Prudential SMART Fund

ICICI Prudential S.M.A.R.T. (Structured Methodology Aiming at Returns over Tenure) Fund Application Form for Resident Indians and NRIs/ PIOs/FIIs NJ India Broker Code Invest / ARN-0155 54934 Sub-Broker Code Date & Time of Receipt Application No. Serial Number New Fund Offer Opens on : August 18, 2008 (Application to be filled in BLOCK LETTERS in ENGLISH only) 1 FOR EXISTING UNITHOLDERS New Fund Offer Closes on : September 19, 2008 If you have an existing folio with PAN validation & KYC validation (if applicable), please mention the folio number in the space provided and proceed to Step 5. Please note that the applicable details and mode of holding will be as per the existing folio. Folio No. Date: 2 ABOUT YOU Date of Birth (Mandatory) D D M M Y Y Y Y Status [Please tick ( )] Minor NRI/PIO Resident Individual HUF Sole Proprietorship Trust Bank/FI AOP/BoI Club/Society Company Name of First Applicant Mr. Ms. M/s. Name of Guardian (in case of minor) / Contact Person (In case of non-individual investors) Mr. Ms. Designation of the Contact Person (In case of non-individual investors) Mailing Address (Please provide full address) Partnership Firm FII Others (Please specify) _______ _______________________ (Mandatory) (Mandatory) City PIN (Mandatory) Country Tel. (Off.) Mob _______________________ _______________________ State Communication Tel. (Res.) E-Mail Overseas Address (in case of NRIs/FIIs) City State Name of Second Applicant Mr. Ms. Name of Third Applicant Mr. Ms. Permanent Account Number (PAN) - Mandatory {Please submit a copy of PAN card. In case the 1st applicant is minor, please provide Guardian’s PAN. Refer to Instruction No. II-b(4) } 1st Applicant Guardian (in case 1st applicant is minor) 2nd Applicant 3rd Applicant (Mandatory) (Mandatory) ZIP/P I N Country Mode of holding [Please tick ()] Single Joint Anyone or Survivor (Default option: Anyone or Survivor) Know Your Customer (KYC) (Please refer to instruction no. IX) Please tick () (Mandatory for investment of Rs.50,000 & above) Copy of KYC acknowledgement enclosed Copy of KYC acknowledgement enclosed Copy of KYC acknowledgement enclosed Copy of KYC acknowledgement enclosed Occupation [Please tick ()] Professional Housewife Business Service Retired Student Others (Please specify) _____________________ _____________________ _____________________ 3 E-MAIL COMMUNICATION – I/We wish to receive the following via e-mail instead of physical document: Account Statement Quarterly Review & Annual Report Other statutory information ICICI PRUDENTIAL S.M.A.R.T. (STRUCTURED METHODOLOGY AIMING AT RETURNS OVER TENURE) FUND ACKNOWLEDGEMENT SLIP (To be filled in by the Investor) Received from: Application No. ess Addr Options (Tick Series C - 24 months any of the boxes below) Series F - 36 months Options (Tick Retail any of the boxes below) Institutional Sub-Options (Please Tick Cumulative ) Signature, Stamp & Date Dividend Payout 4 MANDATORY BANK ACCOUNT DETAILS OF FIRST APPLICANT (Refer instruction No.III) Bank Particulars (Name of the Bank) Branch Address City Account Number 9 Digit MICR code IFSC Code (11 digit) Account Type Current Savings NRO NRE If “Mandatory Details” are not provided, your application is liable to be rejected. 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 cheque number). Please attach a blank “cancelled” Cheque or a clear photocopy of a cheque issued by your bank verifying of the Code No. The AMC reserves the right to make dividend payments through ECS where MICR code is available. 5 YOUR INVESTMENT DETAILS UNDER ICICI PRUDENTIAL S.M.A.R.T. (STRUCTURED METHODOLOGY AIMING AT RETURNS OVER TENURE) FUND Plans (Tick below) Options (Tick below) Sub-Options (Tick any of the boxes below) Default Option & Sub-option: Retail with Cumulative will be the default option & sub-option. Hence, If an investor fails to specify the option/sub-option or has selected multiple options/sub-options, he will be allotted units under the default option/sub-option. Account Type (For NRI Investors) Series C - 24 months Series F - 36 months Amount Invested Rs. Bank Name & Branch Retail Option Institutional Option Cumulative Dividend Payout Cheque/DD No. Cheque/DD Date D D M M Y Y NRO NRE FCNR City The cheque/demand draft should be drawn in favour of “ICICI Prudential SMART Fund - Series C - 24 months” or “ICICI Prudential SMART Fund - Series F - 36 months” and crossed “Account Payee Only”. The cheque/demand draft should be payable at the centre where the application is lodged. 6 NOMINATION DETAILS (Optional) (For single nomination) 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 made to such Nominee and signature of the Nominee acknowledging receipt thereof, shall be a valid discharge by the AMC/Mutual Fund/Trustees. Date of Birth (If nominee is minor) - Mandatory Name of the Nominee Mr. Ms. M/s. Address of Nominee (Please provide full address) PIN Code Relationship with minor Signature of Guardian / Nominee PIN Code D D M M Y Y Y Y Name of the Guardian (If nominee is minor) - Mandatory Address of Guardian 7 YOUR CONFIRMATION The Trustee, ICICI Prudential Mutual Fund I/We have read and understood the SID/Key Information Memorandum of ICICI Prudential S.M.A.R.T. (Structured Methodology Aiming at Returns DD MM YYYY over Tenure) Fund. I/We apply for the units of the ICICI Prudential S.M.A.R.T. (Structured Methodology Aiming at Returns over Tenure) Fund and I/we agree to abide by the terms, conditions, rules and regulations of the scheme. I/We confirm to have understood the terms & conditions. Its investment objectives, investment pattern, fundamental objectives and risk factors applicable to the Plans under the Scheme. I/We agree to abide by the terms, conditions, rules and regulations of the Scheme. I/We have understood the details of the scheme and I/ we have not received nor been induced by any rebate or gifts, directly or indirectly, in making this investment. I/We agree to abide by the terms, conditions, rules, regulations and other statutory requirements of SEBI, AMFI, Prevention of Money Laundering Act, 2002 and such other regulations as may be applicable from time to time. I/We declare that the amount invested in the Scheme is through legitimate sources only and is not designed for the purpose of contravention or evasion of any Act, Regulation, Rule, Notification, Directions or any other applicable laws enacted by the Government of India or any Statutory Authority. First Applicant SIGNATURE(S) Second Applicant Third Applicant REGISTRAR Computer Age Management Services Pvt. Ltd. Floor III, Tower 1, Rayala Towers, 158, Anna Salai, Chennai 600 002, Ph: (044) 30212631/673 ICICI Prudential S.M.A.R.T. (Structured Methodology Aiming at Returns over Tenure) Fund – ACKNOWLEDGEMENT SLIP (To be filled in by the Investor) Investment Plan Cheque/DD No. Dated Amount (Rs.) Drawn on (Name of Bank & Branch)