Document Sample
					                                                                             APPLICATION FORM CUM KEY INFORMATION MEMORANDUM

For a period of 3 years from the date of allotment
                                                                                                                                                                                                                                 App. No. C
 Offer for Units of Rs. 10 Per Unit during the New Fund
                       Offer Period
   New Fund Offer Opens : 30th August, 2006
   New Fund Offer Closes : 28th September, 2006                                                                                                                                                                                                             Trustees
                                                                                                                                       For a period of 3 years from the date of allotment
 Sponsor:                                                                      New Fund Offer Opens : 30th August, 2006; New Fund Offer Closes : 28th September, 2006
 ING      GROUP N. V.
 Strawinskylaan 2631, Amsterdam, P.O. Box 810,
 1000 Amsterdam,The Netherlands                                                  Please read the instructions before completing this Application Form and fill the sections in CAPITALS                        Existing Folio No. [If any]
 Asset Management Company                                                          DISTRIBUTOR INFORMATION [only for AMFI registered empanelled Distributors/Brokers]
                                                                                                Distributor’s/Broker Code                                                  Sub-Broker's Code                                             Registrars/Bank Serial No.
 17, Lincoln Lodge, Altamount Road, Mumbai-400 036
 Board of Trustees:                                                              ARN-             1022
                                                                             1       APPLICANT'S PERSONAL DETAILS                                                                                                                                                Refer Instruction 1
 ING Vysya Mutual Fund, Office - 17, Lincoln Lodge,
 Altamount Road, Mumbai-400 036.                                                    SOLE/FIRST APPLICANT
OptiMix is a division of ING Investment Management (I) Pvt.
Ltd., Wockhardt Towers, West Wing, Level 2, Bandra Kurla
                                                                                      TITLE                                FIRST NAME                                                 MIDDLE NAME                                                   LAST NAME
Complex, Mumbai 400 051.                                                            Date of Birth
                                                                                    (in case of minor)         DD                 MM            YYYY
This Key Information Memorandum (KIM) sets forth the                                PAN (mandatory if purchase is Rs. 50,000/- or more)                                                                                             OR         Form 60/61 attached [Please     ]
information, which a prospective investor ought to know                             Provide a copy of proof. [Refer instructions 1(g)]                                                                                                      Please provide proof of address
before investing. For further details of the scheme/Mutual                          Guardian (in case Sole/First Applicant is minor)
Fund, due diligence certificate by the AMC, Key Personnel,                          or Contact person (For Institutional Applications)                      FIRST NAME                                   MIDDLE NAME                                      LAST NAME
investors' rights & services, risk factors, penalties &                             Address for Correspondence [In India]                                                                  Overseas Address (mandatory in case of NRI/FII)
pending litigations, associate transactions etc. investors
should, before investment, refer to the Offer Document
available free of cost at any of the Investor Service Centres
or distributors or from the website
The Scheme particulars have been prepared in accordance                                                                                                                                                                                                ZIP/
with Securities and Exchange Board of India (Mutual Funds)                          City                                                        Pin                                        City
                                                                                                                                                                                                                                               Postal Code
Regulations 1996, as amended till date, and filed with
Securities and Exchange Board of India (SEBI). The units                            State                                                                                                  Country
being offered for public subscription have not been
approved or disapproved by SEBI, nor has SEBI certified the                         Tel. (O)    STD                                      Tel. (R)     STD                                  Mobile                                             Fax   ISD
accuracy or adequacy of this KIM. This KIM is dated August
25, 2006.                                                                           Status of SOLE/FIRST APPLICANT (Please              )
INSTRUCTIONS FOR FILLING THE APPLICATION FORM                                           Individual                   On behalf of minor                      HUF                 Company                    AOP/BOI                 Partnership Firm                   Body Corporate
a) Please fill up the Application Form legibly in English in                            Trust          Registered Society              Others              NRI - Non Repatriable           Bank/Financial Institution           Sole Proprietorship             NRI - Repatriable (NRE)
b) Please read the Memorandum and the Offer Document                                Occupation of SOLE/FIRST APPLICANT (Please                  )
   before investing. Your application for allotment of units in                         Service                    Professional                 Business                  Housewife                  Retired                 Student                  Agriculture               Others
   the scheme is construed to have been made with a full
   understanding of the terms and conditions applicable to it                2      JOINT APPLICANTS’ DETAILS                                                                                                                                                   Refer Instruction 2
   and the same is binding on you in respect of your
   investment in the Scheme.                                                        SECOND APPLICANT [Joint Holder#1]
c) Please refer to the checklist at the end of these notes to                                                                                                                                                                                        OR     Form 60/61 attached
   ensure that the necessary details and attachments are                                    FIRST NAME                            MIDDLE NAME                          LAST NAME                   PAN
                                                                                                                                                                                                                                                                 (Please )
   made available. This will help to avoid processing delays                                                                                                                                                  Please provide a copy of proof        Please provide proof of address
   and / or rejection of your Application Form.                                     THIRD APPLICANT [Joint Holder#2]
d) Please strike out with a line across any section that is not                                                                                                                                                                                      OR     Form 60/61 attached
   applicable.                                                                              FIRST NAME                            MIDDLE NAME                          LAST NAME                   PAN
                                                                                                                                                                                                                                                                 (Please )
e) Application Form incomplete in any respect or not                                                                                                                                                         Please provide a copy of proof         Please provide proof of address
   accompanied by a Cheque / Demand Draft are liable to be                          MODE OF HOLDING (Please            )              Single           Anyone or Survivor          Joint           (Default option will be Joint)
   rejected. In case your investment application gets
   rejected on account of the same being incomplete in any                   3      BANK ACCOUNT DETAILS [Mandatory]                                                                                                                                            Refer Instruction 3
   respect, your investment amount would be refunded
   without interest within 6 weeks from the date of closure of                      Bank Name                                                                                              Account No.
   New Fund Offer. Interest will be payable for amounts
                                                                                    Branch Name
   refunded later than 6 weeks from the closure of New Fund                         & Address
                                                                                                                                                                                                                                     City            CLEARING CIRCLE
   Offer period at the rate of 15% per annum for the period in
   excess of 6 weeks. The refund cheques will be dispatched                         MICR Code                                                                                 IFSC Code for NEFT
   by registered post.
                                                                                                     (This is a 9 Digit Number next to your Cheque Number)                                               (This is a 11 Digit Number, obtain from your bank branch)
f) All applicants are deemed to have accepted the terms
   subject to which this offer is being made and bind                               Account type (Please       )           Savings                          Current                        NRE                         NRO                           FCNR                       Others
   themselves to the terms upon signing the Application Form                        Pay my dividends electronically if available (provide a copy of cancel cheque leaf from an ECS eligible bank)      (Please )
   and tendering the payment.                                                       Note : IIM (India) OptiMix division, ING Vysya Mutual Fund reserves the right to use any other mode of payment as deemed appropriate.
g) All communications and payments shall be made to the First                       I/We understand that IIM (India) OptiMix division, ING Vysya Mutual Fund shall not be responsible if transaction through ECS / EFT / NEFT could not be carried out
   Applicant only irrespective of the holding basis.                                because of incomplete or incorrect information.
h) The right to accept or reject any application in the whole or in
   part lies with theAMC / Trustee / Mutual Fund.
                                                                                                                                       ACKNOWLEDGMENT SLIP                                                                                                    App. No. C
                                                                                                                                                                   To be filled by the applicant
   Applicant must provide all the details as mentioned in the                                                                                         Growth Option                Amount                      Cheque/DD No.
   Application Form.                                                                                                                                        OR
a. Name and address must be given in full (P.O. Box Address
                                                                                                                                        Dividend Option(Payout)
   alone is not sufficient). Please do not abbreviate any                                                                                                                           Date                   Bank & Branch Details
   name.                                                                                                                                                    OR
b. In case of NRIs / FIIs, 'Overseas Address' should also be                                                                      Dividend Option(Reinvestment)
c. Please provide the name of the Contact Person in case of                                                                  Received from                                                                                                          Official Collection Centre
   investments by a Company / Body Corporate / Partnership                                                                                                                                                                                     Acceptance Point [Stamp & Signature]
   Firm / Trust / Society / FIIs / Association of Persons / Body
   of Individuals.                                                         number appearing to the right of the cheque number on                      option will be as follows: -                                        shall be provided by the Unit holder along with proof of
d. Please fill in your date of birth as this may be required to            the bottom white strip of a cheque leaf. Investor should                                                                                       PAN.
                                                                                                                                                       Indication not made                  Default
   identify you when communicating with us.                                submit a copy of a cancelled cheque to verify these                                                                                         d. The Nominee shall not be a trust, (other than a religious
                                                                                                                                                       Dividend/Growth Option Growth Option
e. If you have an email ID please include it as this will help us          details.                                                                                                                                       or charitable trust) society, body corporate, partnership
                                                                                                                                                       Dividend Payout /             Dividend Payout
   resolve any queries more promptly.                                   c. The 11-digit IFSC code for NEFT can be obtained from                                                                                           firm, Karta of Hindu Undivided Family or a Power of
f. To help us service you better, your telephone number(s)                 the bank branch, that is mentioned in the application as                                                                                       Attorney holder. A non-resident Indian can be a Nominee
                                                                                                                                                       Mode of holding (in case Jointly
   should also be provided including the relevant STD / ISD                bank details.                                                                                                                                  subject to the exchange controls in force, from time to
                                                                                                                                                       where there are more
   code.                                                                                                                                                                                                                  time. Nomination can also be made in favour of the
                                                                                                                                                       than one applicant)
g. PAN (Permanent Account Number): In case of investment                4. INVESTMENT DETAILS                                                                                                                             Central Government, State Government, and Local
                                                                                                                                                      viii) In case of NRIs, Persons of Indian Origin, FIIs :- The
   of Rs. 50,000/- or more, it is mandatory for all applicants          a. The minimum application amount for OptiMix Dynamic                                                                                             Authority, any person designated by virtue of his office
                                                                                                                                                      Foreign Exchange Management (Transfer of Issue of
   to state the PAN in the application form and support it with            Multi Manager FoF Scheme is Rs. 5000/-.                                                                                                        or a religious or charitable trust.
                                                                                                                                                      Security by a Person Resident Outside India) Regulations,
   a self attested photocopy of the PAN card, PAN allotment             b. Applicants should indicate the Option (Dividend /                                                                                           e. Nomination in respect of the Units stands rescinded
                                                                                                                                                      2000 (the “FEMA Regulations”) permit a NRI / PIO to
   letter or an assessment order/refund cheque from Income                 Growth) for which the application is made.                                                                                                     upon the transmission of Units.
                                                                                                                                                      purchase on repatriation or non-repatriation basis,
   Tax department. If a PAN has not been allotted to any                c. Cheques / Demand Drafts should be crossed “A/c Payee                                                                                        f. Transmission of Units in favour of a Nominee shall be
                                                                                                                                                      without limit, units of domestic mutual funds. Payment
   applicant, 'FORM 60/61' (for agriculture income) and                    only” and drawn in favour of “OptiMix Dynamic Multi                                                                                            valid discharge by the AMC / Mutual Fund / Trustees
                                                                                                                                                      for such units must be made either by cheque or demand
   documents supporting address therein should be attached                 Manager FoF Scheme” or “OptiMix Dynamic FoF”.                                                                                                  against the legal heir.
                                                                                                                                                      draft by means of (a) Inward Remittance through normal
   to the application form. If these are not provided, the              d. The following mode of payments are not valid and                                                                                            g. The cancellation of nomination can be made only by
                                                                                                                                                      banking channels, or (b) Out of Funds held in the NRE /
   application will be rejected. If a FORM 60/61 is attached               applications accompanied by such payments are liable                                                                                           those individuals who hold Units on their own behalf
                                                                                                                                                      FCNR account, in the case of purchases on a repatriation
   or the applicant is a Non-Resident not having PAN, the                  to be rejected: i) Outstation Cheques. ii) Cash / Money                                                                                        singly or jointly and who made the original nomination.
                                                                                                                                                      basis or out of funds held in the NRE / FCNR /NRO
   words 'FORM 60/61' or Non-Resident' as applicable should                Order / Post Order. iii) Post dated Cheques. ( C h e q u e s                                                                                h. On cancellation of the nomination, the nomination shall
                                                                                                                                                      account, in the case of purchases on a non-repatriation
   be written in the spaced provided for the PAN. If any                   once returned in clearing will not be represented and                                                                                          stand rescinded and the AMC / Mutual Fund / Trustees
                                                                                                                                                      basis. Investment by NRIs / FIIs shall be in accordance
   applicant is a minor, this should be indicated by ticking in            the accompanying applications may not be considered                                                                                            shall not be under any obligation to transmit the Units in
                                                                                                                                                      with the prevailing laws governing such investments.
   the place provided. The guardian's PAN should be stated                 for allotment).iv) If you are residing / located in a city /                                                                                   favour of the Nominee.
                                                                                                                                                      Payment by the FII must be made either by inward
   (unless the minor applicant has a PAN).                                 town where we do not have any official collection centre                   remittance through normal banking channels or out of
                                                                           (for the New Fund Offer), please draw a demand draft                       funds held in foreign currency account or non resident           6. SERVICES
2. JOINT APPLICANT’S DETAILS                                               payable at your nearest city where we have such office. v)                 rupee account maintained by the FII with a designated              In case, if you would like to receive statement of
a. The Names and PAN details of joint applicants (i.e. second              Bank charges for outstation demand drafts will be borne                    branch of an authorized dealer in terms of paragraph 2             account by email rather than by post, please tick at
   and third applicants) should be provided.                               by the AMC and will be limited to the bank charges as per                  of Schedule 2 to the FEMA Regulations. ix) The investors           appropriate place and mention your email address.
b. The mode of holding for operating the folio should be                   table below. The AMC will not entertain any request for                    should provide Unique Identification Number (UIN) as
   indicated in this section. “Single” will entitle only the first         refund of demand draft charges.                                            and when made applicable by SEBI.                                7. DECLARATION AND SIGNATURES
   holder to operate the account to the exclusion of the joint                      Amount                   DD Charges                                                                                                a. Signatures can be in English or in any Indian language.
   holders. “Anyone or Survivor” will entitle any one of the                 Upto Rs. 10,000/-        Upto Rs. 25 per instrument.
                                                                                                                                                5. NOMINATION DETAILS                                                     Thumb impressions must be attested by a Magistrate /
   joint holders to operate the folio and “Jointly” will allow               Above Rs. 10,000/- Upto Rs. 100 per instrument
                                                                                                                                                a. Applicants applying for Units singly / jointly can make a              Notary Public under his / her official seal. In case of HUF,
   operation of the account only if all the holders sign the
                                                                          Demand Draft Charges on Rs. 50,000 and above may be                      nomination at the time of initial investment or during                 the Karta will sign on behalf of the HUF.
   instruction. If this is left blank or it is not clear, the default
                                                                          reimbursed only where the Mutual Fund doesn't have a                     subsequent investments.                                             b. Applications on behalf of minors should be signed by
   will be treated as “Jointly”.
                                                                          collection facility. Demand Draft charges shall not be                b. The nomination can be made only by individuals                         their Guardian.
                                                                          reimbursed for investment made from Overseas.                            applying for / holding units on their own behalf singly or          c. If the application form is signed by a Power of Attorney
3. BANK ACCOUNT DETAILS                                                                                                                            jointly. Non-individuals including society, trust, body                (PoA) holder, the form should be accompanied by a
                                                                          Demand Draft charges shall not be reimbursed
a. Applicants should provide the name of the bank, branch                                                                                          corporate, partnership firm, Karta of Hindu Undivided                  notarized photocopy of the PoA. Alternatively, the
                                                                          for investments made by bank. (Investor needs to
   address, account type and account number of the Sole /                                                                                          Family, holder of Power of Attorney can not nominate. If               original PoA can be submitted, which will be returned
                                                                          provide a copy of charge slip of the bank for getting
   First Applicant. As per SEBI guidelines, it is mandatory for                                                                                    the units are held jointly, all joint holders will sign the            after verification.
                                                                          reimbursement of DD charges). vi) During the New
   investors to mention their bank account details in the                                                                                          nomination form.                                                    d. In case of corporates or any non-individual investors, a
                                                                          Fund Offer, Application Form along with the
   application. Applications received without the bank                                                                                          c. A minor can be nominated and in that event, the name,                  list of authorized signatories should be submitted along
                                                                          Cheque/Demand Draft may be lodged with Official
   account details will be rejected                                                                                                                address and PAN (if available) of the Guardian of the                  with the application form.
                                                                          Collection Centres (listed in back cover). vii) I f n o
b. The 9-digit MICR (Magnetic Ink Character Recognition)                                                                                           minor nominee (in case the minor does not have PAN)
                                                                          indication is given for the investment the default

                                                                 If you have any queries with regard to completing this form, email us at
                                                                      For Investor Grievances/Complaints contact CAMS at Ph: 044-2855 9977, Fax: 044-2852 8709                                                                                                                      1
App. No. C                                                                                                                                                                                                Official Collection Centres
                                                                                                                                                                                                             (for New Fund Offer)
4      INVESTMENT DETAILS [Please               choice of Option] Note: Separate form/cheque should be given for different plans                                 Refer Instruction 4
                                                                                                                                                                                                        STANDARD CHARTERED BANK LIST
                                 Dividend Option                                                                            Cheque/DD No.                                                    Ahmedabad - Standard Chartered Bank, Abhijeet II, Ground
                                                            Investment Amount       Min. Amount Rs. 5000/-                                                                                   Floor, Meetakali, 6th Road, Ahmedabad - 380 006, Allahabad -
          Growth Option                 Reinvestment
                                                                                                                                                                                             Standard Chartered Bank, 2 Sardar Patel Marg, Civil Lines,
                         OR            OR                           DD Charges                                                      Dated
                                                                                                                                                                                             Allahabad - 211 001, Amritsar - Standard Chartered Bank,
        Mode of Payment         Cheque                                                                                                                                                       Gandhi Bazar, The Mall, Post Box 3, Amritsar - 143 001,
                                                                   Net Amount                                                    Drawn on           Bank and Branch                          Bangalore - Standard Chartered Bank, 26th Floor, West Wing,
                                                           Account Type [Please     ]         Savings           Current           NRE           NRO              FCNR           Other        Raheja Tower, M G Road, Bangalore - 560 001, Bhopal -
                                Fund Transfer
                                                                                                                                                                                             Standard Chartered Bank, Ground Floor, Northern Wing,
              Cheques / Demand Drafts should be crossed “A/c Payee only” and drawn in favour of “OptiMix Dynamic Multi Manager FoF Scheme” or “OptiMix Dynamic FoF”.                         Alankar Complex, Plot No 10, Zone II, MP Nagar, Bhopal - 462
                                                                                                                                                                                             011, Bhubaneshwar - Standard Chartered Bank, Plot No 3,
 5     NOMINATION DETAILS                                                                                                                                        Refer Instruction 5         Bapuji Nagar, Janpath, Bhubaneshwar - 751 009, Chandigarh -
       I/We do hereby nominate the undermentioned Nominee to receive the Units allotted to my/our credit against this application in my folio in the event of my/our                         Standard Chartered Bank, SCO, 137-138 Sector - 9 C, Madhya
                                                                                                                                                                                             Marg, Chandigarh, Chennai - Standard Chartered Bank, 19
       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                       Rajaji Salai, Chennai - 600 001, Cochin - Standard Chartered
       discharge by AMC/Mutual Fund/Trustee.                                                                                                                                                 Bank, XXIV/1633, KPK Menon Road, Willingdon Island, Cochin -
                                                                                                   Details of Guardian (In case nominee is Minor)                                            682 003, Coimbatore - Standard Chartered Bank, 509, D B
                                                                                                                                                                                             Road, R S Puram, Coimbatore - 641 002, Ernakulum - Standard
                                                                                                   Relationship with the Minor                                                               Chartered Bank, M G Road, HDFC House, Ernakulum, Kerala -
       Details of Nominee
                                                                                                                                                                                             682 015, Guwahati - Standard Chartered Bank, G N Bardoli
       Name                                                                                        Name                                                                                      Road, Ambari - Guwahati, Guwahati - 781 001, Hyderabad -
                                                                                                                                                                                             Standard Chartered Bank, 6-3 1090 Raj Bhavan Road,
       Address                                                                                     Address                                                                                   Somajiguda, Hyderabad - 500 082, Indore - Standard Chartered
                                                                                                                                                                                             Bank, 21/1 Dm Tower, Race Course Road, Indore - 452 001,
                                                                                                                                                                                             Jalandhar - Standard Chartered Bank, Plot No 34, G T Road,
                                                                                                                                                                                             Jalandhar - 144 001, Jaipur - Standard Chartered Bank, H 8,
                                                                                                                                                                                             Showroom No 1, Bhawat Bhawan, MI Road, Jaipur, Kanpur -
                                                                                                                                                                                             Standard Chartered Bank, 16/105, M G Marg, Kanpur - 208 001,
       City                                                Pin                                     City                                              Pin                                     Kolkata Standard Chartered Bank, 19 Netaji Subhas Road,
                                                                                                                                                                                             Kolkata - 700 001, Lucknow - Standard Chartered Bank, 4
       State                                                                                       State                                                                                     Shahnajaf Road, Lucknow, Up 226 001, Ludhiana - Standard
                                                                                                                                                                                             Chartered Bank, SCO 16-17 Feroze Gandhi Market, Ludhiana,
       Tel. (O)   STD                                 Tel. (R)   STD                               Tel. (O)   STD                              Tel. (R)    STD                               Punjab - 141 001, Mumbai - Standard Chartered Bank, 270 D N
                                                                                                                                                                                             Road, Fort, Mumbai - 400 001, Nagpur Standard Chartered
       Date of Birth
       (In case Nominee is Minor)     D D M M Y Y Y Y                                                                                                                                        Bank, Narang House, Palm Road, Civil Line, Nagpur - 440 001,
                                                                                                                                                                                             New Delhi - Standard Chartered Bank, Connaught Circle, New
                                                                                                                                 Signature                 Guardian                          Delhi - 110 001, Patna - Standard Chartered Bank, Bhagwati
                                                                                                                                                                                             Dawarka Arcade, Plot No 830 P, Exhibition Road, Patna - 800
                                                                                                                                                                                             001, Pune - Standard Chartered Bank, Shrirang House, 364-365
                                                                                                                                                                                             Junglee Maharaj Road, Shivaji Nagar, Pune - 411 005, Rajkot -
                                                                                                                                                                                             Standard Chartered Bank, Business Empire, 5 Jagnath Plot,
 6     SERVICES                                                                                                                                                  Refer Instruction 6         Gymkhana Road, Rajkot 360 002, Surat - Standard Chartered
                                                                                                                                                                                             Bank, C K Tower, 1st Floor, Near Sargam Shopping Center,
       I would like to receive statements by email rather than by post (Please      )      email                                                                                             Towards Surat-Dumas Road, Parle Point, Surat - 395 007,
                                                                                                                                                                                             Vadodara - Standard Chartered Bank, Gokulesh, R C Dutt Road,
 7     DECLARATION AND SIGNATURES                                                                                                                                Refer Instruction 7         Vadodara - 390 009

       I/We have read and understood the contents of the offer document and I/We hereby apply to the trustee of ING Vysya Mutual Fund for units of OptiMix Dynamic
       Multi-Manager FoF Scheme, as indicated above and agree to abide by the terms, conditions, rules and regulations of the relevant scheme.                                                                     HDFC BANK LIST
       I/We have not received nor been induced by any rebate or gifts, directly or indirectly, in making this investment.                                                                Agra - HDFC Bank Ltd., Shop No F 3, F 3-A, 1st Floor, Friends
        I/We hereby declare that I/We am/are authorised to make this investment in the above mentioned Scheme and that the amount invested in Scheme is through legitimate               Plaza, Sanjay Place Agra - 282 002, Ahmedabad - HDFC Bank
        sources only and does not involve and is not designed for the purpose of any contravention and evasion of any Act, Rules, Regulations, Notifications or Directions issued
                                                                                                                                                                                         Ltd., HDFC Bank House, Near Mithakali Six Roads, Navrangpura
                                                                                                                                                                                         - 380 009, Ajmer - HDFC Bank Ltd., AMC No - 13/10 & 14/10,
        by any regulatory authority in India.                                                                                                                                            Near Suchma Kendra, Adajcent To Swami Complex Ajmer - 305
        Applications other than Individuals/HUF:                                                                                                                                         001, Allahabad - HDFC Bank Ltd., 54/1 S.P. Marg, Civil Lines,
                                                                                                                                                                                         Allahabad - 211 003, Amritsar - HDFC Bank Ltd., 39, The Mall
        I/We certify that as per the Memorandum and Articles of Association of the Company, By laws, Trust Deed or Partnership Deed and resolutions passed by the                        Amritsar, Asansol - HDFC Bank Ltd., Cms Dept P C Chatterjee
        Company/Firm/Trust. I/We authorise to enter into this transactions for and on behalf of the Company/Firm/Trust.                                                                  Market, G.T Road, Rambhandu Tala, Asansol - 713 303,
                                                                                                                                                                                         Aurangabad - HDFC Bank Ltd., Shivani Chambers, Manjeet
        Applicable to NRIs only:
                                                                                                                                                                                         Nagar, Jalna Road, Opp Akashwani, Aurangabad - 431 001,
        I/We confirm that i am/we are Non Resident of Indian Nationality/Origin and I/We hereby confirm that the funds for the subscriptions have been remitted from abroad              Bangalore - HDFC Bank Ltd., No 8 / 24 Salco Centre, Richmond
        through approved banking channels or from my/our Non Resident External/Ordinary account/FCNR/NRSR Account.                                                                       Road, Bangalore - 560 025, Bareilly - HDFC Bank Ltd., 154,
                                                                                                                                                                                         Krishna Palace, Civil Lines, Bareilly - 243 001, Baroda - HDFC
        Please         Yes     No        If Yes        Repatriation basis      Non-repatriation basis                                                                                    Bank Ltd., 5th Floor, Midway Heights Next To Panchmukhi
                                                                                                                                    Date D D M M Y Y Y Y                                 Hanuman Temple, Lokmanya Tilak Road, Kirti Mandir, Near
        SIGNATURES                                                                                                                                                                       Kala Ghoda, Raopura, Baroda - 390 001, Belgaum - HDFC Bank
                                                                                                                                                                                         Ltd., 4830 / 28 A, Opp District Hospital, Dr Ambedkar Road,
                                                                                                                                                                                         Belgaum - 590 002, Bhavnagar - HDFC Bank Ltd., Gopi Arcade,
                                                                                                                                                                                         Opp Takhteshwar, Post Office, Bhavnagar, Bhilwara - HDFC
        First/Sole                                                  Second                                                     Third                                                     Bank Ltd., 2-3-4, S.K Plaza Complex, Pur Road, Bhilwara,
        Applicant                                                   Applicant                                                  Applicant                                                 Bhopal - HDFC Bank Ltd., E - 1/57, Arera Colony, Bhopal - 462
                                                                                                                                                                                         016, Bhubaneshwar - HDFC Bank Ltd., Junction Of Janpath &
                                                                                                                                                                                         Gandhi Marg, Hotal Jajati Complex, Kharvelanagar, Unit - Iii,
                                                                                                                                                                                         Master Canteen Square, Bhubaneshwar - 751 001, Calicut -
                                                                                                                                                                                         HDFC Bank Ltd., Malabar Palace, G.H Road, Calicut - 673 001,
                                                                                                                                                                                         Chandigarh - HDFC Bank Ltd., Sco 371/372, Sector 35 B,
   CHECK LIST : Please ensure that: l Name, Address and Contact details are mentioned in full (Pin Code Mandatory). l Permanent Account Number (PAN) of all                              Chandigarh 160 034, Chennai - HDFC Bank Ltd., 751 - B Anna
   Applicants is mentioned and necessary documents are enclosed, if the investment amount is Rs. 50000/- or more. In case any person does not have a permanent                           Salai, Mariam Centre, Chennai - 600 002, Cochin - HDFC Bank
   account number and who enters into any transaction specified in this rule shall make a declaration in Form No. 60/61 giving therein the particulars of such transactions.             Ltd., 2nd Floor, Elmar Square, M.G Road M.G Road,
   Otherwise your application will be rejected. l Bank Account details are entered completely and correctly. This is mandatory; if this is not included your application will            Ravipuram, Cochin - 682 016, Comibatore - HDFC Bank Ltd.,
                                                                                                                                                                                         1635, Classic Tower, Trichy Road, Coimbatore - 641 018,
   be rejected l Preferred option is selected (i.e. Growth or Dividend Option) l Investment is not less than the minimum investment amount of Rs. 5000/- l Application
                                                                                                                                                                                         Cuttack HDFC Bank Ltd., Bajrakbati Road, Cuttack - 753 001,
   Form is complete in all respects and signed by all applicants. l Cheques / Demand Drafts are drawn in favour of “OptiMix Dynamic                                                      Dehradun - HDFC Bank Ltd., 56, Rajpur Road, Uttaranchal,
   Multi-Manager FoF Scheme” or “OptiMix Dynamic FoF” dated and signed l Please write the Applicant's Name and Application Serial Number on the reverse of the                           Dehradun - 248 001, Dhanbad - HDFC Bank Ltd., Sri Ram Plaza,
   Cheque / Demand Draft l Please ensure to mention the date of birth in the application l The original Power of Attorney or a duly notarized copy of the Power of                       1st Floor, Bank More, Dhanbad, Jharkhad 826 001, Durgapur -
                                                                                                                                                                                         HDFC Bank Ltd., A102 & 103, City Centre, Bengal Shristi
   Attorney shall be required to be submitted where applications are made under a Power of Attorney. l For Non-Individual investors, the officials should sign the
                                                                                                                                                                                         Complex, City Center, Durgapur Road Durgapur - 713 216,
   application under their official designation and the following documents are to be submitted:                                                                                         Guntur - HDFC Bank Ltd., 87-90, Main Road Lakshmipuram,
                                                                                                                                                                                         Guntur 522 007, Guwahati - HDFC Bank Ltd., House No 126,
                                                                                                                                                                                         Opp. Times Of India Bhangagarh, Guwahati - 781 005, Hubli -
        Sr.             Documents                                       Companies          Trusts       Societies          Partnership         FIIs         Investment         NRIs   HDFC Bank Ltd., T B Revankar Complex, Vivekanand Hospital
        No.                                                                                                                   Firms                        through POA                Road, Hubli - 580 029, Hyderabad - HDFC Bank Ltd., 6-1-73 3rd
                                                                                                                                                                                      Floor, Saeed Plaza, Lakadikapaul, Hyderabad - 500 004, Indore -
         1     Resolution / Authorisation to invest                           Y               Y              Y                   Y               Y                Y                   HDFC Bank Ltd., 3 Rd Floor, 9/1a, U.V.House South Tukonj,
         2     List of Authorised Signatories with                                                                                                                                    Indore - 452 001, Jaipur - HDFC Bank Ltd., 1st Floor, O - 10, Ashok
               Specimen Signature(s)                                          Y               Y              Y                   Y               Y                Y                   Marg Ahimsa Circle, C Scheme, Jaipur - 302 001, Jalandhar -
                                                                                                                                                                                      HDFC Bank Ltd 911, Near Narinder Cinema, G T Road, Jalandhar
         3     Memorandum & Articles of Association                           Y                                                                                                       - 144 001, Jamnagar - HDFC Bank Ltd Plot No 6, Park Colony St
                                                                                                                                                                                      Ann's School, Bedi Bunder Road Jamnagar - 361 008, Jamshedpur
         4     Trust Deed                                                                     Y                                                                                       - HDFC Bank Ltd., C/O Mithila Motors Ltd., Near Ram Mandir,
               Bye-Laws                                                                                                                                                               Bistupur, Jamshedpur - 831 001, Jodhpur - HDFC Bank Ltd., Plot
         5                                                                                                   Y                                                                        No 57 / B, 9th Chopasani Road, Jodhpur - 342 003, Kanpur - HDFC
         6     Partnership Deed                                                                                                  Y                                                    Bank Ltd., Navin Market Branch, 15/46 Civil Lines, Kanpur - 280
                                                                                                                                                                                      001, Kolkata - HDFC Bank Ltd., Abhilasha II, 6 1st Floor, 6 Royd
         7     Overseas Auditors’ Certificate                                                                                                    Y                                    Street, Kolkata - 700 016, Kottayam - HDFC Bank Ltd., Unity
         8     Notarised Power of Attorney                                                                                                                        Y                   Building, Opp. MIDC Centre, K K Road, Kottayam- 686 002,
                                                                                                                                                                                      Lucknow - HDFC Bank Ltd., Pranay Tower, Darbari Lal Sharma
         9     Foreign Inward Remittance Certificate,                                                                                                                                 Marg, Beside Pratibha Cinema, Lucknow - 226 001, Ludhiana -
               in case payment is made by DD from                                                                                                                                 Y   HDFC Bank Ltd., Cms Dept, 5th Floor, Mall Road, Ludhiana 141
               NER/FCNR a/c or where applicable                                                                                                                                       001, Madurai - HDFC Bank Ltd., 7 - A, West Veli Street, Opp
                                                                                                                                                                                      Railway Station, Madurai - 625 001, Mangalore - HDFC Bank Ltd.,
M.N Towers, Kadri, Mangalore - 575 002, Meerut - HDFC Bank Ltd., 381 Western Kachery Road, Meerut - 250 001, Moradabad - HDFC Bank Ltd., Chaddha Shopping Complex, Gmd Road, Moradabad - 244 001, Mumbai - HDFC Bank Ltd., Maneckjiwadia
Building, Nanik Motwani Marg, Mumbai - 400 023, Borivali - HDFC Bank Ltd., Jayabhadra Villa, Ground Floor, S V Road, Borivali (W), Mumbai - 400 092, Andheri - HDFC Bank Ltd., Ganga Jamuna Apartments, Ground Floor, Opp. Shoppers Stop, S V Road,
Andheri (W), Mumbai - 400 058, Thane - HDFC Bank Ltd., Sharad Kunj, Dr Moos Road, Talao Pali, Thane (W), Mysore - HDFC Bank Ltd., Nageetha Complex, Vishwamanawa Double Road, Saraswathi Puram, Mysore - 570 009, Nagpur - HDFC Bank Ltd., 303 &
304 3rdfloor, Wardh Road 12, Milestone, Near Lokmat Square, Nagpur - 440 010, Nasik - HDFC Bank Ltd., Archit Centre, 3rd Floor, Chandak Circle Link Road, Opp Sandeep Hotel, Near Mahamarg Bus Stand, Nasik - 422 002, Navsari - HDFC Bank Ltd.,
Nandini Complex, Ground Floor Station Road, Sandh Kuva Navsari - 396 445, New Delhi - HDFC Bank Ltd., Figops, Ist Floor Kailash Building, 26 K G Marg, New Delhi - 110 001, Panipat - HDFC Bank Ltd., 801 / 4, G.T Road, Panipat - 132 103, Panjim -
HDFC Bank Ltd., Swami Vivekanand Road, 301, Milroc Lar Menezes, Opp. Gomantak Maratha Samaz, Panjim - 403 001, Patiala - HDFC Bank Ltd., S.C.O 70 - 73, Leela Bhawan Market, Patiala - 147 001, Patna - HDFC Bank Ltd., Rajendra Ram Plaza
Exhibition Road, Patna - 800 001, Pondhicherry - HDFC Bank Ltd., TS No 6, 100 Feet Road, Ellaipillaichavady, Pondhicherry - 605 005, Pune - HDFC Bank Ltd., 5th Floor Millennium Tower, Bhandarkar Road Shivaji Nagar, Pune - 411 004, Raipur - HDFC
Bank Ltd., Chawla Complex, Near Vanijya Bhawan, Sai Nagar, Devendra Nagar Road, Raipur - 492 009, Rajkot - HDFC Bank Ltd., Opp. Alfred High School, 2nd Floor, Panchratna Bldg, Jawahar Road, Rajkot - 360 001, Ranchi - HDFC Bank Ltd., Ranchi
Club Shopping Complex Apt No . 11, Main Road, Ranchi - 834 001, Rourkela HDFC Bank Ltd., Bisra Road, Dwivedi Bhawan, Dwivedi Square, Rourkela 769 001, Saharanpur - HDFC Bank Ltd., Mission Compound, Court Road, Adjoining Top Shop,
Saharanpur - 247 001, Salem - HDFC Bank Ltd., 5 / 241 - F, Rathna Arcade Omalur Main Road, Salem - 636 004, Surat - HDFC Bank Ltd., 7th Floor, Kashi Plaza Next To Dr Bipin Desai Children Hospital, Majura Gate, Surat - 395 002, Trichur - HDFC Bank
Ltd., Kalliyath Royal Square Palace Road, Trichur - 680 020, Trichy - HDFC Bank Ltd., A - 10, Lakshmi Arcade, 11th Cross Main Road, Thillainagar, Trichy - 620 018, Trivandrum - HDFC Bank Ltd., Kenton Towers, Vazhuthacaud, Trivandrum - 695 014,
Udaipur - HDFC Bank Ltd., 358 Post Office Road, Chetak Circle, Adjacent To Chetak Cinema, Udaipur - 313 001, Valsad - HDFC Bank Ltd., 1st Floor, Ekta Appt, Near R J J High School, Thithal Road, Valsad - 396 001, Varanasi - HDFC Bank Ltd., D 58 / 2
Kuber Complex, Rathyatra Crossing, Varanasi - 221 010, Vijaywada - HDFC Bank Ltd., 40 - 1 - 48 / 2, M.G Road, Labbipet, Vijaywada - 520 010, Vishakapatnam - HDFC Bank Ltd., 1st Floor, Potluri Castle Above Rayomond Showroom, Dwarka Nagar
Vishakapatnam 530 016, Yamunagar - HDFC Bank Ltd., 103, Model Town Nehru Park Road, Yamunanagar -135 003.
  Official Collection Centres (Post New Fund Offer) - for Repurchases only                        OptiMix Investor Service Centres: New Delhi: 201 - 205, 2nd Floor, Narain Manzil, 23, Barakhamba Road, New Delhi - 110001. Mumbai: Wockhardt
Towers, West Wing, Level 2, Bandra Kurla Complex, Mumbai - 400 051 OR Ground Floor, Mulla House, 30, Homi Street, Fort, Mumbai - 400 001.Bangalore: DBS House, Private Office No. 404, 26, Cunningham Road, Bangalore - 560 062.Chennai: DBS
Business Centre, No. 31A, Cathedral Garden Road, Near Palm Grove Hotel, Nunganbakkam, Chennai - 600 034. Kolkata: Auro Business Centre, Central Plaza, 8th floor, Room 803, 2/6, Sarat Bose Road, Kolkata - 700 020
CAMS Investor Service Centres (ISCs): Ahmedabad - 079-3008 2468, Bangalore - 080-3094 2468, Bhubaneswar - 0674-395 3307, Chandigarh - 0172-3048 720, Chennai - 044-39115 563, Cochin - 0484-323 4651, Coimbatore - 0422-301 8000, Durgapur -
0343-329 8890, Goa - 0832-395 1755, Indore - 0731-395 3692, Jaipur - 0141-396 9126, Kanpur - 0512-391 8000, Kolkata - 033-3058 2278, Lucknow - 0522-391 8000, Ludhiana - 0161-301 8000, Mangalore - 0824-395 1357, Mumbai - 022-3028 2480, Nagpur -
0712-395 8275, New Delhi - 011-3048 1201, Patna - 0612-325 5284, Pune - 020-3028 3005, Hyderabad - 040-3918 2468, Surat - 0261-396 2267, Vadodara - 0265-301 8029, Vijayawada - 0866-329 5202, Vizag - 0891-329 8397
CAMS Transaction Points (TPs): Agra - 0562-394 0202, Ajmer - 0145-329 2040, Allahabad - 0532-329 1273, Amaravati - 0721-309 1965, Amritsar - 0183-395 7404, Asansol - 0341-3295235, Aurangabad - 0240-329 5202, Belgaum - 0831-309 9598, Bhilai -
0788-3099 040, Bhopal -0755-3095 878, Calicut - 0495-325 5984, Cuttack - 0671-3099572, Dehradun - 0135-325 1357, Dhanbad - 0326-3290217, Gorakhpur - 0551-329 4771, Guntur - 0863-395 2671, Gurgaon - 0124-3263833, Guwahati 0361-2607771,
Hubli -0836-309 3374, Jabalpur - 0761-329 1921, Jalandhar - 0181-395 4883, Jamnagar - 0288-309 9737, Jamshedpur - 0657-309 4202, Jodhpur - 0291-325 1357, Kota - 0744-329 3202, Madurai - 0452-395 1357, Manipal - 0820-395 5827, Meerut - 0121-
325 7278, Moradabad - 0591 -309 7202, Mysore - 0821-309 4503, Nasik - 0253-309 7084, Nellore - 0861-329 8154, Panipat - 0180-395 0525, Patiala - 0175-329 8926, Pondicherry - 0413-309 2468, Raipur - 07713296404, Rajahmundry - 0883-325 1357,
Rajkot - 0281-329 8158, Ranchi - 0651-329 6202, Rourkela - 0661-3090575, Salem - 0427-395 2271, Sambalpur 0663-3090591, Siliguri - 0353-3091103, Trichur - 0487-325 1564, Trichy - 0431-309 6906, Trivandram - 0471-324 0202, Udaipur - 0294-309
3202, Valsad - 02632-394 631, Varanasi - 0542-325 3264
CAMS is an Official Point of Acceptance for Electronic transactions received from specified banks, financial institution etc (mobilized on behalf of the clients) with which OptiMix has entered or may enter into specific arrangement for Purchase/ Sales/
 2    switch of units. Additionally secure internet sites operated by CAMS will also be Official Point of Acceptance.