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Mirae Assets Emerging Bluechip Fund Application Form

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Mirae Assets Emerging Bluechip Fund Application Form Powered By Docstoc
					Key Information Memorandum and Application Form
(Investors must read the accompanying Key Information Memorandum and Instructions before completing this form)

Mirae Asset Emerging Bluechip Fund (An Open Ended Equity Fund)
New Fund Offer (NFO) Opens On : 24th May, 2010; NFO Closes On : 22nd June, 2010
Scheme re-opens for continuous sale and re-purchase on or before 21st July, 2010

            Broker Name / ARN                                  Sub Broker Code / ARN                           Collection Centre / ISC Reference No.       Application No.
                                                                                                                                      ISC Name & Stamp / Receipt Date
                                                                                                                                                           MAEBF-MAIN-
            ARN - 25682                                                                                                                                                     120510
“Upfront commission shall be paid directly by the investor to the AMFI registered Distributors based on the investors’ assessment of various factors including the service rendered by the distributor”.

(Please 3)              Lumpsum Investment                         Micro SIP ( < Rs. 50,000 per annum)                                   Non Micro SIP (> Rs. 50,000 per annum)
 1. EXISTING UNIT HOLDER INFORMATION [Please fill in your Folio Number, Name, Section 2 & proceed to Section 8 - Investment Details]
 Folio No.                                                     Name of 1st Unit Holder
2. PAN AND KYC COMPLIANCE STATUS DETAILS
For Lumpsum Investment / Non - Micro SIP PAN # (refer instruction 2(d)) KYC Compliance Status** (if yes, attach proof)                           $
                                                                                                                                                     (For Micro SIP) [Refer SIP Instruction 2 (d)]
                         @                                                                                          No
First / Sole Applicant                                                                       Yes                                                        Document Type

Second Applicant                                                                             Yes                    No                                  Document Reference No.

Third Applicant                                                                              Yes                    No                            $
                                                                                                                                                      Please indicate the same in section 12 on the reverse
@                                                                                                                     # Please attach PAN proof.                             **Refer instruction 2(e).
  If the first/sole applicant is a Minor, then please provide details of Natural / Legal Guardian.
3. APPLICANT(S) INFORMATION [Refer Instruction 2]
NAME OF FIRST / SOLE APPLICANT / CORPORATE INVESTOR / MINOR                                                                     DATE OF BIRTH                                D   D   /   M    M    /   Y    Y   Y    Y
                                                                                                            (Mandatory in case of Minor & Preferred in case of Micro SIP)
Mr. Ms. M/s.
Contact Name                         (In case of Corparate Investor)                                                         Designation

NAME OF SECOND APPLICANT
Mr. Ms. M/s.
NAME OF THIRD APPLICANT
Mr. Ms. M/s.
NAME OF THE GUARDIAN (In case First Applicant is a Minor)                                                                                                               Relationship with Minor Please (3)
Mr. Ms. M/s.                                                                                                                                                          Mother     Father    Legal Guardian

Mode of Holding Anyone or Survivor                        Single                Joint                   (Default option is Anyone or Survivor)
Occupation           Business                             Service               Professional            Retired
                                                                                                  Student          Housewife
                                                                                                                                              Others
Status         Resident Individual        Trust             NRI - NRO       HUF                   Bank / Fls       NRI - NRE               Please specify
               Minor thru Guardian        Company           Flls            Partnership Firm      AOP / BOI        Society
 4. MAILING ADDRESS [Please provide Full Address. P. O. Box No. may not be sufficient. Overseas Investors will have to provide Indian Address]
 Local Address of 1st Applicant -
                                                                                                                                   Please give landmark if any -
City                                                          State                                                                                                          Pin Code
Tel. Off.                                                     Resi.                                                                     Mobile
E - Mail P L E A S E                 U S E           B L O C K              L E T T E R S
Mandatory for NRI / Fll Applicant - Overseas Correspondence Address


City                                                          Country                                                                                         ZIP
 5. COMMUNICATION (Please 3)                                                                                                          6. TRANSACT ON-LINE (Refer instruction No. 6)
                             I / We wish to receive Account Statements / Annual Reports / Quarterly Statements / Newsletter /                 I / We wish to transact On-line through Mirae Asset e-Fund Market Facility
                             Updates or any other Statutory Information via E- mail / SMS alerts in lieu of Physical Documents.
 7. BANK ACCOUNT DETAILS - Mandatory [Refer Instruction Nos. 3 , 4 & 5]
Name of the Bank

Core Banking A/c No.                                                                                                          A/c. Type NRE               CURRENT            SAVINGS          FCNR          NRO
                                                                                                                              Please (3)
Branch Name                                                                  Address
Bank Branch City                                                             State                                                                                           Pin Code
MICR Code                                                                     Please attach a cancelled cheque OR
                                                                                                         IFSC Code (Mandatory for Credit
                                                                                 a clear photo copy of a cheque          via NEFT/RTGS)
 Direct Credit facility is available as per instruction No. 4. However, if you wish to receive a cheque payout, please tick here (3).
 Electronic Clearing Services (ECS) facility is available for receiving dividends. If you wish to avail of this facility, please tick here (3).


 ACKNOWLEDGEMENT SLIP [To be filled in by the investor]
Received from                                                                                                                                             App. No.
Regular Plan (Min Rs. 5,000 /-)                                                                                                                       MAEBF-MAIN-            120510
Please Select *Option :           Growth                     Dividend Payout                       Dividend Reinvestment
Investment Amount Rs.            Cheque No. / DD           Cheque / DD Date                            Cheque / DD Drawn on (Bank and Branch)                                               Date & Stamp of
                                                                                                                                                                                         Collection Centre / ISC

*Default Option is Growth. In case of Dividend, default option is Dividend Reinvestment Units will be allotted subject to realisation of above detailed Cheque / DD
 8. $INVESTMENT DETAILS (Please 3)                       Please issue separate cheque(s) in case you are opting for different Options
Mirae Asset Emerging Bluechip Fund - Regular Plan (Min Rs. 5,000 /-)                                                                                                     Growth                  Dividend Payout
$
    Default Option is Growth. In case of Dividend, default option is Dividend Reinvestment                                           Please Select Option :
For complete information on Investment details, please refer to Instructions No. 5.                                                                                            Dividend Reinvestment
 9. PAYMENT DETAILS [Payment through Cash / Non-MICR Cheques / Outstation Cheques not accepted]

 Special instructions for NRI Applicants: 1. It is mandatory for NRIs to attach a copy of the payment cheque / FIRC / Debit Certificate to ascertain the repatriation status of the amount invested. 2. The AMC
and the Registrar may ascertain the repatriation status purely based on the details provided in the NFO form under Payment details and will not be liable for any incorrect information provided by the applicant(s).
                                                                                                                                                                   Þ
Please indicate (3) - This is a One time Lumpsum Investment                                                  ‘OR’     This is a SIP Application                          Must be accompanied with SIP Registration Form
Cheque / DD to be made in favour of ‘Mirae Asset Emerging Bluechip Fund’                                                            A/c. Type NRE                  CURRENT               SAVINGS             FCNR            NRO
                                                                                                                                    Please (3)
Cheque / DD No.                                                Cheque / DD Date
                                                                                                                                                      
                                                                                                                                                          Kindly provide photocopy of the payment instrument or Foreign Inward
                                                                                                                                                               Remittance Certificate (FIRC) Evidencing source of Funds

Drawn on Bank                                                                                                            Branch Name                                               Branch City

 (I) Net Amount - DD/CHEQUE             (Rs. in figures)                                                (Rs. in words)

 (II) DD Charges (N.A. for Cheque) (Rs. in figures)                                                     (Rs. in words)

 Total Amount (I + II)                  (Rs. in figures)                                                (Rs. in words)
 10. SWITCH REQUEST - I/We wish to Switch Units
For (Rs. in figures)                                        (Rs. in words)                                                                                                                           OR All Units Please ()

From Scheme                                                                                                               Plan & Option

  11. NOMINATION DETAILS (OPTIONAL) [Minor / HUF / POA Holder / Non Individuals cannot Nominate - Refer Instruction No. 8]
I / We, the Applicant(s) do here by nominate the undermentioned Nominee(s) to receive the units to my / our credit in this folio no. in the event of my / our death. I / We also understand that all
payments and settlements made to such Nominee(s) and Signature of the Nominee(s) acknowledging receipt thereof, shall be a valid discharge by the AMC / Mutual Fund / Trustees. Nomination
in respect of the units stands rescinded upon Registration of Fresh/Change in Nomination and the AMC shall not be under any obligation to transfer the units in favour of the erstwhile Nominee(s).
(Please 3)              Fresh Nomination                        Change in Nominees
No.                   Nominee(s) Name                              Date of Birth (in case of Minor) Name of the Guardian (in case of Minor) Relationship @% of Share Signature of Nominee / Guardian

 1                                                                  D    D    M    M     Y     Y    Y    Y

 2                                                                  D    D    M    M     Y     Y    Y    Y

    3                                                               D    D    M    M     Y     Y    Y    Y

@
    If the percentage of share is not mentioned then the claim will be settled equally amongst all the indicated nominee(s)
 12. DOCUMENTS ENCLOSED (Please 3)
 For Lumpsum Investment / Non-Micro SIP Applications:                                     Memorandum & Articles of Association                                Bye-Laws
        Resolution / Authorisation to Invest                                              Partnership Deed                                                    List of Authorised Signatories & Specimen Signature(s)
        KYC Compliance Status Proof                                                       Trust Deed                                                          Power of Attorney
        PAN Proof                                                                         Cancelled Cheque Copy                                               FIRC
 For Micro SIP Applications:         Voter Identity Card                                       Driving License                Government / Defense identification card
    Passport                         Photo Ration Card                                         Photo Debit Card               Employee ID cards issued by companies registered with ROC
    Photo Identification issued by designated authorities                                      ID card issued to employees of specified banks
    Senior Citizen / Freedom Fighter ID card                                                   Cards issued by educational institutions
    PRAN card issued to NPS subscribers by CRA (NSDL).                                         Any other photo ID card issued by certain Government authorities.

 13. DECLARATION AND SIGNATURES / THUMB IMPRESSION OF APPLICANT(s) [Refer Instructions 2(f)]
To The Trustees, Mirae Asset Mutual Fund - Having read and understood the contents of the SID of the Scheme(s) applied for hereby apply for units of the scheme and agree to abide by the terms, conditions, rules and regulations
governing the scheme. I/We understand that the investments are exposed to market risks. I/We confirm that all the risks which the scheme is subject to, will be borne by me/us and that there is no guarantee given by the Fund of any
returns including repayment of principal. I/We hereby declare that the amount invested in the scheme (s) is through legitimate sources only and does not involve and is not designed for the purpose of the contravention of any Act, Rules,
Regulations, Notifications or Directions of the Provisions of the Income Tax Act, Anti Money Laundering Laws or any other applicable laws enacted by the Government of India from time to time. I/We have understood the details of the
scheme (s) and I/We have not received nor have been induced by any rebate or gifts, directly or indirectly in making this investment. I/We confirm that the funds invested in the Scheme, legally belong to me/us. I/We confirm that I/We
have read and understood the ‘Know Your Customer’ (KYC) norms as mentioned under the General Instructions in point 2(e) of this Key Information Memorandum.
“The ARN holder has disclosed to me/us all the commissions (in the form of trail commission or any other mode), payable to him for the different competing Schemes of various Mutual Funds from amongst which
the Scheme is being recommended to me/us”.
“I/We do not have any existing Micro SIPs which together with the current application would result in aggregate investments exceeding Rs. 50,000 in a rolling 12 month period or in a financial year”.
Applicable for NRIs only:- I/We confirm that I am/We are Non-Resident of Indian Nationality/Origin and I/We hereby confirm that the funds for subscription have been remitted from abroad through normal banking channels or from
funds in my/our Non-Resident External / Ordinary Account / FCNR Account. I/We undertake that all additional purchases made under this folio will also be from funds received from abroad through approved banking channels or from
funds in my/our NRE/FCNR Account.
Applicable to Foreign Resident’s Residing in India:- I/We confirm that I/We satisfy the Residency test as prescribed under FEMA provisions. I/We further declare that I/We am/are “Person Resident in India” and are allowed to invest
into the Scheme as per the said FEMA regulations.
The Companies investing in this fund declares that they have complied with all the laws, rules, regulations, guidelines, etc. as applicable to them.
I/We confirm that the details provided by me/us are true and correct.
I/We am/are aware that the underlying scheme(s) could charge entry load/exit load which may affect the returns to the investors and that the load structure of the underlying scheme(s) may change from time to time.




               Signature of 1st Applicant / Guardian /                                       Signature of 2nd Applicant / Guardian /                                       Signature of 3rd Applicant / Guardian /
                    Authorised Signatory /PoA                                                      Authorised Signatory /PoA                                                    Authorised Signatory /PoA




 Risk Factors: Mutual fund investments are subject to market risks and there is no assurance or guarantee that the objectives of the scheme will be achieved. As with any investment
 in securities, the Net Asset Value (NAV) of the units issued under the Schemes can go up or down depending on the factors and forces affecting the capital markets. Investments in
 mutual funds are prone to risks of fluctuation in NAVs, uncertainty of dividend distributions etc. Past performance of the Sponsor / AMC / Mutual Fund / Trustee does not guarantee the future
 performance of the Schemes of Mirae Asset Mutual Fund. The sponsors are not liable or responsible for any loss resulting from the operation of the fund beyond the initial contribution made
 by them of an aggregate amount of Rupees One Lakh towards setting up of the fund. The past performance may not necessarily be an indication of future results and may not be necessarily
 provide a basis for comparison with other investments. Mirae Asset Emerging Bluechip Fund is only the name of the scheme and does not in any manner guarantee either the quality of
 the scheme or its future prospects or returns. Investors in the scheme are not being offered any guaranteed / indicative/ assured returns. Please see “Risk Factors”, “Scheme Specific Risk
 Factors and Special Consideration” and “Right to limit redemptions” in the Scheme Information Document (SID). Please read the Statement of Additional Information (SAI)/ SID carefully
 before investing. A copy of SAI / SID/ Key Information Memorandum cum Application form will be available at AMC offices/AMC web-site www.miraeassetmf.co.in / Investor Service Centre /
 Distributors on request.
                                        INVESTOR SERVICE CENTRES OF MIRAE ASSET MUTUAL FUND DURING THE NFO
• Ahmedabad 107, 1st floor, Abhijeet I, Mithakhali Circle, Near HDFC Bank, Ahmedabad - 380009., 079-44227777. • Asansol M/s. Safe Investment, Street No:1, House No:2, Hindustan Park, Asansol - 713304. • Bangalore Unit No.809, 8th Floor,
Prestige Meridian-I, No.29, M.G. Road, Bangalore - 560001., 080-44227777. • Baroda Office No.209 of Second Floor, Siddharth Complex, R C Dutt Road, Baroda-390 005., 0265-2342112/6549815. • Bhubaneshwar Subham Capital, Plot no: 251,
Kharvel Nagar, Bhubaneshwar-751001., 0674-6540346/ 0674-2531601 • Chennai Flat – 2A, Second Floor, Pioneer Sudarsan Plaza, New No. 10/Old No. 9, Mohan Kumaramangalam Street, Nungambakkam, Chennai, 044-44227777. • Durgapur
Mr. Samit Roy, Stall No.C/SO-10, Central Market, City Centre, Durgapur - 713216. • Hyderabad Unit No. 104/A, Mahavir Chambers MCH No.3-6-363 and 3-6-1/1, Basheerbagh, Himayathnagar Road, Hyderabad 500029., 040-44227777. • Jaipur
445, Ganpati Plaza, M I Road, Jaipur, Rajasthan-302 001, 0141-4040445. • Kanpur 1st Floor, Shop No.111, KAN Chambers, 14/113, Civil Lines, Kanpur - 208001, 0512-3012896 • Kolkata A-15, 2nd floor, FMC FORTUNA, No. 234/3A, AJC Bose
Road, Kolkata - 700020., 033-44227777. • Ludhiana #202,2nd Floor, SCO-18, Feroze Gandhi Market, Ludhiana-141001, 0161-4649771/2/3. • Mumbai Unit No. 606, 6th Floor, Windsor Bldg.,Off CST Road, Kalina, Santacruz (E), Mumbai – 400
098, 022-67800300. • New Delhi Flat no 814 , Ashoka Estate, 24, Barakhamba Road, New Delhi 110001, 011-44227777. • Pune 85, 4th Floor, Sreenath Plaza, Dnyaneshwar Paduka Chowk, F C Road, Shivaji Nagar, Pune-411005., 020-44227777.
• Surat U/17, 1st Floor, Jolly Plaza, Athawagate, Surat-395001, 0261-3043803.

                                                                                        LIST OF COLLECTION CENTRES
AXIS BANK LTD - AGRA-Ground Floor, Block No.41/4A, Friends Tower, Sanjay Place, Agra - 282 002 (U.P.), AHMEDABAD-‘Trishul’, Opposite Samartheshwar Temple, Law Garden, Ellis Bridge, Ahmedabad 380 006, Gujarat, AJMER-AMC No.481-
485/10, Kutchery Road, India Motor Circle, Ajmer 305 001, Rajasthan, AMRITSAR-29, Kennedy Avenue, Court Road, Amristar 143001, Amristar District, Punjab, ANAND-Shiv Shalin Complex, Opp. Chemistry Department, Near H. M. Patel House,
Dist : Anand, Gujarat, Vallabh Vidyanagar - 388 120, ASANSOL-Purbasha Banquet Hall, Apurba Complex, Apcar, Garden, Sen Raleigh Road, Asansol 713 304, AURANGABAD-‘Sakar Building’, Adalat Road, Near Kranti Chowk, Aurangabad 433
001, Maharashtra, BANGALORE-No. 9, M. G. Road, Block A, Bangalore 560001, BANKURA-240/A, Nutan Chati, PO and District Bankura, PIN 722 101, West Bengal, BARODA-Vardhaman Complex, Opp GB Circle, Near Pizza Hut, Race Course
Circle (South), Vadodara 390 015, BHAVNAGAR-Plot No.6 B Opposite Dakshinamurthy School, Waghawadi Road, Bhavnagar 364 002, Bhavnagar District, Gujarat, BHOPAL-Star Arcade, Plot No.165 A & 166, Zone - I, M.P.Nagar,, Bhopal -462
011, BHUBANESHWAR-C/o. Archbishop’S House, Satyanagar,, Bhubaneshwar 751 007, BURDWAN-37, G. T. Road, Burdwan 713101, CALICUT-”Karupalli Arcade”, YMCA Cross Road, Calicut 673 001, Kerala, CHANDIGARH-SCO 343-344,
Sector 35-B, Chandigarh 160 022, CHENNAI-82, Dr.Radhakrishnan Salai, Mylapore, Chennai 600 004, COIMBATORE-Vigneswar Cresta, No.1095, Avinashi Road, Pappanaickenpalayyam, Coimbatore - 641 037, CONTAI-Plot No. 232, Ward No.
II, Serpur Etwaribar, PO + PS Contai, District Purba Medinipur, PIN 721 401, West Bengal, CUTTACK-Jayashree Plaza, 34, Dolamondai, Badambadi, Cuttack 753 009, DEHRADUN-56, Raipur Road, Dehradun – 248 001, DURGAPUR-No. 101/N,
Sahid Khudiram Sarani, City Center, Durgapur 713 216, District Barddhaman, West Bengal, FARIDABAD-Plot No. 40, SCO, Sector 7, Ballabhgarh, Faridabad - 121006, Uttar Pradesh, GHAZIABAD-Plot No. III, N/30, Ambedkar Road, Nehru Nagar,
Ghaziabad 201001, Uttar Pradesh, GURGOAN-SCO-29, Sector-14, Near HUDA Office, Old Delhi-Gurgaon Road, Gurgaon-122001, Haryana, GUWAHATI-Ground Floor, Chibber House, G.S. Road, Dispur,, Guwahati 781 005, Assam, HALDIA-Akash
Ganga Commercial Complex, Basudevpur, P.O. Haldia, District Purba Medinipur, Pin 721 602, HYDERABAD-6-3-879/B, G. Pulla Reddy Bldg., First Floor, Begumpet Road, Hyderabad 500 016, INDORE-Kamal Palace, 1, Yeshwant Colony, Y N Road,
Indore 452003, JAIPUR-O-15, Green House, Ashok Marg, C-Scheme, Jaipur 302 001, JALANDHAR-50, Badri Dass Colony, Mahavir Marg, Near Bmc Chowk,, Jalandhar 144 001, Punjab, JAMSHEDPUR-Voltas House, Near Ram Mandir, Bistupur,
Jamshedpur 831 001, JODHPUR-Showroom No.4, Panchratan Apartments, 818, Chopasni Road, Jodhpur 342 001, KANPUR-18/179, The Mall, Opp Phool Bagh, Kanpur 208 001, Dist-Kanpur, Uttar Pradesh, KOCHI-41/419, Ground Floor,, Chicago
Plaza, Rajaji Road, Ernakulum, Kochi - 682 035, KOLKATA-Ground & First Floors, 7, Shakespeare Sarani, Kolkata 700 071, LUCKNOW-Halwasiya House, 11, M. G. Road, Hazratganj, Lucknow - 226 001, LUDHIANA-Shop No.3, Lgf, Surya Towers,
108, The Mall, Ludhiana (Punjab) 141 001, MADURAI-Door No. 4, Goods Shed Street, Madurai 625 001, Tamil Nadu, MANGALORE-Essel Towers, Bunts Hostel Circle, Mangalore - 575 003, MORADABAD-No.8/10/6, Sarai Khalsa, Civil Lines,
Near Head Post Office, Moradabad 244 001, Uttar Pradesh, MUMBAI-Universal Insurance Bldg., Ground Floor, Sir. P. M. Road, Fort, Mumbai 400 001, MYSORE-Haripriya Complex, Temple Road, V V Mohalla, Mysore 570 002, NAGPUR-1st Floor,
Sanskrutik Sankul, Jhansi Rani Square, Sita bldg., Nagpur - 440 012, NASIK-Malpani Pride, Behind Raymond Retail Shop, New Pandit Colony, Sharanpur Road, Nashik 422 005, Maharashtra, NEW DELHI-”Statesman House”, 148, Barakhamba
Road, New Delhi 110 001, NOIDA-B2-B3, Sector 16, Noida, U.P. - 201 301, PANJIM-Atmaram Commercial Complex, Dr. Atmaram, Borkar Road, Opp. Hotel Nova Goa, Panjim- 403 001, PATNA-Saket Towers, S.P. Verma Road, Patna 800 001,
Bihar, PUNE-Sterling Plaza, Plot No.1262/B, Jangli Maharaj Road, Near Deccan Gymkhana, Pune 411004, RAJKOT-Aradhana, Nr. Bank Of Baroda,, Kalawad Road, Rajkot - 360 001, RANCHI-No. 4, 5 A, 5B, Ward No. 15, Ground Floor, Below Bata
Showroom, Main Road, Albert Ekka Chowk, Ranchi 834001, Jharkhand, SILIGURI-Spectrum House, Sevoke Road, Siliguri 734 401, West Bengal, SURAT-Digvijay Towers, Opp. St. Xavier’S School, Ghod Dod Road, Surat - 395 001, TRICHUR-151-152,
Ground Floor, Parihar Bhawan, Chetak Marg, Udaipur, Rajasthan 313 001, TRIVANDRUM-C-19/134, M-B, Ground & First Floor, Shastri Nagar, Sigra, Varanasi 221 002, Uttar Pradesh, UDAIPUR-151-152, Ground Floor, Parihar Bhawan, Chetak
Marg, Udaipur, Rajasthan 313 001, VARANASI-C-19/134, M-B, Ground & First Floor, Shastri Nagar, Sigra, Varanasi 221 002, Uttar Pradesh, VIJAYAWADA-Ground Floor, D No. 59A 1-7, Matha Towers, Ring Road, Near Benz Circle, Vijayawada
520008, VISAKHAPATNAM-No.47-10-24/25, Dwaraka Nagar, Visakhapatnam 530 016, Andhra Pradesh, Andhra Pradesh
HDFC BANK LTD - AGRA-F3-F3A, First Floor Friends Wasan Plaza, Sanjay Place, Agra-282002, AHMEDABAD-501-502, Broadway Business Centre, Nr Law Garden, Opp Samarteshwar Mahadev Mandir, Ellis Bridge, Ahmedabad - 380 009,
AHMEDNAGAR-Ambar Plaza, “ A” wing, second floor, Station road, Ahmednagar-414001, AJMER-Near Suchna Kendra, Adj.to Swami Complex, Ajmer. (Raj) -305001, AKOLA-Sethi Heights, 1st Floor, Opp. Zilla Parishad, AKOLA 444 001,
ALIGARH- 3-316 Bhalla Complex Ramghat Road Aligarh, (U.P) -202001, ALLAHABAD-58, SP Marg Civil lines Allahabad-211003, ALWAR-Bhagat Singh Circle, Opp.UIT, Alwar(Raj.)-301001, AMBALA-6352/11, Nicholson Road First Floor Ambala
Cantt-133001, AMRAVATI -C/o Rasik Plaza, Morshi Rd, Jaystambh Chowk-444601, AMRELI-STREET # 2, Manekpara Main Road-365601, AMRITSAR-26 Kennedy Avenue First Floor Amritsar-143001, ANAND- 1st Floor, Sanket Complex, Next to
Sales India, Grid Cross Road, Anand – 388001, ANKLESHWAR- Commercial Plot 73/P, GIDC Estate, S.A.Motors Building, Old Ankleshwar Highway, Ankleshwar – 393001, ASANSOL-P.C Chatterjee Market, Rambandhu Talaw, Asansol, Pin – 713303,
AURANGABAD- Divekar Plaza, CTS No 18272, IInd Floor, Railway Station Road, Padampura-431001, BAGALKOT-opp:railway Station ward No 10 Bagakot -587101, BALASORE-F.M.Circle, Balasore Branch, Orissa-756001, BANGALORE-Cash
Management Services, “SALCO CENTRE”, # 8/24, Richmond Road-560025, BARDOLI-Shree Ambika Niketan, Station Road, Sardar Baug, Bardoli-394601, BAREILLY-WBO, 1st Floor, 154, Krishna Place, Civil Lines, Bareilly - 243 001 Uttar Pradesh-243001,
BARODA-5th Floor, Midway Heights, Near Panchmukhi Hanuman Temple, Lokmanya Tilak Road, Nr Kirti Mandir, Kala Ghoda, Raopura, Baroda -390 001, BATALA-SCF173-174, Jalandhar Road-143505, BEGUSARAI-Kachhari Chowk, Today
Market-851101, BELGAUM-No 4830/2A Opp District Hospital Dr Ambedkar Road. Belgaum 590 002, BHAGALPUR-Triveni appartment, Dr. R. P Road, Bhagalpur-812002, BHARUCH-127, Alfa Society, Link Road-392001, BHATINDA- 83/1, Liberty
Chowk, Civil Lines Bhatinda-151001, BHAVNAGAR-1st floor, Sterling Point, Waghawadi Road-364001, BHILAI-Chauhan Estate, G.E. Road, Supela-490023, BHILWARA- WBO, Shop no. 1-2-3-4, “A” Block, First Floor, SK Plaza, Pur Road Bhilwara
(Raj.) 311001, BHIWADI-Riico Chowk, Bhiwadi-301019, BHIWANI-S-175D/1, Jalan Nagar, Meham Chowk-127021, BHOPAL-Asha Avenue, 1st Floor, Z-1, Zone-1 M P Nagar, Bhopal-462011, BHUBANESWAR-C111, Business park, 1st Floor, Sahid
Nagar-751007, BHUJ-101/102 Sunrise Tower, Vijay Nagar, Hospital Road, Bhuj-370001, BHUSAVAL-Mansingh Complex. C.T.S. No. 3294 ( H.No. 4/285 ) Jamner Road, Opp CSM Complex, Bhusaval - 425 201, BIKANER- Roshan Plaza, Rani Bazar,
Bikaner-334001, BILASPUR-A-99 Link Road Near Agresen Chowk, Bilaspur Chhattisgarh -495001, BOKARO-B-9, City Centre, Sector-4, Bokaro Steel City-827001, BURDWAN-45 GT Road, Burdwan-713101, CALICUT- III Floor, Simax Towers, Kannur
Road, Nadakkave, Calicut -673011, CHANDIGARH-SCO-189-190 Sector 17 C-160017, CHENGANASSERY-Golden Towers, MC Road Chenganassery-686101, CHENGANNUR-Bin Tower, Govt Hospital Junction, M.C Road, Chengannur-689121,
CHENNAI-751 B, Mount Road Chennai-600002, COCHIN-First Floor, Palarivattom-682025, COIMBATORE-WBO, 1552, B7, First floor, Classic Towers, Trichy Road, Coimbatore-641018, CUDDAPAH- RRR Towers, Dwaraka Nagar, RS Road,
Nagarajupalli-516001, CUTTACK- Holding No 32, 32/A Bajrakabati Road, Cuttack, Orissa - 753 001, DAHANU-Matru Ashish, Irani Road-401602, DAMAN- Ace Shopping Mall, Dilip Nagar, Teen Batti-396210, DARBHANGA-Natraj Bhawan, Ist
Floor, Katki Bazar, Tower Chawk, Darbhanga, Bihar-846004, DAVANGERE-#651 B H M Enclave, HM Road, Mandipet, Davangere-577001, DEHRADUN-WBO Deptt, HDFC Bank, 56, Rajpur Road -248001, DELHI-Fig-Ops 1st Floor, Kailash Bldg-New
Delhi-110001, DEOGHAR-Assam Acess Road, Near Tower Chowk Deoghar, 814112, DHANBAD-Sri Ram Plaza, 1st Floor, Bank More Dhanbad-826 001, DHARAMSHALA-363/3, Centre Point, Civil Line, Dharamshala-176215, DHULE-Wholesale
Banking Operations(CMS), Lane No- 6, Mundada Arcade, Parola Road, Dhule -424001, DURGAPUR-Balai Commercial Complex, 3rd Floor. Benachity, Nachan Road-713213, ERODE-NO.680, Lotus Enclave, Brough Road, Erode-638001, FAZILKA-MC
No. 594, Gaushala Road-152123, FEROZEPUR-Building No.30/7, Udham Singh Chowk-152001, GANDHIDHAM-Plot no.1, Sector-8, Rabindranath Tagore Road-370201, GAYA-K.P.Road Near Ghanta Ghar-823001, GONDAL- Wholesale Banking
Operations, 1st Floor, Aadinath Complex, College Chowk-360311, GORAKHPUR-Wholesale Banking Operations, Shreenath Complex, 10, Park Road, Civil Lines-273 001, GURDASPUR- SCF-1 Improvement Trust Bldg, Hanuman Chowk, Gurdaspur-143521,
GUWAHATI-1st floor, Mishra Complex, Jail Raod, Fancy Bazar, Guwahati-781001 ,GWALIOR-J K Plaza, Gast Ka Tazia, Lashkar -474001, HAJIPUR-Vimel Complex, Dak Banglow Road, Hajipur-844101, HALDWANI-8/6 Bhotia Paraw, Nainital Road,
Haldwani-263139, HAMIRPUR-NH-88, New Road, Hamirpur, HP-177001, HAZARIBAGH-HDFC Bank, Annanda Chowk, Hazaribagh, 825301, HIMMATNAGAR-G.F Shop No 5-8 & First Floor 4 – 9, Kumar House, Durga Oil Mill Compound-383 001,
HISAR-3 & 4 MC Area Red Square Market Railway Road Hisar-125000, HOSHIARPUR-WBO, Ist Floor, opp Maharaja Hotel, Sutheri Road, Hoshiarpur 146001, HOSUR-NO.24 & 25, Maruthi Nagar, SIPCOT PO, Near Dharga-635126, HUBLI-Shriram
Plaza Dervice Branch Club Road-580029,HYDERABAD-WBO 1-10-60/3, III Floor, Suryodaya, Begumpet- 500 016, ICHALKARANJI-House No 7-55(Old No9-148) Main Road, Janta Chowk-416115, INDORE- 1st Floor, Brilliant Avenue, Sch No. 94,
Sector -B, Behind Bombay Hospital, Ring Road-452010, JABALPUR- 1st Floor, Kumbhare Mension, 636, Vijay Nagar, MR- 4, Main Road, SBI Chowk, Jabalpur (MP) – 482002, JAGADHRI-Plot No.1, Rajesh Nagar Colony, Ambala Road-135001,
JAGRAON-Opp SSP Office, Tehsel Road -142026, JAIPUR-HDFC Bank House, 2nd Floor, O-10, Ashok Marg, C-Scheme, Jaipur-302001, JALANDHAR- 1st Floor, 911, GT Road, Nr. Narinder Cinema, Jalandhar-144001, JALGAON-3rd Floor, Sugan
Heights, P P NO 324/2, TPS II, Near Central Bus Stand Jalgaon-425001, JAMMU-CB-13, Rail Head Commercial Complex, Gandhi Nagar-180004, JAMNAGAR-Abhishek3rd Floor, Saru Section Road, Near Savan Apartment, Jamnagar -361008,
JAMSHEDPUR- 1st floor, 105, SNP Area, Sakchi, Jamshedpur -831001, JHANSI- Damroo Cinema complex, civil Lines Jhansi 284003, JIND- SCF-5, Rani Talab Jind-126102, JODHPUR- Ist Floor, 15, Keshav Comlex, Nimbera House, Paota, Mandore
Road, Jodhpur -342010, JUNAGADH-Ground Floor, Moti palace, opp.Rayji Nagar, Moti baugh road-362001, KADI- Radhaswami Complex, kadi-382715, KAITHAL-1450/51 Ambala road, Pehowa Chowk kaithal -136027, KANGRA-Near Bus Stand
Kangra -176001, KANNUR-HDFC Bank, Ist Floor KVR Tower, South Bazar, Kannur-2, Kerala-670002, KANPUR-15/46, 1st floor, Civil Lines, kanpur-208001, KAPURTHALA-The Mall, Near Mgn Public School-144601, KARAD-Besides Hotel Sangam,
Kolhapur Naka, Karad-415110, KARNAL-Basement, Sco 778-779, opp. Mahabeer Dal Hospital-132001, KARUR-126/D/E, Annai Plaza, Kovai Road-639002, KHANNA-Opp. Bus Stand. G.T. Road, Khanna, Punjab-141401, KOLHAPUR-Gemstone,
517/A/2 E ward New Shahupuri, Nr Central bus stand Kolhapur-416001, KOLKATA-Abhilasha - II, 6 Royd Street (2nd Floor)-700016, KOLLAM-VGP Bulidings, Near Irumpupalam, Kollam 691001, KOTA-13-14, Main Jhalawar Road-324007,
KOTKAPURA-B-X/740, Faridkot Road, Kotkapura-151204, KOTTAYAM-3rd Floor, Unity Buildings, KK Road-686002, KURUKSHETRA-Shop No.1-5, Kalawati Market, Railway ROad, Kurukshetra-136118, LATUR-II nd Floor, Shri Prabha Arcade, Vora
Bunglow, Main Road, Nr Nagar Parishad-413512, LUCKNOW-Pranay towers 38, Darbari Lal Sharma Marg Lucknow -226001, LUDHIANA-SCO-54, Phase -2 Urban Estate Dugri-141001, MADURAI-Sri Nithyakalyani Towers, No 34 Krishnarayan
Tank Street, North Veli Street-625001, MANDI GOBINDGARH-Hukam Chand Building, Near Main Post Office-147301, MANGALORE-Ideal Towers 1st floor, Opp Sharavu Ganapathi Temple, G T road Mangalore-575001, MANJERI- Kurikkal Plaza,
Kacherippadi-676121, MATHURA-169/2 Gaushala Road OPP BSA College Mathura-281001, MEERUT- 1st Floor 381, Western Kutchery Rd Meerut U.P-250001, MEHSANA-Prabhu Complex “ Nr Rajkamal Petrol Pump, Highway Road, Mehsana-384002,
MOGA-GT Road, Opp D C Office, Thaman Singh Gill Market, Moga-142001, MORADABAD- First Floor, Chaddha Complex, GMD Road-244001, MORVI-Om Shopping Complex, Ravapar Road-363641, MUMBAI-Ground Floor, Maneckji Wadia
Building, Nanik Motwani Marg, Near Kala Ghoda, Opp Mumbai University, Fort Mumbai-400001, MUZAFFARNAGAR-53/4-A, Bagh Kambal Wala, Jansath Road-251001, MUZAFFARPUR- Tilak Maidan Road, Muzaffarpur-842001, MYSORE-Mythri
Arcade, Saraswathipuram, 1st Main, Mysore -570009, NABHA-SCF 14, 15 Patiala gate Nabha -147201, NADIAD-Shootout Building, College Road, Nadiad-387001, NAGPUR - 2, “Mile Stone “ Block No 303 & 304, Near Lokmat Square, Wardha
Road, Nagpur-440010, NARNAUL-Opp. S. P. Residence, Mahinder Garh Road, Haryana-123001, NASIK-3rd Floor, Archit Centre, Opp Sandeep Hotel, Chandak Circle Link Road, Near Mahamarg Bus Stand, Nasik 422002, NAVSARI-Gr Flr, Nandani
Complex, Station Road -396445, NAWANSHAHAR-B 1/148, Banga Road, Nawanshahar-144514, NELLORE-17/126, G.V.R. Enclave, G.T. Road, NELLORE – 524001, PALAKKAD-VIII/246, 1st Floor, Chandranagar Jn. Palakkad- 678007, PALANPUR-
Nr. Cozy Tower, Opp : Joravar Palace-385001, PANIPAT-801/4, Opps Railway Road, G.T Road, Panipat-132103, PANJIM-301, Milroc Lar Menezes, Swami Vivekanand Road-403001, PATHANAMTHITHA-Aban Arcade, Ring Road, Pathanamthitha,
Kerala-689645, PATIALA-Building No 11520, 1st Floor Leela Bhawan, Near Gopal Sweets-147001, PATNA-plot no 651 Jamal Rd, Patna- -800002, PERINTHALMANA-Wholesale Banking, Sree Complex, Calicut Road, Perinthalmanna- 679322,
PHAGWARA-Kalra Complex G T Road Phagwara-144401,PONDICHERRY-T.S.No.6, 100Ft Road, Ellaipillaichavady-605005,PORBANDAR-Om Shiv Shakti, R.D.Chambers, M.G. Road, Porbandar - 360 575, PUNE-Fortune Square 3 rd Floor, Deep
Bungalow Chowk, Model Colony, Shivajinagar-411016, RAIPUR- Chawla Towers, Near Bottle House, Shankar Nagar, Raipur, Chhattisgarh-492007, RAJAHMUNDRY-46-17-20, 1stFloor, Danavaipet, Rajahmundry-533103, RAJAPALAYAM-251 E
Kadabankulam Main, Rajapalayam Thenkasi Road, Rajapalayam-626117, RAJKOT-Shivalik - V, 3rd Floor, Gondal Road, Rajkot-360002, RAJPURA-# 11-12B, Clibre Market, Rajpura-140401, RAMGANJ MANDI-Bazaar no -1 Opp SBBJ bank, Ramganj
Mandi-326519, RAMHGARH-N.H-33 Main Road, Near Bank of Baroda, Ramgarh Cantt-829122, Jharkhand -829122, RANCHI-56, Rohini Complex Circular Road Lalpur Ranchi-834001, RANIGANJ-A/29, N S B ROAD, Opposite Asoka Petrol Pump,
Raniganj, Dist Burdwan-713347, RATLAM-WBO, 90, Station Road, Ratlam-457001, RATNAGIRI-Show room No.3, Mangesh Shanta, Apartment, Near Maruti Mandir, Ratnagiri-Kolhapur Highway-415639, REWARI-L203, 1st floor, Modal Town,
Old court Road, Rewari, Haryana -123401, RISHIKESH-MC NO 53, MJ Mall, Railway Road-249201, ROHTAK-Jawahar market, Opp D-Park, Model town-124001, ROORKEE-313/8, Civil Lines, Roorkee-247667, ROPAR- Raj Hotel Complex, College
Road, Ropar ( Punjab)-140001, ROURKELA-Dewadi Bhavan-769001, RUDRAPUR-Plot No1&2, Nanital Road-263 153, SAHARANPUR- Court Road, Saharanpur(UP)-247001, SALEM-5/241-F Rathan Arcade, Five Roads, Meyyanur, Salem-636004,
SAMBALPUR- Nayapara Golebazar Sambalpur-768001, SANGAMNER-1 Janak Plaza, New Nagar Road Sangamner- 422 0605, SANGLI-640, Venkatesh senate, Sangli Miraj road, Sangli-416416, SANGRUR-SCO-1, 2, 3.Kaula Park, Sangrur(PB)-148001,
SHILLONG-Anders Mansion, Police Bazar, Shillong-793001, SHIMLA- Shimla3, Jankidas Bldg, Shimla-171001, SHIMOGA- WBO, No 447, Sharavathi Complex, Savarlane Road, Shimoga-577201, SILIGURI-136/115 Hill Cart road-734401, SILVASSA-1-16,
Jaypee House, Opp. Patel petrol pump, Silvassa-396230, SINDHANUR-No 6-1-2992/1, Ward No 12, Kushtagi Road-584128, SOLAN-The Mall Road, Opp.Uco Bank, Solan-173212, SOLAPUR-8516/11 Murarji Peth, Sun Plaza Bldg, Lucky Chowk,
Solapur-413007, SRINAGAR-First Floor, M. S. Shopping Mall, Residency Road-190001, SURAT-1st Floor, Crossway Mall, Near Ram Chowk, Ghod Dod Road -395007, SURENDRANAGAR-Middle Point, A Wing, Nr. Milan Cenama, Main Road,
Surendranagar-363002, THALASSERY-Sahara Centre, AVK Nair Road-670101, THENI- WBO – Theni, #422-A, Periyakulam Road, Theni Allinagaram-625531, THIRUVALLA-Illampallil Buildings, 26/149, 1&2, MC road, Ramanchira-689101,
TIRUNELVELI- 12, 13, Trivandrum High Road, Vannarpettai, Palayamkottai, Tirunelveli-627002, TIRUPATI- 19-8-180, Krishna Arcade, Beside IBP Petrol pump, Near Annamaiah Circle-517501, TIRUPUR-No-169, Chidambaram Complex, Kumaran
Road, Tirupur – 641601, TIRUR-KMS Tower, Thazhepalam-676101, TRICHUR-Global Centre, MG Road-680004, TRICHY-No.11, PLA Kanagu Towers, 11 th Cross, Main Road, Thillainagar-620018, TRIVANDRUM-BOB Plaza, Second Floor, T. C. 12
/ 149(3), Pattom, Trivandrum-695004, UDAIPUR-Uday 2nd Floor 3 Durga nursery-313001, UDUPI-Panduranga Tower/ Diana Circle, Court Road, Udupi -5760101, UNJHA-1st Floor, Suvidhi Complex, Station Road -384170, VALSAD-1st Floor, Ekta
Apt, Tithal Road, Valsad-396001, VAPI-1 st Floor, Kanta Trade Center, GIDC Char Rasta-396195, VARANASI-D 58/9a-1k, kush complex sigra varanasi-221010, VELLORE-73, Officers Line-632001, VERAVAL- “Amrut Deep”, Rajmahal Road, Opp.
Public Garden, Veraval-362265, VIJAYAWADA-40-1-48/2, 2nd Floor, Valluri Complex, M G Road-520010, VISAKHAPATNAM-1st Floor, Potluri Castle, # 48-14-9, Dwarakanagar, Visakhapatnam-530016, WARANGAL-1-8-605/1, Nakkalagutta,
Hanamkonda, Warangal-506001.
CITIBANK - AHMEDABAD - C.G Road, Near Panchvati Circle, BANGALORE - 30, Mahatma Gandhi Roadd, CHENNAI - GTS, 3rd Flr., No. 2, Club House Road, DELHI - Connaught Circus, HYDERABAD - Queens Plaza, S.P.
Road, Begumpet, Secunderabad, KOLKATA - Kanak 41, Chowringhee Road, MUMBAI - 4th Flr, 224, D.N. Road,Fort House, Fort, PUNE - 2413 East Street,Camp.
IDBI BANK LTD. - AHMEDABAD-IDBI Complex, Lal Bungalows Off. C.G. Road, Ahmedabad – 380006, BANGALORE-CMS Desk, No.32 & 32/1, 2nd Foor, R.V Road, Basavangudi, Bangalore – 560004, BARODA-CMS Desk,
3rd Floor, Garg Complex, 46 A, Gautam Nagar, Oppo. Pizza Hut, Race Course, Baroda – 390007, BHAVNAGAR-Radheshyam Complex, Waghawadi Road, Bhavnagar – 364001, CHENNAI-PM Tower, 37 Greams Road,
Chennai-600006, NEW DELHI-Surya Kiran Building, Ground Floor, 19 K G Marg, New Delhi-110001, FARIDABAD-Ground Floor, SCO - 99 ,Sector 16,Behind Sagar Cinema house, Faridabad-121002, HYDERABAD-Mahavir
House, Basheerbagh Square, Hyderabad-500029, INDORE-Alankar Chambers, Ratlam Kothi, A. B. Road, Indore – 452001, JAIPUR-11/8, Govind Marg, Near Parnami Hospital, Raja Park, Jaipur-302001, KANPUR-Jeevan
Vikas M.G. Road, Near Statue Junction, Kanpur – 208001, LUDHIANA-107, The Mall Road, Ludhiana – 141001, MUMBAI-Mittal Tower, ‘C’ Wing, Ground Floor, Nariman Point, Mumbai-400021, KOLKATA-Regional
Processing Unit(East), CMS Ops Dept, 6, Royd Street, Abhilasha Annex, First Floor, Beside RBI NCC, Kolkata – 700016, PUNE-Dynaneshwar Paduka Chowk, Fergusson College Road, Pune – 411004, RAJKOT-”Shivdarshan”
Nr.Kathiawad Gymkhana, Dr.Radhakrishnan Road, Rajkot – 360001, SURAT-202, 21st Century Business House, 2nd Floor, Nr Mandarwaja, Ring Road, Surat - 395002.
SYSTEMATIC INVESTMENT PLAN (SIP)
Mirae Asset Emerging Bluechip Fund                                                   (An Open Ended Equity Fund)
Registration Cum Mandate Form For SIP Through ECS or Direct Debit (Auto Debit) at Select Locations/Bank Branches
Investor must read the instructions before completing this form.
             Broker Name / ARN                                  Sub Broker Code / ARN                       Collection Centre / ISC Reference No.       Application No.
                                                                                                                                   ISC Name & Stamp / Receipt Date
                                                                                                                                                        MAEBF-MAIN-
             ARN - 25682                                                                                                                                         120510
“Upfront commission shall be paid directly by the investor to the AMFI registered Distributors based on the investors’ assessment of various factors including the service rendered by the distributor”.
 1. EXISTING UNIT HOLDER INFORMATION (The details in our records under the folio number mentioned will apply for this application.)

 Folio No.                                                    Name of 1st Unit Holder

 2. SIP ENROLMENT DETAILS
Scheme / Mirae Asset Emerging Bluechip Fund -                             < Rs. 50,000 per annum Frequency                   Monthly                                   Quarterly
Plan :   Regular Plan                                                     > Rs. 50,000 per annum Please (3) (Min. 6 installments of Rs. 1,000/- each) (Min. 4 installments of Rs. 1,500/- each)
SIP Date                                                                                                             SIP PERIOD (Default End Date would be 12 months from the 1st installment)
                     01st            10th (Default)               15th             21st             28th
Please (3)                                                                                                        Start Month A      U G      2   0    1   0     End Month       M   M M        Y Y   Y   Y

 There should be a minimum time gap of 30 days and maximum time gap of 60 days between the first cheque for SIP investment and first installment of SIP through ECS (Debit Clearing) or Direct Debit.
      $                                                 $
 3.       INVESTMENT DETAILS (Please 3)                     Default Option is Growth. In case of Dividend, default option is Dividend Reinvestment
Please Select Option :         Growth                        Dividend Payout                    Dividend Reinvestment
 4. SIP PAYMENT DETAILS
 First SIP via Cheque and Subsequent SIP via ECS (Auto Debit Clearing) at select locations** given below OR via Direct Debit facility for Investors having their bank
 accounts with Core Banking Branches of the following 8 banks - Axis Bank Limited, Bank of Baroda, Bank of India, HDFC Bank Ltd#, IDBI Bank Limited, IndusInd
 Bank, Kotak Mahindra Bank Limited, and Punjab National Bank. (# Excluding Merged Branches of Centurion Bank of Punjab).

 Each SIP Amount (Rs.) (Min. Rs. 1000/-)                                                       First SIP Cheque No.                                             Chq. Date

 Drawn on Bank                                                                                             Branch Name & City
                                                                            
 A/c. Type NRE       
                            CURRENT             SAVINGS            NRO         Kindly provide photocopy of the payment instrument or Foreign Inward Remittance Certificate (FIRC) Evidencing source of Funds

 5. ECS / DIRECT DEBIT BANK ACCOUNT DETAILS (Mandatory)
I/We hereby authorise Mirae Asset Global Investments (India) Pvt. Ltd., Investment manager to Mirae Asset Mutual Fund acting through their authorised service providers to
debit my/our following Bank A/c. by ECS (Auto Debit Clearing / Direct Debit) Facility or any other facility for collection of SIP payments.
Name of A/c. Holder as in Bank Records

Bank Name                                                                                           Core Banking A/c. No.

Branch Name & Address                                                                                                                                  City

9 Digit MICR Code                                                         Bank Account Type Please (3)                NRE    
                                                                                                                                       CURRENT                  SAVINGS                NRO

Mandatory Enclosures : Main Application Form and Please (3) Blank Cancelled Cheque                                   “OR” Copy of Cheque

DECLARATION & SIGNATURE: I/We hereby declare that the particulars given in this SIP Application Form are correct and express my/our willingness to make payments referred above through
participation in ECS / Direct Debit Facility. I/We also agree that if the transaction is delayed or not effected for reasons of incomplete or incorrect or any other operational reasons. I/We would
not hold Mirae Asset Global Investments (India) Pvt. Ltd., their appointed service providers or representatives responsible. I/we will also inform Mirae Asset Global Investments (India) Pvt. Ltd.
(Investment Managers to Mirae Asset Mutual Fund) about any change in my/our bank account and also undertake to keep sufficient funds in my bank account on the date of execution of the said
standing instructions. I / We have read and understood the contents of the SID/SAI of the Scheme and agree to the Terms and conditions mentioned therein.
“The ARN holder has disclosed to me/us all the commissions (in the form of trail commission or any other mode), payable to him for the different competing Schemes of various
Mutual Funds from amongst which the Scheme is being recommended to me/us”. “I/We do not have any existing Micro SIPs which together with the current application would
result in aggregate investments exceeding Rs. 50,000 in a rolling 12 month period or in a financial year”.




              Signature of 1st Applicant / Guardian /                           Signature of 2nd Applicant / Guardian /                               Signature of 3rd Applicant / Guardian /
                   Authorised Signatory /PoA                                          Authorised Signatory /PoA                                            Authorised Signatory /PoA
                   (AS IN BANK RECORDS)                                               (AS IN BANK RECORDS)                                                  (AS IN BANK RECORDS)

 6. AUTHORISATION OF BANK ACCOUNT HOLDER [To be signed by the Account Holder(s) as per Bank Records]
This is to inform I/We have registered for the RBI’s Electronic Clearing Service (ECS / Direct Debit) Facility and that my / our payment towards my / our investment in Mirae Asset Mutual Fund shall be
made from my / our below mentioned Bank Account Number with your bank. I / We authorise Mirae Asset Mutual Fund, acting through their service providers and representative carrying this ECS Mandate
/ Direct Debit Facility Form to get it verified & executed. Mandate verification charges, if any, may be charged to my/our account.
Name of A/c. Holder as in Bank Records

Core Banking A/c. No.                                                                                                            Each SIP Amount (Rs.)




              Signature of 1st Applicant / Guardian /                           Signature of 2nd Applicant / Guardian /                               Signature of 3rd Applicant / Guardian /
                   Authorised Signatory /PoA                                          Authorised Signatory /PoA                                            Authorised Signatory /PoA
                   (AS IN BANK RECORDS)                                               (AS IN BANK RECORDS)                                                  (AS IN BANK RECORDS)

**Select ECS Locations (Anand, Agra, Ahmedabad, Allahabad, Amritsar, Aurangabad, Bangalore, Bardhaman, Baroda, Belgaum, Bhavnagar, Bhilwara, Bhopal, Bhubaneshwar,
Bijapur, Calicut, Chandigarh, Chennai, Kochi, Coimbatore, Davangere, Dehradun, Delhi, Dhanbad, Durgapur, Erode, Gadag, Gorakhpur, Guwahati, Gwalior, Haldia, Hubli,
Hyderabad, Indore, Jabalpur, Jaipur, Jalandhar, Jammu, Jamnagar, Jamshedpur, Jodhpur, Kakinada, Kanpur, Kolhapur, Kota, Kolkata, Lucknow, Ludhiana, *Madurai, Mangalore,
Mumbai, Mysore, Nagpur, Nasik, Nellore, Panjim, Patna, *Pondicherry, Pune, Raipur, Rajkot, Ranchi, Salem, Shimla, Sholapur, Siliguri, Surat, Thirupur, Tirupati, Trichur, *Trichy
(Available through Direct Debit facility), Trivandrum, Udaipur, Udupi, Varanasi, Vijayawada, Vizag). *For Madurai - SIP through ECS date available is 01st & for Pondicherry - 15th.

                                  For more information                                                                    E-mail us at customercare@miraeassetmf.co.in
                          visit us at www.miraeassetmf.co.in                                                                     Call us at 1-800-1020-777 (Toll Free)

				
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Description: Download Mirae Assets Emerging Bluechip Fund Application Form. NFO Closing on 24 June 2010.