L&T Mutual Fund Application Form
L&T Mutual Fund Application Form
L&T Mutual Fund Application Form
App. No.
Time Stamp
Please refer to the general instructions for assistance and complete all sections in English. For legibility, please use BLOCK LETTERS in black or dark ink.
Distributor/RIA Code Sub-Distributor ARN EUIN Branch Code Relationship Managers Name
Initial Commission will be paid by the investor directly to the distributor, based on assessment of various factors including the service rendered by the Distributor.
Transaction Charges Investors Declaration where EUIN is not furnished
SEBI (Mutual Fund) Regulations allow deduction of transaction charges of I/We conrm that the EUIN box has been intentionally left blank by me/us as this is
Rs. 100/- from your investment for payment to your distributor if your distributor has an execution only transaction without any interaction or advice by the employee/
opted to receive transaction charges for investments sourced by him. The transaction relationship manager/sales person of the above distributor and/or notwithstanding the
charges deductible are Rs. 150/- if you are investing in Mutual Funds for the rst time. advice of inappropriateness, if any, provided by the employee/relationship manager/
If you are making a SIP Investment, the transaction charges would be deducted over 3-4 sales person of distributor and the distributor has not charged any advisory fees on this
instalments. No transaction charges would be levied if you are not investing through a transaction.
Distributor or your investment amount is less than Rs.10,000/-
If this is the rst time, you are investing in any mutual fund, please tick here
Sole/1st Applicant 2nd Applicant 3rd Applicant
1. EXISTING UNIT HOLDERS INFORMATION (If you hold a Folio with L&T Mutual Fund, please furnish the below information and move to Investment & Payment Information section.)
Name of Sole/1st Unit Holder Mr. Ms. M/s First Name Middle Name Last Name Folio No.
Proof of Relationship of Guardian Birth Certicate Copy Passport Copy Court Appointment Order Others (please specify)
City/Town Pin
City/Town Pin
State Country
State Country
Tel (R) (ISD) (STD) Tel (O) (ISD) (STD) Fax (ISD) (STD)
Account Number Account Type Savings Current NRE NRO FCNR Others
Bank Name
Branch City
IFSC MICR
If you are not making the investment from the above mentioned bank account, please attach an original cancelled cheque leaf of the above account with the name
of the rst holder printed.
3. MODE OF HOLDING
4. DETAILS OF OTHER APPLICANT(S) (Please note that where the sole/1st applicant is a minor, no joint holders are allowed)
2nd Applicant
3rd Applicant
KYC is mandatory. Please enclose copies of KYC acknowledgement letters for all applicants. #PEKRN required for Micro investments upto Rs. 50,000 in a year.
^ 14 digit KYC Identication Number (KIN) and Date of Birth is mandatory for Individual(s) who has registered under Central KYC Records Registry (CKYCR).
5. POWER OF ATTORNEY (PoA) HOLDER DETAILS
If your investment is being made by a Constituted Attorney on your behalf, please furnish the below details and enclose a notarised copy of the Power of Attorney for registering
the same:
POA for Sole / First Applicant Second Applicant Third Applicant E-mail Id
6. INVESTMENT & PAYMENT INFORMATION (Please ensure that the cheque complies to the CTS 2010 standards)
Investment Type () Lumpsum SIP Multi-Scheme SIP (Please ll Multi-Scheme SIP Investment Form)
Micro SIP (Also ll & attach SIP Investment Form)
For Lumpsum & SIP Investment (Please issue cheque favouring scheme name)
Scheme Name L&T Option () Growth* Dividend Reinvestment Dividend Payout
Dividend Frequency (wherever applicable) Daily Weekly Monthly* Quarterly Annual^ Semi-Annual^
Payment Mode : Cheque / DD / Pay Order Electronic Transfer One Time Mandate (OTM)
OTM Debit Mandate is already registered in the folio. Please ll, Unique Mandate Reference Number (UMRN)
UTR No.
Bank Branch Bank City
Investment Amount (`)
DD Charges (if applicable `) Account Type Saving Current NRE NRO FCNR
Subject to realisation of cheque and furnishing of mandatory information/documents. Please retain this slip till you receive your Account Statement.
call 1800 2000 400 or 1800 4190 200 email investor.line@lntmf.co.in www.lntmf.com
Please note our lines are open from 9 am to 6 pm, Monday to Friday and 9 am to 1 pm on Saturday
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For Multi-Scheme SIP (Please issue cheque favouring L&T MF Multi-Scheme SIP)
Scheme 1
L&T Option () Growth* Dividend Payout Dividend Reinvestment
Dividend
Frequency SIP Amount (`)
Scheme 2
L&T Option () Growth* Dividend Payout Dividend Reinvestment
Dividend
Frequency SIP Amount (`)
Scheme 3
L&T Option () Growth* Dividend Payout Dividend Reinvestment
Dividend
Frequency
SIP Amount (`)
Investment Amount (`) Account Type Saving Current NRE NRO FCNR
If you wish to hold your investment in dematerialised mode please furnish the below details and enclose a copy of the Client Master that you may have received from your
Depository Participant.
Below 1 lac 1-5 Lacs 5-10 Lacs 10-25 Lacs 25 Lacs - 1 crore > 1 Crore
For First Applicant/
Guardian
Net-worth (`) as on D D / M M / Y Y Y Y (Not older than 1 year) (Mandatory for Non-Individuals)
Gross Annual
Income Below 1 lac 1-5 Lacs 5-10 Lacs 10-25 Lacs 25 Lacs - 1 crore > 1 Crore
(For Individuals For Second Applicant
and Non Net-worth (`) as on D D / M M / Y Y Y Y (Not older than 1 year)
Individuals)
Below 1 lac 1-5 Lacs 5-10 Lacs 10-25 Lacs 25 Lacs - 1 crore > 1 Crore
For Third Applicant
Net-worth (`) as on D D / M M / Y Y Y Y (Not older than 1 year)
For First Applicant/ Private Sector Service Public Sector Service Government Service Business Professional
Guardian Housewife Retired Student Forex Dealer Agriculturist Others Please specify
Occupation
Details Private Sector Service Public Sector Service Government Service Business Professional
For Second Applicant
(For Individuals Housewife Retired Student Forex Dealer Agriculturist Others Please specify
only)
Private Sector Service Public Sector Service Government Service Business Professional
For Third Applicant
Housewife Retired Student Forex Dealer Agriculturist Others Please specify
For First Applicant/ Guardian I am politically Exposed Person I am Related to Politically Exposed Person Not Applicable
Others
(For Individuals For Second Applicant I am politically Exposed Person I am Related to Politically Exposed Person Not Applicable
only)
For Third Applicant I am politically Exposed Person I am Related to Politically Exposed Person Not Applicable
Is the company a Listed Company or Subsidiary of Listed Company or Controlled by a Listed Company YES NO
Others (If No, please attach Ultimate Beneciary Ownership Declaration mandatorily)
(For If the Entity involved/providing any of the following services:
Non-Individuals Gaming/Gambling/Lottery/Casino Services YES NO
only) Foreign Exchange/ Money Changer Services YES NO
Money Lending/Pawning YES NO
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9. INFORMATION REQUIRED FOR TAX REPORTING (Mandatory. If left blank the application is liable to be rejected)
FOR INDIVIDUALS:
The below information is required for all applicant(s)/Guardian including Sole proprietor and POA Holder.
Sole/First Applicant/Guardian Second Applicant Third Applicant POA Holder
I am a tax resident of India and not a resident of any Yes Yes Yes Yes
other country
No No No No
If No, please mandatorily enclose the FATCA & CRS Declaration for Individual Investors.
FOR NON-INDIVIDUALS: Please mandatorily enclose the FATCA, CRS & UBO Declaration for Non Individuals with all the sections lled.
10. NOMINATION DETAILS (Please note that where the sole/1st applicant is a minor, no nomination is allowed)
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Systematic Investment Plan (SIP) / Micro SIP Form
Please refer to the General Instructions & Checklist for assistance. If you are not investing through a Distributor, write DIRECT in the Distributor Code. Time Stamp
Distributor Code Sub-Distributor ARN EUIN Branch Code Relationship Managers Name
Mobile +91-
ARN- Sub-Distributor Code
E-mail
Initial Commission will be paid by the investor directly to the distributor, based on assessment of various factors including the service rendered by the Distributor.
Transaction Charges Investors Declaration where EUIN is not furnished
SEBI (Mutual Fund) Regulations allow deduction of transaction charges of Rs. 100/- from your I/We conrm that the EUIN box has been intentionally left blank by me/us as this is an execution only
investment for payment to your distributor if your distributor has opted to receive transaction charges transaction without any interaction or advice by the employee/relationship manager/sales person of
for investments sourced by him. The transaction charges deductible are Rs. 150/- if you are investing the above distributor and/or notwithstanding the advice of inappropriateness, if any, provided by the
in Mutual Funds for the rst time. If you are making a SIP Investment, the transaction charges would be employee/relationship manager/sales person of distributor and the distributor has not charged any
deducted over 3-4 instalments. No transaction charges would be levied if you are not investing through advisory fees on this transaction.
a Distributor or your investment amount is less than Rs.10,000/-
If this is the rst time, you are investing in any mutual fund, please tick here
Sole/1st Applicant 2nd Applicant 3rd Applicant
1. APPLICANT INFORMATION (Mandatory. If left blank, the application is liable to be rejected)
Name of Sole/1st Unit Holder First Name Middle Name Last Name Folio No.
PAN/PEKRN** KIN^ Date of Birth^ D D M M Y Y Y Y
KIN^ First Unit Holder Second Unit Holder Third Unit Holder
Date of Birth^ (1st Unit Holder) D D M M Y Y Y Y Date of Birth^ (2nd Unit Holder) D D M M Y Y Y Y Date of Birth^ (3rd Unit Holder) D D M M Y Y Y Y
KYC is mandatory. Please enclose copies of KYC acknowledgement letters for all applicants. **PEKRN required for Micro investments upto Rs. 50,000 in a year.
^ 14 digit KYC Identication Number (KIN) and Date of Birth is mandatory for Individual(s) who has registered under Central KYC Records Registry (CKYCR).
Mobile No. +91- E-mail ID
2. SIP & INVESTMENT DETAILS (Mandatory. If left blank, the application is liable to be rejected)
New SIP Registration SIP Renewal Update new OTM debit mandate for already registered SIP (If selected, move to Section 4)
OTM Debit Mandate is already registered in the folio. Please ll, Unique Mandate Reference Number (UMRN)
Debit Bank Name Account No.
OTM Debit Mandate to be registered in the folio. (If selected, Section 4 to be lled in mandatorily)
To 3 1 1 2 2 0 9 9 Signature of First Account Holder Signature of Second Account Holder Signature of Third Account Holder
or Until Cancelled 1. Name as per Bank Records 2. Name as per Bank Records 3. Name as per Bank Records
This is to conrm that the declaration has been carefully read, understood & made by me/us. I am authorizing the User entity/Corporate to debit my account based on the instructions as agreed and signed by me.
I have understood that I am authorized to cancel/amend this mandate by appropriately communicating the cancellation/amendment request to the User entity/Corporate or the bank where I have authorized the debit. 7