SIP TRANSACTION FORM

Single / Multiple SIP Option

Please read the instructions before filling up the Application Form. Tick () whichever is applicable, strike out whichever is not required.

1. DISTRIBUTOR INFORMATION
ARN code RIA code ARN / RIA Name Sub broker ARN code Sub broker code EUIN*
ARN - RIA - ARN -
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. Declaration for
“execution-only” transaction (only where EUIN box is left blank). I/We hereby confirm that the EUIN box has been intentionally left blank by me/us as this transaction is executed without any interaction or advice by
the employee/relationship manager/sales person of the above distributor/sub broker or notwithstanding the advice of in-appropriateness, if any, provided by the employee/relationship manager/sales person of the
distributor/sub broker. By mentioning RIA code, I/We authorize you to share my/our transactions data feed/portfolio holdings/ NAV details under Direct Plan of scheme(s) managed by you with the Investment Adviser.
2. UNIT HOLDER DETAILS (Mandatory)
Name of Unitholder: First Name Middle Name Last Name
Folio No. PAN 1
Note: Please mention Guardian pan if the 1st holder is below 18 years of age.
1

3. SIP DETAILS - New SIP Registration

Investment Details Monthly1 Quarterly
In case of multiple schemes, cheque should be drawn in favour of “PGIM India Mutual Fund - Common Collection A/c”
Scheme / Plan Growth IDCW 2 IDCW Amount SIP Date DD (Any date of the month
Payout Reinvestment except 29/30/31)

PGIM INDIA r Minimum Rs. 1000 SIP Period

PGIM INDIA r Minimum Rs. 1000 From DD/MM/YYYY
PGIM INDIA r Minimum Rs. 1000 To DD/MM/YYYY
TOTAL3 r Until cancelled
Initial Investment Details Amt. (r) Cheque No. Dated: Drawn on:
Note: 1 If the frequency is not opted the default option shall be Monthly. 2 IDCW option not available for FOF schemes. 3 If Multiple SIP option is opted then the investment amount should match with the total SIP amount.
4
For New SIP registration if you are using the existing OTM mandate please provide the details in the space provided below.
SIP renewal Change in OTM (For SIP registered earlier - OTM to be filled in mandatorily)
PGIM INDIA Scheme Plan Option Amount r
Frequency: Monthly Quarterly SIP Date DD SIP Period: From DD/MM/YYYY To DD/MM/YYYY Until cancelled
OTM Debit Mandate is already registered in the folio. Please fill, Unique Mandate (UMRN)*
4

Debit Bank Name Account No.

OTM Debit Mandate to be registered in the folio. (If selected, OTM to be filled in mandatorily) Note: *Existing Mandate should be valid for the enrolled period.
4. SIP TOP-UP
Top Up Amount r Top Up Frequency () Half Yearly* Yearly
Top Up to continue till# DD/MM/YYYY (Please  any one) OR Top Up to continue till SIP amount reaches^ r
* Default option if not selected. # It is the date from which SIP Top Up amount will cease. ^ SIP Top Up will cease once the mentioned amount is reached.
DECLARATION & SIGNATURE(S) : l/We hereby declare that the particulars given above are correct and express my willingness to make payments referred above to debit my/our account directly or through
participation in Auto Debit. If the transaction his delayed or not effected at all for reasons of incomplete or incorrect information. l/We would not hold the user institution responsible. l/We will also inform
AMC, about any changes in my/our bank account. l/We have read and agreed to the terms and conditions mentioned. l/We confirm that 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 different competing Schemes of various Mutual Funds from amongst which the Scheme is recommended to me/us. For investors investing
in Direct Plan: l/We hereby agree that the AMC has not recommended or advised me/us regarding the suitability or appropriateness of the product/scheme/plan. Applicable to Micro Investors (Delete
if not applicable): l/We hereby declare that l/We do not have any existing Micro Investments which together with the current application will result in aggregate investments exceeding r 50,000 in a year.
SIGNATURE (S) ✘ ✘ ✘
(Applicants must sign as per
Common Application Form) Sole/1st Applicant/Guardian/Authorised Signatory/POA 2nd Applicant/Guardian/Authorised Signatory/POA 3rd Applicant/Guardian/Authorised Signatory/POA

ONE TIME MANDATE FORM FOR NACH / ECS / AUTO DEBIT / LUMPSUM / SIP (*Mandatory field)

UMRN For office use Date* D D M M Y Y Y Y

Sponsor Bank Code CITI000PIGW Utility Code CITI 00002000000037
CREATE
I/We hereby authorize PGIM INDIA MUTUAL FUND to debit (Please ) SB / CA / CC / SB-NRE / SB-NRO / Other
MODIFY
CANCEL Bank a/c number*
With Bank* Name of customers bank IFSC* MICR*
an amount of Rupees* Amount in words ` In Figures
FREQUENCY* Mthly Qtly H-Yrly As & When presented DEBIT TYPE* Fixed Amount Maximum Amount
Reference - 1 Application no. / Folio number Phone No
Reference - 2 Email ID
I agree for the debit of mandate processing charges by the bank whom I am authorizing to debit my account as per latest schedule of charges of the bank.

PERIOD*
From D D M M Y Y Y Y
Signature of first account holder Signature of second account holder Signature of third account holder
To D D M M Y Y Y Y
OR Until Cancelled Name of first account holder* Name of second account holder* Name of third account holder*
• This is to confirm that the declaration has been carefully read, understood & made by me/us. I am authorizing the User entity/ Corporate to debit my account.
• 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 were I have authorized the debit.
 INSTRUCTIONS TO FILL IN THE SIP TRANSACTION FORM
1. DISTRIBUTOR INFORMATION • Minimum amount per instalment
a) In case, the investor is directly applying, then they should clearly mention “DIRECT” in the ARN • Minimum number of instalments
column. • Aggregate investment via SIP
b) Any edition or cancellation of the Distributor Information should be countersigned by the investor else e) Please furnish/indicate the below mentioned details with respect to your systematic investment.
the same is liable to be rejected. Investor can register up to 3 different SIPs in the same Folio using the Multiple SIP Registration
facility.
c) Quoting of EUIN is mandatory in case of advisory transactions.
i) Scheme/Plan/Option and IDCW Frequency, where applicable.
d) Distributors are advised to ensure that the sub broker affixes his/her ARN code in the column “Sub
broker ARN code” separately provided in addition to the current practice of affixing the internal code ii) SIP Instalment Amount. In case of multiple SIP, The initial Amount should match the total amount.
issued by the main ARN holder in the “Sub broker code (as allotted by ARN holder)” column and the iii) SIP Frequency - Monthly or Quarterly. Please tick the appropriate option.
EUIN of the Sales Person (if any) in the “EUIN” column. iv) SIP Dates (Monthly/Quarterly) - All dates available of the month except 29/30/31.
e) Distributors are advised to ensure that they fill in the RIA code, in case they are a Registered v) SIP Instalment Requirement:
Investment Advisor.
f) Investors are requested to note that EUIN is applicable for transactions such as Purchases, SIP (All open ended schemes except PGIM India Long Term Equity Fund)
Switches, Registrations of SIP / STP / Trigger STP / IDCW Transfer Plan and EUIN is not applicable Frequency Min Amount Rs. Multiple of Rs. Min Number of Instalments
for transactions such as Installments under SIP/ STP / SWP / STP Triggers, IDCW Reinvestments,
Redemption, SWP Registration, Zero Balance Folio creation and installments under IDCW Transfer Monthly & Quarterly 1000 1 5
Plans.
SIP - PGIM India Long Term Equity Fund
g) Investors are requested to note that EUIN is largely applicable to sales persons of non individual ARN
holders only (whether acting in the capacity of the main distributor or sub broker). Further, EUIN will Frequency Min Amount Rs. Multiple of Rs. Min Number of Instalments
not be applicable for overseas distributors who comply with the requirements as per AMFI circular Monthly 500 500 12
CIR/ ARN-14/12-13 dated July 13, 2012.
1000 and above 500 6
2. Unit holder details:
Quarterly 1000 500 6
a) Please furnish the name of the Sole/First Unit Holder and the existing Folio Number.
b) Please provide us with CKYC form for you to comply with the revised KYC requirements. For f) Your first Instalment can be for any day of the month. However, please note that there has to be a
more details, please visit our website http://www.pgimindiamf.com and download the CKYC minimum gap of 21 days between your first SIP and your second SIP instalment (if you are paying
form. for your subsequent SIP through Auto Debit).
Note: Renaming of Dividend Options g) SIP renewal -Please provide the scheme details and the OTM details.
Investors are requested to note that pursuant to SEBI circular no. SEBI/HO/IMD/DF3/CIR/P/2020/194 h) Change in OTM -Change in OTM for a SIP registered earlier fresh OTM has to be filled in.
dated October 05, 2020, the ‘Dividend options’ under all the existing schemes of PGIM India Mutual Fund
Multiple SIP Details:
(‘the Mutual Fund’) shall be renamed as follows with effect from April 1, 2021.
a) Investors can register upto 3 different SIP’s in the same folio using the multiple SIP registration facility.
Option/facility Name b) If the Multiple SIP is opted then the investment amount should match with the total SIP amount.
Dividend Payout Payout of Income Distribution cum Capital Withdrawal option (IDCW)
SIP TOP UP INSTRUCTIONS (Optional):
Dividend Re-investment Reinvestment of Income Distribution cum Capital Withdrawal option This sections is to be filled only if the investor wish to increase the SIP amount on half yearly/ yearly basis
(IDCW)
by pre-decided incremented amount.
Dividend Transfer/Sweep Plan Transfer/Sweep of Income Distribution cum Capital Withdrawal plan
a. SIP Top-Up Facility: Investors can opt for SIP Top Up facility wherein the amount of SIP can be
(IDCW)
increased at fixed intervals.
Investors are requested to note that the above changes are changes in the disclosure requirements. There • The minimum amount of increase under SIP Fixed Amount Top-Up facility should be
is no change in the current manner of calculation and distribution of dividend. Whenever distributable Monthly SIP: Rs. 100/- and in multiples of Re.1/- thereof.
surplus will be distributed, a clear segregation between income distribution (appreciation on NAV)
and capital distribution (Equalization Reserve) shall be suitably disclosed in the Consolidated Account Quarterly SIP: Rs. 100/- and in multiples of Re. 1/- thereof.
Statement provided to investors. • For PGIM India Long Term Equity Fund the minimum amount of increase under SIP Fixed Amount
should be Rs. 500/- and in multiples of Rs. 500/- for monthly and Rs. 1000/- and in multiples of Rs.
3. SIP DETAILS:
500/- for quarterly frequency.
a) Investors subscribing under Direct Plan of the Schemes should indicate the Scheme/Plan name in the
• SIP Top-Up frequency in case of investors availing Monthly SIP facility will be half yearly and yearly
transaction form as “Scheme Name - Direct Plan” for e.g. “PGIM India Midcap Opportunities Fund
and for availing Quarterly SIP facility, the frequency will be yearly. In case the SIP Top-Up frequency
- Direct Plan”. Investors should also indicate “Direct” in the ARN column of the transaction form.
is not indicated under Monthly SIP, it will be considered as half yearly.
However, in case Distributor code is mentioned in the transaction form, but “Direct Plan” is indicated
against the Scheme name, the Distributor code will be ignored and the transaction will be processed b. Your investment cheque should be crossed “Account Payee only” and drawn favoring the scheme
under Direct Plan. name where the investment is in a specific scheme h. Please ensure that the investment cheque
issued by you complies with CTS 2010 requirement stipulated by the Reserve Bank of India. The

V2 Febraury 2023
b) Please note, where application is received for Regular Plan without Distributor code or “Direct”
words “CTS 2010” should appear on the face of the cheque.
mentioned in the ARN Column, the application will be processed under Direct Plan.
c. Payments made by Cash/Money Order/Postal Order, Non-MICR cheque, outstation cheques are not
c) Please indicate whether your request is for Registration of a new SIP, Renewal of an existing SIP or
accepted.
for Change in Bank Details of an existing SIP.
d. For detailed terms and conditions on SIP, SIP Top-up, OTM facility, please visit our website
d) The below mentioned criteria should be met for an SIP investment as specified in the Scheme
www.pgimindiamf.com and also refer to scheme related documents.
Information Document or any addenda issued there to:

ONE TIME MANDATE INSTRUCTIONS FOR NACH / AUTO DEBIT

1. One Time Mandate (OTM) is an authorization to the bank issued by an investor to debit their bank account Key Information Memorandum, Instructions and Addenda issued from time to time of the respective
up to a maximum limit as provided by the investor in the OTM mandate. Scheme(s) of PGIM India Mutual Fund.
This would facilitate debits for all purchases initiated by the investor up to maximum limit from the bank 6. Date and the validity of the mandate should be mentioned in DD/MM/YYYY format.
account provided in the section. 7. Utility Code of the Service Provider will be mentioned by PGIM India Mutual Fund
To avail this facility the investors of the fund shall be required to submit one time mandate, completely filled 8. Tick on the respective option to select your choice of action and instruction.
in with all the details in the designated mandate form. Please attach a cancelled cheque copy.
9. The numeric data like Bank account number, Investors account number should be left padded with zeroes.
2. Investors, who have not registered for OTM facility, may fill the OTM form and submit duly signed with their
10. Please mention the Name of Bank and Branch, IFSC / MICR Code also provide An Original Cancelled
name mentioned.
copy of the cheque of the same bank account registered in One Time Mandate.
3. Mobile Number and Email Id: Unit holder(s) should mandatorily provide their mobile number and email id
11. Amount payable for service or maximum amount per transaction that could be processed in words. The
on the mandate form. Where the mobile number and email id mentioned on the mandate form differs from
amount in figures should be same as the amount mentioned in words, in case of ambiguity the mandate
the ones as already existing in the folio, the details provided on the mandate will be updated in the folio.
will be rejected.
All future communication whatsoever would be, thereafter, sent to the updated mobile number and email
id. 12. For the convenience of the investors the frequency of the mandate will be ”As and When Presented”
4. Unit holder(s) need to provide along with the mandate form an original cancelled cheque (or a copy) with 13. Please affix the Names of customer/s and signature/s as well as seal of Company (where required) and
name and account number pre-printed of the bank account to be registered or bank account verification sign the undertaking.
letter for registration of the mandate failing which registration may not be accepted. The Unit holder(s) 14. PGIMIMF may amend the above terms and conditions, at any time without prior notice to investors and
cheque/ bank account details are subject to third party verification. such amended terms and conditions will there upon apply to and will binding on the investor
5. Investors are deemed to have read and understood the terms and conditions of OTM Facility, SIP
registration through OTM facility, the Scheme Information Document, Statement of Additional Information,

For more information visit us at E-mail us at Call us (Toll free) at

www.pgimindiamf.com [email protected] 1800 266 7446