HDFC Nifty LargeMidcap 250 Index Fund Application No.

:
An open ended scheme replicating/tracking Nifty LargeMidcap 250 Index (TRI)
Investors must read the Key Information Memorandum and the instructions before completing this Form.
This Form should be completed in English and in BLOCK LETTERS only.
Offer of Units of Rs. 10 each Per Unit for cash during the New Fund Offer Period (NFO) and at NAV based prices upon re-opening
New Fund Offer (NFO) Opens on: September 20, 2024
New Fund Offer (NFO) Closes on: October 04, 2024
Scheme re-opens on: Scheme will re-open for continuous Sale and Repurchase within 5 business days from the date of allotment of units under NFO
The AMC/Trustee reserves the right to change the New Fund Offer Dates / Period, subject to the condition that the New Fund Offer shall remain open for subscription for a minimum period of three (3) working days
not be kept open for more than 15 days or such other time permitted under the applicable regulations / law. An addendum shall be uploaded on the Fund’s website notifying the change in the NFO Dates / Period.
THIS PRODUCT IS SUITABLE FOR INVESTORS WHO ARE SEEKING* Scheme Riskometer# Benchmark Riskometer (As at August 31, 2024)

• Returns that are commensurate (before fees and expenses) with the performance of the Nifty LargeMidcap 250 Index (TRI)
Nifty LargeMidcap 250 Index (TRI), over long term, subject to tracking error. Modera
te
Modera
te
rate High ly rate High ly
• Investment in equity securities covered by the Nifty LargeMidcap 250 Index (TRI) Mode Mode
to Hi to Hi
w ate gh w ate gh
Lo der Lo der
*Investors should consult their financial advisers, if in doubt about whether the product is M o M o

Very

Very
suitable for them.

Low

Low
# The product labeling assigned during the New Fund Offer (NFO) is based on internal

High

High
assessment of the scheme characteristics or model portfolio and the same may vary post NFO
when the actual investments are made. RISKOMETER RISKOMETER
For latest riskometer, investors may refer to the Monthly Portfolios disclosed on the website of Investors understand that their principal
the Fund viz. www.hdfcfund.com will be at very high risk

KEY PARTNER / AGENT INFORMATION (Investors applying under Direct Plan must mention “Direct” in ARN column.) (Refer Instruction 1) FOR OFFICE USE ONLY CAMS bar code
ARN/RIA Code/Stock Broker/ ARN/RIA/Portfolio Internal Code Employee Unique (TIME STAMP)
Portfolio Manager Registration Manager's/ Stock Broker's Sub Agent’s ARN Bank Branch Code for Sub-Agent/ Identification Number
Number (PMRN) Name Employee (EUIN)

ARN-
EUIN Declaration (only where EUIN box is left blank) (Refer Instruction 1)
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.
SIGN

First/ Sole Applicant/ Guardian/ PoA Holder Second Applicant Third Applicant

TRANSACTION CHARGES FOR APPLICATIONS THROUGH DISTRIBUTORS ONLY (Refer Instruction 2)

I confirm that I am a first time investor across Mutual Funds. OR I confirm that I am an existing investor across Mutual Funds.
In case the purchase/ subscription amount is Rs. 10,000 or more and your Distributor has opted in to receive Transaction Charges, the same are deductible as applicable from the purchase/
subscription amount and payable to the Distributor. Units will be issued against the balance amount invested.
1. EXISTING UNIT HOLDER INFORMATION (IF YOU HAVE EXISTING FOLIO, PLEASE FILL IN SECTIONS viz. 1, 5, 9, 10 AND 14 ONLY. Refer instruction 3).
Folio No. The details in our records under the folio number mentioned alongside will apply for this application.

2. MODE OF HOLDING [Please tick (P)] Single Joint Anyone or Survivor

3. UNIT HOLDER INFORMATION (Refer instruction 4) DATE OF BIRTH@/DATE OF INCORPORATION D D M M Y Y Y Y Proof of date of birth@ Please (P)
Attached
NAME OF FIRST / SOLE APPLICANT (In case of Minor, there shall be no joint holders) (Name of the unitholder needs to as per PAN records (all unitholder)
Mr. Ms. M/s.
Nationality PAN#/ PEKRN#
KYC Number KYC # [Please tick (P)] (Mandatory) Proof Attached
Status of First/ Sole Applicant [Please tick (P)] Individual Non - Individual* [Please attach FATCA, CRS & Ultimate Beneficial Ownership (UBO) Self Certification Form]
(Mandatory) (Refer Instruction 4 & 18)
Resident Individual Partnership Trust HUF AOP PIO Company Minor through guardian BOI OCI Body Corporate LLP Society / Club
NRI-Repatriation NRI-Non Repatriation Foreign National Resident in India FPI Sole Proprietorship Non Profit Organisation (please specify)
Others _________________________
LEI No. Expiry Date: D D M M Y Y Y Y
(Mandatory for Non - Individuals transacting / proposing to transact for an amount of Rs. 50 crores or more)
* Trust/Societies/Section 8 companies to give below declaration
We are a “Non-Profit Organization” [NPO] which has been constituted for religious or charitable purposes referred to in clause (15) of section 2 of the
Income-tax Act, 1961 (43 of 1961), and is registered as a trust or a society under the Societies Registration Act, 1860 (21 of 1860) or any similar State YES NO
legislation or a Company registered under the section 8 of the Companies Act, 2013 (18 of 2013).
If yes, please quote Registration No. of Darpan portal of Niti Aayog.
(If not registered already, please register immediately and confirm with the above information)

NAME OF GUARDIAN (in case of First / Sole Applicant is a Minor) / NAME OF CONTACT PERSON – DESIGNATION (in case of non-individual Investors)
Mr. Ms.
Nationality Designation Contact No.
PAN#/ PEKRN# DATE OF BIRTH D D M M Y Y Y Y
KYC Number KYC # [Please tick (P)] (Mandatory) Proof Attached
Relationship with Minor@ Please (P) Father Mother Court appointed Legal Guardian Proof of relationship with minor@ Please (P) Attached @ Mandatory
# Please attach Proof. Refer instruction No 15 for PAN/PEKRN and No 17a for KYC (KRA). Refer instruction No 17b for KYC Identification Number issued by CKYCR.

ACKNOWLEDGEMENT SLIP (To be flled in by the Investor) [For any queries please contact our nearest Investor Service Centre or call us at our Customer Service Number 1800 3010 6767 / 1800 419 7676 (Toll Free)]
Date : HDFC MUTUAL FUND
Head Office : HDFC House, 2nd Floor, H.T. Parekh Marg, 165-166,
Backbay Reclamation, Churchgate, Mumbai - 400 020. Application No.:

Received from Mr. / Ms. / M/s. ________________________________________________________________________________________________

ISC Stamp & Signature
an application for subscription / redemption of _________ Units of HDFC Nifty LargeMidcap 250 Index Fund.

... continued overleaf

 MAILING ADDRESS OF FIRST / SOLE APPLICANT (Mandatory) (Refer Instruction 4A)

CITY STATE PIN CODE

COUNTRY
CONTACT DETAILS OF FIRST / SOLE APPLICANT Country Code - Mobile
STD Code STD Code Res. Telephone No. Office
eAlerts Mobile eDocs Email of First / Sole holder^ IN CAPITALS
This mobile number belongs to (Mandatory Please P): Self Spouse Dependent Children Dependent Siblings Dependent Parents Guardian POA Custodian (for FPIs only) PMS
This email id belongs to (Mandatory Please P): Self Spouse Dependent Children Dependent Siblings Dependent Parents Guardian POA Custodian (for FPIs only) PMS
I hereby declare that I shall immediately notify any change to the mobile number/ email id. (Refer instruction 9)
I/ We would like to register for online access to transact on HDFCMFOnline Investors as per the terms & conditions displayed on website: www.hdfcfund.com (Email id mandatory)
(only for non individuals and individuals with mode of holding as 'Joint'). Refer Instruction 11.
^ On providing email-id investors shall receive the scheme wise annual report or an abridged summary thereof/ account statements/ statutory and other documents by email.
However, if the investors wish to receive physical copy of the scheme wise annual report or an abridged summary thereof [Please tick (P)] Opt-in (Refer Instruction 9)
4. JOINT APPLICANT DETAILS, If any (Refer instruction 4) (In case of Minor, there shall be no joint holders)
1. NAME OF SECOND APPLICANT DATE OF BIRTH D D M M Y Y Y Y
Mr. Ms. M/s.
Nationality PAN#/ PEKRN#
KYC Number KYC # [Please tick (P)] (Mandatory) Proof Attached
CONTACT DETAILS OF SECOND APPLICANT
eAlerts Mobile eDocs Email of First / Sole holder^ IN CAPITALS
This mobile number belongs to (Mandatory Please P): Self Spouse Dependent Children Dependent Siblings Dependent Parents Guardian POA Custodian (for FPIs only) PMS
This email id belongs to (Mandatory Please P): Self Spouse Dependent Children Dependent Siblings Dependent Parents Guardian POA Custodian (for FPIs only) PMS
2. NAME OF THIRD APPLICANT DATE OF BIRTH D D M M Y Y Y Y
Mr. Ms. M/s.
Nationality PAN#/ PEKRN#
KYC Number KYC # [Please tick (P)] (Mandatory) Proof Attached
CONTACT DETAILS OF THIRD APPLICANT
eAlerts Mobile eDocs Email of First / Sole holder^ IN CAPITALS
This mobile number belongs to (Mandatory Please P): Self Spouse Dependent Children Dependent Siblings Dependent Parents Guardian POA Custodian (for FPIs only) PMS
This email id belongs to (Mandatory Please P): Self Spouse Dependent Children Dependent Siblings Dependent Parents Guardian POA Custodian (for FPIs only) PMS
# Please attach Proof. Refer instruction No 15 for PAN/PEKRN and No 17a for KYC (KRA). Refer instruction No 17b for KYC Identification Number issued by CKYCR.
5. ADDITIONAL KYC DETAILS (Refer instruction 4b)
Occupation details for 1st Applicant 2nd Applicant 3rd Applicant Guardian Politically Exposed Person (PEP) details: Is a PEP Related to PEP Not Applicable
Private Sector Service 1st Applicant
Public Sector Service 2nd Applicant
Government Service 3rd Applicant
Business
Guardian
Professional
Authorised Signatories
Agriculturist
Retired Promoters
Housewife Partners
Student Karta
Proprietorship Whole-time Directors
Others (Please specify) Trustee
Mandatory

Non-Individual Investors involved/ providing any of the mentioned services Foreign Exchange / Money Changer Services Gaming / Gambling / Lottery / Casino Services
Money Lending / Pawning None of the above
Gross Annual Income Range (in Rs.) 1st Applicant 2nd Applicant 3rd Applicant Guardian Gross Annual Income Range (in Rs.) 1st Applicant 2nd Applicant 3rd Applicant Guardian
Below 1 lac 10-25 lac
1-5 lac 25 lac- 1 cr
5-10 lac > 1 cr

OR Networth in Rs. (Mandatory as on

for Non Individual) (not older
than 1 year) DD MM YYYY

6. POWER OF ATTORNEY (PoA) HOLDER DETAILS

Name of PoA Mr. Ms. M/s.
PAN#/ PEKRN#
KYC Number KYC # [Please tick (P)] (Mandatory) Proof Attached
# Please attach Proof. Refer instruction No 15 for PAN/PEKRN and No 17a for KYC (KRA). Refer instruction No 17b for KYC Identification Number issued by CKYCR.
7. MODE OF PAYMENT OF REDEMPTION / IDCW PROCEEDS (refer instruction 10)
The redemption / IDCW proceeds will be directly credited to the investor's bank account.

8. UNIT HOLDING OPTION DEMAT MODE* PHYSICAL MODE (Default) ( refer instruction 12)
*Demat Account details are mandatory for (i) FPIs and (ii) investors who wish to hold the units in Demat Mode (Account statement (CAS) for units held in demat mode will be issued only by NSDL/CDSL)
Beneficiary
NSDL DP Name DP ID I N Account No.

Beneficiary
CDSL DP Name Account No.
*Investor opting to hold units in demat form, may provide a copy of the DP statement for us to match the demat details as stated in the application form.

Particulars
Scheme Name / Plan / Option / Sub-option / Cheque / DD / Payment Instrument /
Drawn on (Name of Bank and Branch) Amount in figures (Rs.)
Payout Option UTR No. / Date

HDFC Nifty LargeMidcap 250 Index Fund

Please Note: All Purchases are subject to realisation of cheques / demand drafts / Payment Instrument.
 9. FATCA AND CRS INFORMATION (for Individual including Sole Proprietor) (Self Certification) (Refer instruction 4)
The below information is required for all applicant(s)/ guardian
Address Type: Residential or Business Residential Business Registered Office (for address mentioned in form/existing address appearing in Folio)

Category First Applicant/Guardian in case of Minor Second Applicant/ Guardian Third Applicant

Place/ City of Birth

Country of Birth

Country of Tax Residency#

Is the applicant(s)/guardian's Country of Birth/Citizenship/ First Applicant/Guardian in case of Minor Second Applicant/ Guardian Third Applicant
Mandatory

Nationality/Tax Residency other than India?

Please indicate all countries in which you are resident for tax Yes No Yes No Yes No
purposes and the associated Tax Reference Numbers below*.
If Yes, please provide the following information [mandatory]
Category First Applicant/Guardian in case of Minor Second Applicant/ Guardian Third Applicant

Tax Payer Ref. ID No^

Identification Type
[TIN or other, please specify]

Country of Tax Residency 2

Tax Payer Ref. ID No. 2

Identification Type
[TIN or other, please specify]

Country of Tax Residency 3

Tax Payer Ref. ID No. 3

Identification Type
[TIN or other, please specify]

#To also include USA, where the individual is a citizen/ green card holder of USA. ^In case Tax Identification Number is not available, kindly provide its functional equivalent.

10. INVESTMENTS & PAYMENT DETAILS [Please (P)] (Refer instruction 6 & 7 for Scheme details and instruction 8 & 9 for Payment Details)
The name of the first/ sole applicant must be pre-printed on the cheque.
Regular Plan - Growth Option (Purchase/ Subscription routed through Distributor) Direct Plan - Growth Option (Purchase/ Subscription made directly with the Fund)
Mention valid ARN in Key Par tner/ Agent Information Mention DIRECT in Key Par tner/ Agent Information
Mode of Payment Cheque Demand Draft NEFT/ RTGS/ Fund Transfer One Time Mandate (OTM)
Name of Bank: HDFC Bank Limited Branch: Manekji Wadia Building, Ground Floor, Nanik Motwani Marg, For t, Mumbai
Beneficiary Name: HDFC NIFTY LARGEMIDCAP 250 INDEX FUND NFO COLLECTION ACCOUNT Account No: 57500001545427
RTGS/ NEFT IFSC Code: HDFC0000060
Please note that OTM can be selected as mode of payment provided OTM is already registered. In case OTM is not registered please fill in the attached OTM Debit Mandate to make future
transactions via OTM

Pay-In Bank Account No. Cheque/ DD/ Cheque/ DD/ Amount of Cheque / DD / DD Charges, Net Cheque/ DD
Drawn on Bank / Branch (For Cheque Only) Payment Instrument/ Payment Instrument/ Payment Instrument / if any
UTR No. UTR Date RTGS/ NEFT in figures (Rs.) Amount

Cheque/ DD Amount (in words):

11. BANK ACCOUNT DETAILS OF THE FIRST / SOLE APPLICANT (For redemption/ IDCW Payments if any) (refer instruction 5)
(Mandatory to attach proof, in case the pay-out bank account is different from the bank account mentioned under Section 10 above.)
For unit holders opting to hold units in demat form, please ensure that the bank account linked with the demat account is mentioned above.
Bank Name
Mandatory

Branch Name Bank City

Account Number
MICR Code (The 9 digit code appears on your cheque next to the cheque number)
Account Type (Please P) Savings Current NRO NRE FCNR Others (please specify) _______________________
*** Refer Instruction 5C (Mandatory for Credit via NEFT / RTGS) (11 Character code appearing on your
IFSC Code*** cheque leaf. If you do not find this on your cheque leaf, please check for the same with your bank)

Please continue on next page

 12. NOMINATION FOR UNITS IN NON-DEMAT MODE (Mandatory for new folios. For existing folios, mandatory to follow instruction no. 14)
I/We wish to make a nomination and do hereby OR I / We hereby confirm that I / We do not wish to appoint any nominee(s) for my mutual fund units held in my / our mutual fund
nominate the following person(s) who shall receive folio and understand the implications / issues involved in non-appointment of any nominee(s) and am/ are further aware that in
all the assets held in my / our account in the event case of my demise / death of all the unit holders in the folio, my / our legal heir(s) would need to submit all the requisite
of my / our death. documents issued by the Court or such other competent authority, as may be required by the Mutual Fund / AMC for settlement
of death claim / transmission of units in favour of the legal heir(s), based on the value of the units held in the mutual fund folio/s.
Nominee Relationship Name of the Guardian (Mandatory) Share of each
Name and Address of Nominee(s) PAN Date of Birth
(Mandatory)* PAN and Address of Guardian (Optional) nominee (%)$
(IN CAPITALS)
(Proof to be attached) (If not equally, please
(Mandatory)
(Mandatory to be furnished in case the Nominee is a minor) specify percentages below)

Equally
Not Equally
Nominee 1

PAN: _______________________ ________________%

Equally
Not Equally
Nominee 2

PAN: _______________________ ________________%

Equally
Not Equally
Nominee 3

PAN: _______________________ ________________%

Mobile/Telephone No. of nominee(s)/

Nominee 1 Nominee 2 Nominee 3
Guardian in case of Minor

Email ID of nominee(s)/ Guardian

Nominee 1 Nominee 2 Nominee 3
in case of Minor

Nominee/ Guardian (in case of Minor) Identification details – [Please tick any one of following and provide details of same]
Photograph & Signature PAN Aadhaar Saving Bank account no. Proof of Identity Demat Account ID
$ Any odd lot after division shall be transferred to the first nominee mentioned in the table above.
*Guardian’s Relationship with Nominee (Mandatory): Mother Father Legal Guardian
Proof of Relationship of Guardian with Minor: Birth Certificate School Leaving Certificate Passport Others _________________________
I/We have read and understood the instructions on nomination and I/We hereby undertake to abide by the same. The instructions contained herein supercedes all previous nominations made by
me/us in respect of the folio(s) mentioned above.
To be signed by ALL holders, irrespective of Mode of Holding or Mode of Operation

POA holder cannot

nominate.
First / Sole Applicant Second Applicant Third Applicant
13. RESOLUTION OF DISPUTES (For Institutional or corporate clients) (Refer instruction 20)
Smart ODR OR by harnessing any independent institutional mediation, independent institutional conciliation and/or independent arbitration institution in India.
14. DECLARATION & SIGNATURE/S (refer instruction 13)
I / We have read, understood the terms and conditions of the scheme related documents and the addendum issued therein till date, Key Information Memorandum of the Schemes as well as the rules and regulations
of SEBI, AMFI, Prevention of Money Laundering Act, 2002 and such other regulations as may be applicable to me/us from time to time and agree to comply with the same as a Unitholder. I /We hereby apply to the
Trustees for allotment of Units of the Scheme(s) of HDFC Mutual Fund (‘Fund’) and confirm and declare as under:
(a) I/We am/are eligible Investor(s) as per the scheme related documents and not prohibited from accessing capital markets by any order/ruling / judgment etc. passed by SEBI/ Statutory Authority or Courts in India
and Foreign laws. I am/We are authorised to make this investment as per the Constitutive documents/ authorization(s). The amount invested in the Scheme(s) is through legitimate sources only and is not for the
purpose of contravention and/or evasion of any act, rules, regulations, notifications or directions issued by any regulatory authority in India.
(b) I / We will be bound by the Fund's terms and conditions as amended from time to time.
(c) The information given by me /us in or along with this application form is true and correct and I/we shall furnish such other further/additional information as may be required by the HDFC Asset Management
Company Limited (AMC)/ Fund. I/We undertake to promptly inform the AMC / Fund/Registrars and Transfer Agent (RTA) in writing about any change in the information furnished by me/us from time to time.
(d) I/We hereby authorize you to disclose, share, remit in any form/manner/mode the above information and/or any part of it including the changes/updates that may be provided by me/us to the Fund, its Sponsor,
Trustees, Asset Management Company, its employees, agents and third party service providers, SEBI registered intermediaries for single updation/ submission, any Indian or foreign statutory, regulatory,
judicial, quasijudicial authorities/agencies including but not limited to Financial Intelligence Unit-India (FIU-IND) etc without any intimation/advice to me/us.
(e) I/We hereby consent for providing transactions data feed, portfolio holdings, NAV etc. in respect of my/our transactions under Direct Plan to the RIA/Portfolio Managers/ Stock Broker registered in the concerned
folio, if applicable.
(f) I/We shall be liable and responsible for any loss, claims suffered, directly or indirectly by AMC/ Fund/ RTA/ SEBI Intermediaries, arising out of any false, misleading, inaccurate and incomplete information
furnished by me/us at the time or investing/redeeming the units. I/We hereby unconditionally and irrevocably indemnify and at all time keep indemnified, save and harmless AMC/Fund/Trustee and their officers,
directors and employees against all actions, proceedings, claims, losses, damages, charges and expenses incurred or suffered /paid by AMC/Fund in this regard and in case of any dispute regarding the
eligibility, validity and authorization of my/our transactions.
(g) The ARN holder (AMFI registered Distributor) has disclosed to me/us all the commissions (in the form of trail commission or any other mode), payable to him/them for the different competing Schemes of
various Mutual Funds from amongst which the Scheme is being recommended to me/us.
(h) I/WE HEREBY CONFIRM THAT I/WE HAVE NOT BEEN OFFERED/ COMMUNICATED ANY INDICATIVE PORTFOLIO AND/ OR ANY INDICATIVE YIELD BY THE FUND/AMC/ITS DISTRIBUTOR FOR THIS
INVESTMENT.
Consent for Telemarketing (Refer Instruction 19):
I/We hereby accord my/our consent to HDFC AMC for receiving the promotional information/ material via email, SMS, telemarketing calls etc. on the mobile number and email provided by me/us in this
Application Form.
July 2024

Consent for disclosure of Personal Information in terms of Privacy Policy

I/We hereby confirm to have read, understood and agree to the terms of Privacy Policy (available on https://www.hdfcfund.com) (“Policy”) of HDFC AMC/ Fund.
I/We hereby accord my/our consent to HDFC AMC/Fund for collecting, receiving, possessing, storing, dealing, handling or disclosure of my/ our Personal Data and hereby authorize to disclose it to the third party
or another body corporate or any person acting under a lawful contract with HDFC AMC, in accordance with the Privacy Policy.
For Foreign Nationals Resident in India only:
I/We will redeem my/our entire investment/s before I/We change my/our Indian residency status. I/We shall be fully liable for all consequences (including taxation) arising out of the failure to redeem on
account of change in residential status.
For NRIs/ PIO/ OCIs/ FPIs only:
I/We confirm that my application is in compliance with applicable Indian and foreign laws.
For NRIs/ PIO/OCIs Please (P) Repatriation basis Non-repatriation basis
SIGN HERE
(Please write Application
Form No. / Folio No.
on the reverse of the
Cheque / Demand Draft /
Payment Instrument.) First / Sole Applicant / Guardian Second Applicant Third Applicant