MULTIPLE SIP COMMON APPLICATION FORM

(Multiple Investment through Single Cheque / One Time Bank Mandate Form)
(Applicable for New Investors Only)
APP No.:

MFD /RIA INFORMATION (Refer Instruction No. I.9 & 10)

Name & ARN Code Sub Agent ARN Code Sub Agent Code /Bank Branch Code/ Internal Code *Employee Unique Identification Number RIA Code
++

ARN-(ARN stamp here) ARN-

*Please sign alongside in case the EUIN is left blank/not provided. 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 not with standing 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 / Second Applicant / Third Applicant /

HERE Authorised Signatory Authorised Signatory Authorised Signatory

1. INVESTOR'S FOLIO NUMBER [Please tick (P) any one] I am a First time investor across Mutual Funds
OR I am an existing investor in Mutual Funds
(If you have an existing folio number with KYC validated, please mention the number here, enter your name in section 4 & proceed to section 9 & 10 to provide FATCA / Additional KYC details. If these details are
already provided please proceed to Section 11. Mode of holding will be as per existing folio number.)

2. UNITHOLDING OPTION - Demat Mode Physical Mode These details are compulsory if the investor wishes to hold the units in DEMAT mode. Ref. Instruction No. XI.
Please ensure that the sequence of names as mentioned in the application form matches with that of the account held with any one of the Depository Participant.

National Securities Depository Limited (NSDL) Central Depository Securities Limited (CDSL)

I N
DP ID No. Beneficiary Account No. Target ID No.

Enclosures (Please tick any one box) : Client Master List (CML) Transaction cum Holding Statement Cancelled Delivery Instruction Slip (DIS)

3. MODE OF HOLDING [Please tick(P)] Single Joint (Default) Any one or Survivor

Single Cheque Multiple Investment New Investor Form / 01st Oct 2023 / Ver 3.2
4. FIRST APPLICANT DETAILS
NAME^
Mr. Ms. M/s.

PAN / PEKRN^** CKYC Id^**

Name of Guardian if first applicant is minor / Mr. Ms.

Contact Person for non individuals
Guardian’s Relationship With Minor Proof of Date of Birth and Guardian’s Relationship with Minor
Date of Birth (Mandatory in
Father Mother Court Appointed Guardian of 1st Applicant D D M M Y Y Y Y case of Minor) Birth Certificate Passport Others (please specify)

Resident Individual PSU AOP/BOI Minor through Guardian Trust /Charities / NGOs HUF Defence Establishment
STATUS^

Private Limited Company FI NRI Body Corporate Sole Proprietor Society Others (please specify)

Public Limited Company PIO FPI^^^ Government Body Partnership Firm Bank
(^^^as and when applicable)

Are you involved / providing any of the mentioned services : Foreign Exchange / Money Changer Services Gaming / Gambling / Lottery / Casino Services
(Applicable only for Non Individuals) Money Lending / Pawning None of the above

Note: In case First Applicant is Non Individual please attach FATCA, CRS & UBO Self Certification Form (Ref Ins No. XIV) **In case First Applicant is Minor then details of Guardian will be required.
^Mandatory for all type of Investors. It is mandatory for investors to be KYC compliant prior to investing in Nippon India Mutual Fund. Refer instruction no.II. 6, 7 & X

5. SECOND APPLICANT DETAILS

NAME^
Mr. Ms. M/s.

PAN / PEKRN^** CKYC Id^** STATUS^: Resident Individual NRI

6. THIRD APPLICANT DETAILS

NAME^
Mr. Ms. M/s.

PAN / PEKRN^** CKYC Id^** STATUS^: Resident Individual NRI

7. CONTACT DETAILS OF SOLE / FIRST APPLICANT (Refer Instruction No. VII & IX)
Correspondence Address ## (P.O. Box is not sufficient) Overseas Address (Mandatory for NRI / FII Applicants)
Please note that your address details will be updated as per your KYC records with CKYC / KRA
##

House /Flat No. House /Flat No.

Street Address Street Address

City/ Town State City/ Town State

Country Pin Code Country Pin Code

Tel. (Res.) STD Code Tel. (Off.) Mobile No. (Country Code)

Email ID (CAPITAL letters only)

Investors providing Email Id would mandatorily receive E - Statement of Accounts in lieu of physical Statement of Accounts and the annual report or abridged summary on email.
Please register your Mobile No & Email Id with us to get instant transaction alerts via SMS & Email.
I wish to receive scheme wise annual report or abridged summary through Physical mode (Applicable only for investors who have not specified the email id)

8. BANK ACCOUNT DETAILS MANDATORY for Redemption/IDCW/Refunds, if any (Refer Instruction No. III)
Account No. M a n d a t o r y A/c. Type ( ) SB Current NRO NRE FCNR

Name of Bank M a n d a t o r y Bank Branch

Branch City PIN IFSC Code F o r C r e d i t v i a R T G S MICR Code 9 Digit For Credit via NEFT

Please ensure the name in this application form and in your bank account are the same. Please update your IFSC and MICR Code in order to get payouts via electronic mode in to your bank account.
9. FATCA and CRS DETAILS For Individuals (Mandatory) Non Individual Investors should mandatorily fill separate FATCA/CRS details form
# Please indicate all Countries in which you are a resident for tax purpose, associated Taxpayer Identification Number and it's Identification type eg. TIN etc.
Sole/First Applicant/Guardian Second Applicant Third Applicant
# ^** Tax Payer Identification # Tax Payer Identification # Tax Payer Identification
Country %
Type Country %
Type Country %
Type
Ref. ID No Ref. ID No Ref. ID No
1 1 1

2 2 2

3 3 3
^** ^** ^**
Country of Birth Country of Birth Country of Birth
^** ^** ^**
Country of Nationality Country of Nationality Country of Nationality
In case Country of Tax Residence is only India then details of Country of Birth & Nationality need not be provided. % In case Tax Identification Number is not available, kindly provide its functional equivalent
10. ADDITIONAL KYC DETAILS
OCCUPATION^** Professional Agriculturist Housewife Retired Government Service/PublicSector Business Forex Dealer Student Private Sector Service Others
1 Applicant
st

2nd Applicant
3 Applicant
rd

Guardian
GROSS ANNUAL INCOME DETAILS^** Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs 25 Lacs-1 Crore >1 Crore NET-WORTH
^**
in ` Date
1st Applicant (Net worth should D D M M Y Y Y Y

2nd Applicant not be older D D M M Y Y Y Y

3rd Applicant than 1 year) D D M M Y Y Y Y

Guardian D D M M Y Y Y Y

PEP DETAILS
^**
1st Applicant 2 nd Applicant 3 rd Applicant Guardian
Are you a Politically Exposed Person (PEP)^** Yes No Yes No Yes No Yes No

Single Cheque Multiple Investment New Investor Form / 01st Oct 2023 / Ver 3.2
Are you related to a Politically Exposed Person (PEP)^** Yes No Yes No Yes No Yes No

11. NOMINATION -(Ref. Instruction No. VI) In case of existing investor, Nomination details shall be replicated from the folio mentioned above. If investor wishes to register / modify any of the nomination details, Registration
/Cancellation of Nominee form shall be provided separately.

Nominee Name & Address PAN of Nominee Date of Birth Nominee Relation Guardian Name Guardian Relation Allocation Sign of Nominee /Guardian
(Optional) of Nominee With Investor (in case Nominee is Minor) with Nominee (%) (in case Nominee is Minor)

DD MM YYYY

DD MM YYYY

DD MM YYYY

FOR NOMINATION OPT-OUT: I/We DO NOT wish to make a nomination. (Please tick (ü) if the unit holder does not wish to nominate anyone)
I / We, the undersigned applicant(s)/unitholder(s) hereby confirm that I / we do not wish to appoint any nominee(s) in respect of the mutual fund application(s) / units held in my / our mutual
fund folio(s) and understand the implications / issues involved in non-appointment of any nominee(s) and am/ are further aware that in 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 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.

12. POWER OF ATTORNEY (POA) HOLDER DETAILS (Refer Instruction No. II. 1) PAN^
First Applicant POA Name Mr./Ms./M/s
Second Applicant POA Name Mr./Ms./M/s
Third Applicant POA Name Mr./Ms./M/s
13. INVESTMENT & PAYMENT DETAILS (Refer instruction no. IV)
(The Cheque / DD should be drawn in favour of “ NIPPON INDIA MUTUAL FUND SUBSCRIPTION POOL A/C” dated and duly signed.)
Mode of Payment Cheque DD (Note: Payment initiated through Cheque/ DD, shall be considered as SIP first instalment and cheque amount should be equal to total SIP amount of all the scheme mentioned below.)

Investment DD Charges Net Amount~

Cheque / DD No. Date Drawn on Bank Bank Branch City
Amount ( ` ) (if applicable) ( ` ) (`)

I II I minus II DD MM YYYY

~Units will be allotted for the net amount minus the transaction charges if applicable.
Reason for Investment: House Children’s education Children’s Marriage Car Retirement Others

14. REQUEST FOR Registration of SIP (Default option if not selected) Registration of Micro SIP Note : It is mandatory to submit One Time Bank Mandate Form
Scheme Details (Refer Instruction No. I-10) (For Product Labeling please refer last page of application form) (If you wish to invest in Direct Plan please mention Direct Plan against the scheme name)
** In case of Nippon India Tax Saver Fund, Nippon India Retirement fund - Income Generation Plan & Nippon India Retirement fund- Wealth Creation Plan, the SIP amount should be in multiples of ` 500.
$ Investor has to mandatorily mention “END DATE”. "END DATE” is mandatory and should be less than or equal to 30 years from the application date.
Scheme / Plan / Option Frequency Enrollment Period SIP Date SIP Amount
(Refer Instruction No. I.16) (Please any one)

Nippon India Daily

$$
Weekly
$$ From To$
Scheme 1

D D
Monthly (Default) M M Y Y Y Y M M Y Y Y Y `
(Any date from 1st to 28th (in figures)
Quarterly Yearly OR Default Date (31/12/2050) of a given month)##
Plan: Direct Regular
From To$
Nippon India Daily Weekly
$$ $$
Scheme 2

D D
Monthly (Default) M M Y Y Y Y M M Y Y Y Y `
(Any date from 1st to 28th (in figures)
Quarterly Yearly OR Default Date (31/12/2050) of a given month)##
Plan: Direct Regular

Daily
$$
Weekly
$$ From To$
Nippon India
Scheme 3

D D
Monthly (Default) M M Y Y Y Y M M Y Y Y Y `
(Any date from 1st to 28th (in figures)
Quarterly Yearly OR Default Date (31/12/2050) of a given month)##
Plan: Direct Regular

Daily$$ Weekly$$ From To$

Nippon India
Scheme 4

D D
Monthly (Default) M M Y Y Y Y M M Y Y Y Y `
(Any date from 1st to 28th (in figures)
Quarterly Yearly OR Default Date (31/12/2050) of a given month)##
Plan: Direct Regular

Nippon India Daily$$ Weekly$$ From To$

Scheme 5

D D
Monthly (Default) M M Y Y Y Y M M Y Y Y Y `
(Any date from 1st to 28th (in figures)
Quarterly Yearly OR Default Date (31/12/2050) of a given month)##
Plan: Direct Regular
Note : $$ Daily & Weekly SIP Frequencies are applicable for normal SIP and not for Flex SIP & Pause Facility. ##For weekly frequency, only 1st, 8th, 15th & 22nd date are eligible of every month.
15. DECLARATION AND SIGNATURE

Single Cheque Multiple Investment New Investor Form / 01st Oct 2023 / Ver 3.2
I/We would like to invest in above mentioned scheme subject to terms of the Statement of Additional Information (SAI), Scheme Information Document (SID), Key Information Memorandum (KIM) and subsequent amendments
thereto. I/We have read, understood (before filling application form) and is/are bound by the details of the SAI, SID & KIM including details relating to various services. I/We have not received nor been induced by any rebate or gifts,
directly or indirectly, in making this investment. I / We declare that the amount invested in the Scheme is through legitimate sources only and is not designed for the purpose of contravention or evasion of any Act / Regulations /
Rules / Notifications / Directions or any other Applicable Laws enacted by the Government of India or any Statutory Authority. I accept and agree to be bound by the said Terms and Conditions including those excluding/ limiting
the Nippon Life India Asset Management Limited (NAM India) liability. I understand that the NAM India may, at its absolute discretion, discontinue any of the services completely or partially without any prior notice to me. I agree
NAM India can debit from my folio for the service charges as applicable from time to time. 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 hereby declare that the above information is given by the undersigned and particulars given by me/us
are correct and complete. Further, I agree that the transaction charge (if applicable) shall be deducted from the subscription amount and the said charges shall be paid to the distributors.
I confirm that I am resident of India. 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. I hereby declare that the information provided in the Form is in accordance with section 285BA of the Income Tax Act, 1961 read with Rules 114F to 114H of the Income
Tax Rules, 1962 and the information provided by me /us in the Form, its supporting Annexures as well as in the documentary evidence provided by me/us are, to the best of our knowledge and belief, true, correct and complete.
++ I/We, have invested in the Scheme(s) of your Mutual Fund under Direct Plan. I/We hereby give you my/our consent to share/provide the transactions data feed/ portfolio holdings/ NAV etc. in respect of my/our investments
under Direct Plan of all Schemes Managed by you, to the above mentioned Mutual Fund Distributor / SEBI-Registered Investment Adviser. I hereby authorize the representatives of Nippon Life India Asset Management Limited and
its Associates to contact me through any mode of communication.

SIGN First / Sole Applicant / Guardian / Second Applicant / Third Applicant /

HERE Authorised Signatory Authorised Signatory Authorised Signatory

ONE TIME BANK MANDATE

(NACH / Direct Debit Mandate Form)
(Applicable for Lumpsum Additional Purchases as well as SIP Registration)

UMRN (For Office Use Only) Date: D D M M Y Y Y Y

Sponsor Bank Code (For Office Use Only) Create x Modify x Cancel

Utility Code (For Office Use Only) I/We hereby authorize Nippon India Mutual Fund
to debit (tick ) SB / CA / CC / SB-NRE / SB-NRO / Other Bank a/c number (Destination Bank Account Number)

With Bank (Name of Destination Bank) IFSC / MICR

an amount of Rupees (Amount in word) ` (Amount in figure)

DEBIT TYPE x Fixed Amount Maximum Amount FREQUENCY: x Monthly x Quarterly x Half Yearly x Yearly as & when presented

Reference 1 (Folio No.) Reference 2

1. 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. 2. This is to
confirm that the declaration has been carefully read, understood & made by me/us. I am authorising the user entity/Corporate to debit my account, based on the
instructions as agreed and signed by me. 3. 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.

From : D D M M Y Y Y Y

Signature of Account Holder Signature of Account Holder Signature of Account Holder

To:*** 3
D 1D 1
M 2M 2
Y 0 5 Y0
Y Y

Phone No: Name as in Bank Record Name as in Bank Record Name as in Bank Record
1 2 3

***As per NPCI Circular dated 18th Aug’2023, mandate can be for maximum duration of 30 years from the date of application.

ACKNOWLEDGMENT SLIP ( Please retain this slip)

To be filled in by the investor. Subject to realization of cheque
and finishing of Mandatory Information.

APP No.:

REQUEST FOR Registration of SIP Registration of Micro SIP

Name of the Investor Mr/Ms/M/s :

Cheque/DD No. Date : Drawn on Bank :

Sr. No. Scheme Name / Plan / Option Amount ( ` )

Stamp of receiving branch
& Signature

Registered Office Address: 4th Floor, Tower A, Peninsula Business Park, Ganapatrao Kadam Marg, Lower Parel (W), Mumbai - 400 013.
 A N K
P T BL
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A L L
N T I ON
IN TE
N I S
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THIS

*I/We hereby declare that the particulars given on this mandate are correct and complete. If the transaction is delayed or not effected at all for reasons of incomplete or incorrect information, I/We

Single Cheque Multiple Investment New Investor Form / 01st Oct 2023 / Ver 3.2
would not hold Nippon India Mutual Fund, their representatives, service providers, participating banks & other user institutions responsible. I/We have read the Terms & Conditions and agree to
discharge the responsibility expected of me/us as a participant/s under the scheme. I/We authorize use of above mentioned contact details for the purpose of this specific mandate instruction
processing. I/We hereby confirm adherence to terms on this mandate.I hereby authorize the representatives of Nippon Life India Asset Management Limited and its Associates to contact me
through any mode of communication.

Authorisation to Bank: I/We wish to inform you that I/we have registered with Nippon India Mutual Fund for NACH / Direct Debit through their authorised Service Provider(s) and representative for
my/our payment to the above mentioned beneficiary by debit to my/our above mentioned bank account. For this purpose I/We hereby approve to raise a debit to my/our above mentioned
account with your branch. I/We hereby authorize you to honor all such requests received through to debit my/our account with the amount requested, for due remittance of the proceeds to the
beneficiary.

FOR OFFICE USE ONLY (Not to be filled in by Investor)

Affix Barcode Date and Time Stamp No.

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