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Fortis PMS Application Form Individual

Fortis PMS Application Form Individual

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Published by Sameep Mehta

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Published by: Sameep Mehta on Sep 06, 2010
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09/06/2010

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PORTFOLIOMANAGEMENT SERVICES
Application Form - Individual
 
1
Personal Data of Sole/First Applicant
(Please fill in BLOCK LETTERS and tick
3
boxes wherever applicable).Title : Mr. Mrs. Ms. Dr. Other _____________________________________________________ Name of Sole/First Applicant :
(First)(Middle)(Last)
Status : Resident Individual Non-Resident Indian (NRI) Repatriable Non-Resident Indian (NRI) Non-RepatriableSex : Male FemalePAN No.Date of Birth :Place of Birth :
(Proof of PAN Mandotory for Resident individuals)
Permanent Address of Sole/First Applicant
(PO box address is not permitted) (Proof of Address - Mandatory)
Flat/Bldg. No./ NameStreet No. / NameAreaCityPin Code
State
CountryNationalityTel.(O)
(R)Fax
Mobile No.Email
In case of NRIs please provide Overseas address (Mandatory)
Correspondence Address of Sole/First Applicant
(PO box address is not permitted) (Proof of Address - Mandatory)
Occupation of Sole/First Applicant
If Salaried, whether employed in :
Public Company Private Company Bank / Institutions Others (please specify)_____________________________________Employer’s NameAddressApplicant’s Designation
If self employed, whether :
Business* Professional* Others*
* Specify details of Business/Professional/Others 
Name of EntityAddress
DDMMYYYY
Flat/Bldg. No./ NameStreet No. / NameAreaCityPin CodeStateCountry
If the Permanent Address is same as Correspondence Address, please tick
Flat/Bldg. No./ NameStreet No. / NameAreaCityPin CodeState CountryTel.(O)
(R)Fax
Mobile No.Email
Please tick(
4
) if you are:
Politician / Ex-Politician Military Official Money Service Bureau PSU EmployeeGovt. Empl. Retd. Govt. Empl./Officer Dealers in high val. commo. - Arms, Bullion, Jewellery, etc.Agriculturist Forex Dealer Other Cash Intensive Business like Hotels, Casinos etc. Relatives/Associate of above
If neither Salaried nor Self Employed, whether :
Student Housewife Retired
Please affix your photograph & sign across it.
Sole/First Applicant
APPLICATION FORM – INDIVIDUAL
 
2
Bank Account Details of Sole / First Applicant
(Preferably of the Account from where the corpus is received) (Proof of Bank Account details-Mandatory)
Bank Name
Bank Address
Account No.Account Type : Savings NRE NRO FCNR
(In case of multiple accounts, please provide the details on a separate sheet)
Demat Account Details of Sole / First Applicant
(Preferably of the Account from where the corpus is received) (Proof of Demat Account details-Mandatory)
Depository Participant Name
Depository Participant ID.Client ID.
(In case of multiple accounts, please provide the details on a separate sheet).
Personal Data of Second Applicant
(Please fill in BLOCK LETTERS and tick
3
boxes wherever applicable).Name of Second Applicant :
(First)(Middle)(Last)
Permanent Address of Second Applicant
(PO box address is not permitted) (Proof of Address - Mandatory)
Flat/Bldg. No./ NameStreet No. / NameAreaCityPin CodeStateCountryNationalityTel.FaxMobile No.Email
In case of NRIs please provide Overseas address (Mandatory)
Status : Resident Individual Non-Resident Indian (NRI) Repatriable Non-Resident Indian (NRI) Non-RepatriableSex : Male FemalePAN No.Date of Birth :Place of Birth :
(Proof of PAN Mandotory for Resident individuals)
Flat/Bldg. No./ NameStreet No. / NameAreaCityPin Code
State
Country
Occupation of Second Applicant
If Salaried, whether employed in :
Public Company Private Company Bank / Institutions Others (please specify)_____________________________________Employer’s NameAddressApplicant’s Designation
DDMMYYYY
Investment Option chosen by the Sole / First Applicant
Please affix your photograph & sign across it.
Second Applicant
Name of ProductIndicative Investment Amount
APPLICATION FORM – INDIVIDUAL

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