REGISTRATION FORM FOR INDIVIDUAL INTERMEDIARY

ASSOCIATION OF MUTUAL FUNDS IN INDIA

709, RAHEHA CENTRE, FREE PRESS JOURNAL MARG, NARIMAN POINT,
MUMBAI – 400 021

1.6x1.8cm WxH
TWO COLOUR
PHOTOGRAPHS

PART-A DETAILS OF AMFI CERTIFICATION EXAM

(ADVISORS MODULE)

AMFI CERTIFICATE NO. :

TEST CENTRE :

DATE OF PASSING THE TEST :

D D M M Y Y Y Y

TESTING AUTHORITY :  PLEASE TICK WHICHEVER APPLICABLE

NCFM IICM

PART-B PERSONAL DETAILS

NAME :

FIRST NAME

MIDDLE NAME

LAST NAME
NAME TO BE PRINTED ON ARN CARD :

DATE OF BIRTH :
D D M M Y Y Y Y

SEX :
F M
ADDRESS :

CITY :

PINCODE :

TELEPHONE NUMBER (RESIDENCE) :

TELEPHONE NUMBER (OFFICE) :

E-MAIL ID :

PAN NO. :

PART- C QUALIFICATIONS

COURSE :

YEAR OF PASSING :

UNIVERSITY / INSTITUTE :

PART-D BANK DETAILS

BANK NAME :

BRANCH :

ACCOUNT NUMBER :
PART-E PAYMENT DETAILS

DEMAND DRAFT NO. :

DATE :
D D M M Y Y Y Y

AMOUNT :

Drawn on (Name & Branch of Bank) :

SIGNATURE OF THE APPLICANT

UNDERTAKING
I, hereby apply for grant of Certificate of Registration by Association of Mutual Funds in India (AMFI). I
acknowledge that Allotment of AMFI Registration Number (ARN) is solely for the purpose of enabling
me to canvass sale of mutual fund schemes.

I warrant that I will canvass business for products of mutual funds in accordance with AMFI Guidelines
and Norms for Intermediaries (AGNI) including Code of Conduct and any Rules and Regulations that
may be framed or amended by AMFI from time to time.

I confirm that I have truthfully filled up the Form above and supplied all the information therein which is
considered relevant for the purposes of grant of Certification of Registration. I shall promptly notify
AMFI of any changes in the information during the period the Certificate of Registration is in force.

I understand that allotment of ARN by AMFI is for the limited purpose of registering the intermediary
with AMFI and should not, in any way, be deemed to imply that AMFI takes any responsibility for any of
my act as intermediary or has vouched for my credentials as intermediary and I shall bring this to the
notice of all concerned while acting as intermediary.

I undertake that any breach of Guidelines and Code of Conduct or any Rules and Regulations framed
by AMFI will render my registration liable to be cancelled.

Place: SIGNATURE OF THE APPLICANT

Date:
 ACKNOWLEDGEMENT

Received Registration form from (Mr./Ms. ) ____________________________________

along with a Demand Draft No. _______________ for Rs. ___________________ (Rs.
__________________________________________) Drawn on (Bank & Branch)
______________________________________________dated ___________________ being
Fees for Registration with AMFI.

(SIGNATURE OF THE RECEIVER)

Note: Kindly fill & return this form to Computer Age Management Services (CAMS)
offices situated near your place (list attached) alongwith copy of certificate and Demand
Draft for Rs.500/- in favour of 'Association of Mutual Funds in India' payable at the
location of the CAMS office to which the form is submitted.