BROKER CODE SUB-BROKER EUIN No.

ARN - 111569 930648 E082608

CONTACT NO.

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.
I/we hereby confirm that the EUIN box has been intentionally left blank by me/us as this is an 'execution-only" transaction without any
ANAND RATHI FINANCIAL SERVICES LIMITED interaction or advice by the employee/relationship manager/sales person of the above distributors or notwithstanding the advice of in-
Corporate Office: 11th Floor,TimesTower,Kamla ity,Lower appropriateness,if any, provided by the employee/relationship manager/sales person of the distributor and the distributor has not charge
Parel,Mumbai-400013 any advisory fees on this transaction'.

Signature First/sole Applicant/Guardian Second Applicant Third Applicant

COMMON TRANSACTION SLIP

Folio / Ac No. Fund Name

1st Holder Scheme Name
2nd holder Plans
3rd holder Option
Dividend Frequency
ADDITIONAL PURCHASE SWITCH
Rs. To Scheme
Rs. (In words) Plans
Drawn On Option
Branch Frequency
Cheque No. Rs.
Dated Rs. (In words)
PAN NO. No of Units
REDEMPTION RTGS PAYOUT / REDEMPTION / CHANGE OF BANK MANDATE
Rs. Bank Name
Rs. (In words) Branch
No. of Units A/c No.
Account Type
IFSC / RTGS Code

DECLARATION AND SIGNATURES

I/We have read and understood the terms and contents of the Scheme Information Document(s),Key Information Memorandum and Addenda issued for the respective Scheme(s). I/We hereby apply to the Trustee of Mutual Fund for allotment of Units of the Scheme(s) of
Mutual Fund, as indicated and agree to abide by the terms, conditions, rules and regulations of the relevant Scheme(s). I/We have understood the details/Risk factors of the Scheme(s) and I/we have neither received nor been induced by any rebate or gifts, directly or
indirectly, in making this investment. The ARN Holder has dislcosed to me with all material information including all the commissions(in the form of trail or any other mode) received for the different competing schemes of various mutual funds from amongst which the
scheme is being recommended to the investors. I/We hereby confirm that I/We have not been offered/communicated any indicative portfolio and/or any indicative yield by the respective Mutual Fund/its distributor for this investment. I/We am/are authorized to undertake this
transaction.

SIGANTURES

_________________________ ___________________________ __________________________

(Signature of the 1st Holder / (Signature of the 2nd Holder / (Signature of the 3rd Holder/
Authorised Signatory) Authorised Signatory) Authorised Signatory)