APPLICATION FORM

Please read Product labeling details

available on cover page and instructions before filling this Form

Application No.:
Distributor ARN and Name Sub Broker ARN & Name Sub Broker/Branch/RM Internal Code EUIN (Refer note below) For Office use only

ARN-58711
I/We confirm that the EUIN box is intentionally left blank by me/us as this is an “execution-only”
transaction without any interaction or advice by the distributor personnel concerned.
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 am a First Time Investor in Mutual Fund Industry. I am an Existing Investor in Mutual Fund Industry. Sole / First Applicant's Signature Mandatory

1. FIRST APPLICANT’S DETAILS

Name of First Applicant (Should match with PAN Card) PAN (1st Applicant / Guardian) KYC

Existing Folio Number Name of Guardian (if minor)/POA/Contact Person PAN (POA) KYC

On behalf of Minor Date of Birth Date of Birth Guardian named is :

D D M M Y Y Y Y
(* Attach Mandatory Documents as per instructions). Minor’s Proof attached * Father Mother Court Appointed
2. CONTACT DETAILS AND CORRESPONDENCE ADDRESS (As per KYC records)
Email ID Address Type (Mandatory)
(in capital)
a. Residential & Business
Mobile +91 Tel (STD Code)
b. Residential
Address c. Business
d. Registered Office

Landmark
City Pin Code
(Mandatory) State
3. KYC DETAILS (Mandatory)
3a. Status of Sole/1st Applicant (Please tick ) Indian Resident Individual Minor (Resident) Minor (Repatriable) Minor (Non Repatriable)
NRI (Repatriable) NRI (Non-Repatriable) PIO Sole Proprietorship HUF - Indian HUF - NRI Partnership Firm Limited Partnership (LLP) Public Ltd. Co.
Private Ltd. Co. Body Corporate Bank FIs Insurance Companies Government Body AOP/BOI Trust Society Provident Fund
Superannuation / Pension Fund Gratuity Fund Mutual Fund FII FPI-Category I/II/III FCRA GDN Defence Establishment NPS Trust
Others _____________________________________________________________ (Please specify)
Are you a Non-Profit Organization [NPO] or Company u/s 25 (Companies Act 1956) or u/s 8 of Companies, Act, 2013: Yes No

3b. Occupation Details (Please tick ) Private Sector Service Public Sector Service Government Service Business Professional
Agriculturist Retired Housewife Student Forex Dealer Others (Please specify)
3c. Gross Annual Income (Please tick ) Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs >25 Lacs-1 crore >1 crore
Net-worth in (Mandatory for Non-Individuals) ` as on D D M M Y Y Y Y (Not older than 1 year)
3d. For Individuals (Please tick )
Not Applicable I am Politically Exposed Person I am Related to Politically Exposed Person

4. JOINT APPLICANTS (IF ANY) DETAILS

Mode of Holding (Please tick ) Joint (Default) Anyone or Survivor
2nd Applicant Name (Should match with PAN Card) PAN (2nd Applicant) KYC

a. Occupation Details (Please tick ) Private Sector Service Public Sector Service Government Service Business
Professional Agriculturist Retired Housewife Student Forex Dealer Others (Please specify)
b. Gross Annual Income (Please tick ) Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs >25 Lacs-1 crore >1 crore
c. Others (Please tick ) Not Applicable Politically Exposed Person (PEP) Related to a Politically Exposed Person (PEP)

3rd Applicant Name (Should match with PAN Card) PAN (3rd Applicant) KYC

a. Occupation Details (Please tick ) Private Sector Service Public Sector Service Government Service Business
Professional Agriculturist Retired Housewife Student Forex Dealer Others (Please specify)
b. Gross Annual Income (Please tick ) Below 1 Lac 1-5 Lacs 5-10 Lacs 10-25 Lacs >25 Lacs-1 crore >1 crore
c. Others (Please tick ) Not Applicable Politically Exposed Person (PEP) Related to a Politically Exposed Person (PEP)

ACKNOWLEDGEMENT SLIP (To be filled in by the investor) DSP BLACKROCK MUTUAL FUND
Received, subject to realisation and verification an application for purchase of Units as mentionedin the application form.
Application No.
From
Scheme Cheque no. Amount
DSPBR
5. FATCA and CRS DETAILS For Individuals (Mandatory) Non Individual investors including HUF should mandatorily fill separate FATCA/CRS details form

Sole/First Applicant/Guardian 2nd Applicant 3rd Applicant POA

Place & Country of Birth PLACE COUNTRY Place & Country of Birth PLACE COUNTRY Place & Country of Birth PLACE COUNTRY

# Please indicate all Countries, other than India, in which you are a resident for tax purpose, associated Taxpayer Identification Number and it's Identification type eg. TIN etc.
*If TIN is not available or mentioned, please mention reason as: 'A' if the country does not issue TINs to its residents; 'B' & mention why you are unable to obtain a TIN; 'C' if the authorities
of the country of tax residence entered above do not require the TIN to be disclosed.

Country # Tax Identification Identification Country # Tax Identification Identification Country # Tax Identification Identification
Number Type/Reason* Number Type/Reason* Number Type/Reason*
1 1 1

2 2 2

3 3 3

6. BANK ACCOUNT DETAILS (Avail Multiple Bank Registration Facility)

Bank Name
Bank A/C No. A/C Type Savings Current NRE NRO FCNR Others

Branch Address
City Pin
IFSC code: (11 digit) MICR code (9 digit) (This is a 9 digit number next to your cheque number)

7. INVESTMENT AND
PAYMENT
DETAILS (Cheque/DD should be in favour of “Scheme Name”)

Scheme/Plan
/Option/Sub Option DSP BlackRock - Scheme Plan Option/Sub Option
(Default
plan/option/sub option will be applied incase of no information, ambiguity or discrepancy)
One time Lumpsum Investment SIP: Systematic Investment Plan. Attach OTM form, if not already registered. Mention First SIP Cheque Details below
Payment Mode: Cheque DD RTGS NEFT Funds transfer Cheque/RTGS/ D D M M Y Y Y Y
NEFT/DD
Date
Cheque/DD/RTGS/NEFT No. Payment from Pay In A/c No.
Amount (Rs.) (i) Bank A/c No.

DD charges, (Rs.)(ii) Bank Name

Total
Amount
(Rs.) (i) + (ii) In
figures Branch

In
Words
Account Type Savings Current NRE NRO FCNR
Documents Attached to avoid Third Party Payment Rejection, where applicable: Bank Certificate, for DD Third Party Declarations
8. NOMINATION DETAILS Individuals (single or joint applicants) are advised to avail Nomination facility.
I/We wish to nominate. I/We DO NOT wish to nominate and sign here 1st Applicant Signature (Mandatory)
Nominee Name Guardian Name (In case of Minor) Allocation % Nominee/ Guardian Signature

Nominee 1
Nominee 2
Nominee 3
Address
Total = 100%

9. UNIT HOLDING OPTION:

In Account Statement In Demat mode: NSDL: I N Depository Participant (DP) ID (NSDL only) Enclose for demat option:
Mode (default): Client Master List
Beneficiary Account Number (NSDL only)
Transaction/Holding Statement
CDSL: DIS Copy

10. DECLARATION & SIGNATURES

Having read and understood the contents of the Scheme Information Document and Statement of Additional Information, Key Information Memorandum, Instructions and addenda issued by DSP BlackRock
Mutual Fund form time to time, I / We, hereby apply to the Trustee of DSP BlackRock Mutual Fund for Units of the relevant Scheme/Plan/Option and agree to abide by the terms and conditions, rules and
regulations. I / We have understood the information requirements of the application form, including FATCA and CRS requirements, terms and conditions (read along with instructions and scheme related
documents) and hereby accept the same and further confirm that the information provided by me/us on this form is true, correct, and complete. 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, Regulation, Rule, Notification, Directions or any other applicable laws enacted by the Government of
India or any Statutory Authority.

Sole / First Applicant / Guardian Second Applicant Third Applicant POA holder, if any

Email: [email protected] Website: www.dspblackrock.com Contact Centre: 1800 200 4499

Quick Name, Address are correctly mentioned Full scheme name, plan, option is mentioned Additional documents provided if investor name is
Checklist not pre-printed on payment cheque or if
Email ID / Mobile number are mentioned Pay-In bank details and supportings are attached
KYC information provided for each applicant Nomination facility opted Demand Draft is used.
FATCA/CRS details provided for each applicant Form is signed by all applicants Non Individual investors should attach
FATCA Details and Declaration Form
UBO Declaration Form
 Unique Benefits Debit Mandate Checklist: SIP Registration Checklist:
● Distributor code & details, if any, ● Distributor code & details, if any,
● Register SIPs within 5 to 10 days
● Bank Account Number, Bank Name, IFSC or MICR Code ● Name, Folio No. / Application No.
● One Form - Multiple SIP’s
● Amount in words AND in Figures, as you would in a cheque ● Scheme/s details
● Multiple Schemes, Multiple Amounts,
(your maximum limit) ● SIP Amount
● Multiple Dates & Multiple Frequencies
● Folio No. / Application No.; Mobile & Email Id ● SIP Date, Frequency & Period
● Debit Mandate form to be filled just ONCE
● Your NAME and SIGNATURE as in your bank account ● Signature/s

Distributor ARN and Name Sub Broker ARN & Name Sub Broker/Branch/RM Internal Code EUIN (Refer note below) For Office use only
ARN-58711
The following Mandate needs to be submitted only once for registration with or without SIP form. Once the mandate is registered, investor need not submit mandate again and can do lump sum investments,
start new SIP registrations, using Physical Forms, Call, SMS or Online.

OTM Debit Mandate Form NACH/ECS/DIRECT DEBIT Date D D M M Y Y Y Y

[Applicable for Lumpsum Additional Purchases as well as SIP Registrations]

UMRN Office use only

Tick()
CREATE Sponsor Bank Code Office use only Utility Code Office use only

MODIFY I/We hereby authorize: DSP BLACKROCK MUTUAL FUND Schemes to debit (tick) SB / CA / CC / SB-NRE / SB-NRO / Other
CANCEL
Bank A/c No.:
With
Bank Name & Branch IFSC OR MICR
Bank:
an amount of Rupees `
FREQUENCY  Mthly  Qtly  H. Yrly  Yrly  As & when presented DEBIT TYPE  Fixed Amount  Maximum Amount
Reference 1 Folio No: Mobile

Reference 2 Appln No: Email id

I agree for the debit of mandate processing charges by the bank whom I am authorising to debit my account as per latest schedule of charges of the bank.
PERIOD
From D D M M Y Y Y Y
1. 2. 3.
to D D M M Y Y Y Y Signature of Account Holder Signature of Account Holder Signature of Account Holder
or  Until Cancelled 1. 2. 3.
Name of Account Holder Name of Account Holder Name of Account Holder
Declaration: This is to confirm that the declaration has been carefully read, understood and made by me/us. I/We have understood that I/we are authorised to cancel/amend this mandate by appropriately communicating the
cancellation/amendment request to the User entity or the bank where I have authorised the debit and express my willingness and authorize to make payments through participation in NACH/ECS/Direct Debit/Standing Instructions.
I/We hereby confirm adherence to the terms of OTM Facility and as amended from time to time and of NACH/ECS (Debits)/Direct Debits /Standing Instructions. Authorisation to Bank: This is to inform that I/We have registered for
ECS / NACH (Debit Clearing) / Direct Debit / Standing instructions facility and that my/our payment towards my/our investment in DSP BlackRock Mutual Fund shall be made from my/our above mentioned bank account with your
Bank. I/We authorize the representatives of DSP BlackRock Mutual Fund carrying this mandate form to get it verified and executed. Please attach a cancelled cheque/cheque copy

SIP Registration/Renewal Form (for OTM registered investors only)

Please tick  as applicable:
Attention: No need to attach OTM Debit Mandate again, if already registered earlier.
 OTM Debit Mandate is already registered in the folio. [No need to submit again]. SIP Auto debit can start in FIVE Days i.e. for debit date 7th, form can be submitted till 2nd of the month.
 OTM Debit Mandate is attached and to be registered in the folio. SIP Auto debit will start after mandate registration which takes Ten to Thirty days depending on NACH or ECS modalities.
The total of all installments in a day should be less than or equal to the amount as mentioned in One Time Mandate already registered or submitted, if not registered.
Distributor ARN and Name Sub Broker ARN & Name Sub Broker/Branch/RM Internal Code EUIN (Refer note below) For Office use only
ARN-58711
I/We confirm that the EUIN box is intentionally left blank by me/us as this is an “execution-only”transaction without any
interaction or advice by the distributor personnel concerned. 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. Sole / FirstApplicant's Signature Mandatory
Investor Name: Existing Investor
Folio No./Application No.

PAN/PEKRAN & KYC

Sole / First Applicant / Guardian Second Applicant / Guardian Third Applicant / Guardian
Sr. SIP Installment SIP Date Start Month/Year Top-Up (Minimum Rs. 500)
Scheme/Plan/Option/Sub-option Frequency
No. Amount (`) ( one only) End Month/Year* Amount (`) Frequency
1st* 7th
1. DSPBR - Monthly* M M Y Y Y Y Half-yearly
10th 14th to Top-Up CAP*: Yearly*
15th 21st Quarterly
M M Y Y Y Y
25th 28th

1st* 7th M M Y Y Y Y
2. DSPBR - Monthly* Half-yearly
10th 14th to Top-Up CAP*: Yearly*
15th 21st Quarterly
M M Y Y Y Y
25th 28th

1st* 7th M M Y Y Y Y
3. DSPBR - Monthly* Half-yearly
10th 14th to Top-Up CAP*: Yearly*
15th 21st Quarterly
M M Y Y Y Y
25th 28th
(*Maximum per Installment Amount after Top-Up shall not exceed Rs. Five Lakh) (*Default option) (*Default End Month/Year - 12/2099)
Declaration: Having read, understood and agreed to the contents of OTM Facility, the Scheme Information Document, Statement of Additional Information, Key Information Memorandum, Instructions and Addenda issued from time to time of the respective Scheme(s) of DSP
BlackRock Mutual Fund mentioned within, I hereby declare that the particulars given above are correct and express my willingness to make payments towards SIP instalments referred above through participation in NACH/ECS/Direct Debit/Standing Instructions. The ARN
holder, where applicable, has disclosed to me/us all the commissions (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.
Signatures [as per Mutual Fund Records/Application]

x First
Unit
Holder’s
Second
Unit
Holder’s
Third
Unit
Holder’s
Signature Signature Signature

Acknowledgement DSP BlackRock Mutual Fund ISC Stamp

Investor Name: Folio No/Application No.
DEBIT MANADATE FORM SIP FORM

Website : www.dspblackrock.com | E-mail : [email protected] | Contact Centre : 1-800-200-4499