APPLICATION FORM

(To be filled in CAPITAL letters)

APP No.:

DISTRIBUTOR / BROKER INFORMATION (Refer Instruction No. I.9 & 10)

Name & Broker Code / ARN Sub Agent ARN Code Sub Agent Code *Employee Unique Identification Number RIA Code++

R. R. LAHORI EUIN - E054671

ARN- (ARN stamp here) ARN-
ARN-53115
*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 notwithstanding 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. GENERAL INFORMATION APPLICATION FOR Zero Balance Folio Investment ^MODE OF HOLDING : [Please tick(P)] Single Joint (Default) Any one or Survivor

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

Equity & Sector Specific CAF / 31st May 2021 / Ver 5.1
Guardian’s Relationship With Minor Date of Birth
D M M
(Mandatory in
Y case of Minor) Proof of Date of Birth and Guardian’s Relationship with Minor
of 1st Applicant D Y Y Y
Father Mother Court Appointed Guardian Birth Certificate Passport Others (please specify)
STATUS^ : Resident Individual PSU AOP/BOI Minor through Guardian HUF Trust /Charities / NGOs
Society FI NRI Company/Body Corporate Sole Proprietor Defence Establishment
PIO Bank FPI^^^ Government Body Partnership Firm Others
(^^^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. 5, 6 & 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 / FPI 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
Email ID provided pertains to Self Family Member (Note: If Email pertains to Family Member please select any one) Spouse Dependent Parents Dependent Children
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 hereby authorize NAM India to send important information and regular updates to me on WhatsApp. (Refer instruction no. XVI for
Terms and Conditions.) 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/Dividend/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.

ACKNOWLEDGMENT SLIP ( Please retain this slip)

To be filled in by the investor. Subject to realization of cheque and finishing of Mandatory Information.
Name of the Investor Mr/Ms/M/s : APP No.:
Scheme /Plan/ Option:
Time Stamp & Date
Payment Details: Amount ` Instrument No/Cash Deposit Slip No. Date : Drawn on Bank
of receiving office
Registered Office Address: 4th Floor, Tower A, Peninsula Business Park, Ganapatrao Kadam Marg, Lower Parel (W), Mumbai - 400 013.
9. FATCA and CRS DETAILS For Individuals (Mandatory) Non Individual Investors should mandatory 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 % Country % Country %
Ref. ID No Type Ref. ID No Type Ref. ID No Type
1 1 1
2 2 2
3 3 3
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
Sole/First Applicant/Guardian Second Applicant Third Applicant
^** ^** ^**
Country of Birth Country of Birth Country of Birth
^** ^** ^**
Country of Nationality Country of Nationality Country of Nationality

10. ADDITIONAL KYC DETAILS

OCCUPATION
^**
Professional Agriculturist Housewife Retired Government Service/PublicSector Business Forex Dealer Student Private Sector Service Others
st
1 Applicant
nd
2 Applicant
rd
3 Applicant
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
Are you related to a Politically Exposed Person (PEP)^** Yes No Yes No Yes No Yes No

11. INVESTMENT & PAYMENT DETAILS (Separate Application Form is required for investment in each Plan/Option. Multiple cheques not permitted with single application form
(Refer instruction no. IV) OTBM facility is available to investors who have Invest Easy facility registered with NIMF.
Scheme / Plan
(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)

Equity & Sector Specific CAF / 31st May 2021 / Ver 5.1
[Please tick (P) the appropriate boxes only if applicable to the scheme in which you plan to invest]
Growth^^ Payout of Income Distribution cum capital withdrawal option
Option
Reinvestment of Income Distribution cum capital withdrawal option Frequency of Income Distribution cum capital withdrawal option
Mode of Payment: Cheque DD Funds Transfer OTBM Facility (One Time Bank Mandate) Cash$ (Refer Instruction No. XV) RTGS / NEFT
LEI No. Valid Upto: D D MM Y Y Y Y
Note: LEI No. is Mandatory for transaction amount 50 Crs and above for Non Individual. Nippon India Mutual Fund LEI number is 335800HSE81TAD65RF98.
Investment DD Charges Net Amount~ Instrument No/Cash
Date Drawn on Bank Bank Branch City
Amount ( ` ) (if applicable) ( ` ) (` ) Deposit Slip No/UTR No.

I II I minus II D D M M Y Y Y Y
( Default option if not selected) ~Units will be allotted for the net amount minus the transaction charges if applicable. $Investors are requested to collect the cash deposit slip from the DISC
^^

Reason for Investment: House Children’s education Children’s Marriage Car Retirement Others
12. NOMINATION - I wish to Nominate Yes No (Mandatory if mode of holding is single) (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. Signature of applicants is mandatory if you do not wish to nominate.

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

1st Applicant

2nd Applicant

3rd Applicant

13. 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

14. DECLARATION AND SIGNATURE

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 including but not limited to Nippon
India Any Time Money Card. 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. This will override registry on DND / DNDC , as the case may be.

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

HERE (X) Authorised Signatory (X) Authorised Signatory Authorised Signatory

Add convenience to your life with our value added service

Simply send **SMS to 966 400 1111 to avail below facilities
Investor Service. A NIMF Virtual Branch Experience.
Types of Facilities Single Folio Multiple Folio
SMS For more details : Visit : mf.nipponindiaim.com
NAV SMS mynav SMS mynav <space> last 6 digits of folio
Balance SMS Balance SMS balance <space> last 6 digits of folio You can also follow us on
Last 3 Transaction SMS Transaction SMS txn <space> last 6 digits of folio
Statement thru mail SMS ESOA SMS ESOA <space> last 6 digits of folio **SMS charges apply
 SIP / SIP INSURE ENROLLMENT DETAILS
APP No.:

DISTRIBUTOR / BROKER INFORMATION (Refer Instruction No. 12 & 13)

Name & Broker Code / ARN Sub Agent ARN Code Sub Agent Code *Employee Unique Identification Number RIA Code++

ARN-53115
ARN- (ARN stamp here) ARN- EUIN - E054671
*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 notwithstanding 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
Upfront commission shall be paid directly by the investor to the AMFI registered distributor based on the investor's assessment of various factors including the service rendered by the distributor.
REQUEST FOR Registration of SIP$ Registration of SIP Insure Registration of Micro SIP $
( Default option if not selected)

APPLICANT DETAILS FOLIO NO.

Name of Sole/1st holder Mr./Ms./M/s PAN No / PEKRN. M A N D A T O R Y KYC
Name of 2nd holder Mr./Ms. PAN No / PEKRN. M A N D A T O R Y KYC
Name of 3rd holder Mr./Ms. PAN No / PEKRN. M A N D A T O R Y KYC
INITIAL INVESTMENT DETAILS
Cheque/ DD No./Cash Deposit Slip No. Cheque / DD / Cash Deposition Date DD Charge `
Net Amount ` Bank Name: Branch: City:
UNITHOLDING OPTION - Demat Mode Physical Mode (Ref. Instruction No. 23) Demat Account details are compulsory if demat mode is opted. Not applicable if you have opted for SIP Insure.
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)

One Time Bank Mandate + SIP & SIP Insure Enrollment Form / 30th July 2021 / Ver 2.5
(Nomination is mandatory if you have opted for SIP Insure) (Refer Instruction No. 26 to 29 ) Date of Birth of First Holder and Nomination details shall be replicated from the folio mentioned above.
NOMINATION In case Date of Birth of First Holder or Nomination details are not available in the folio, SIP insure application shall be liable for rejection. If investor wishes to register/ modify any of the
nomination details, Registration /Cancellation of Nominee form shall be provided separately.
SIP DETAILS Refer Instruction No. 13. Please refer respective SID/KIM for product labeling. Refer SIP Insure instructions in case you have opted for SIP Insure.
Frequency SIP Step-Up Facility (Optional) (Refer Instruction No. 25)
Scheme / Plan / Option (Please any one) Enrollment Period SIP Date Amount Amount Frequency Count
Increase SIP amount
Monthly (Default) From M M Y Y Y Y D D
` ` Half-yearly
time(s)
Quarterly Yearly To$ (Any date from 1st to
M M Y Y Y Y
28th of a given month) (in figures) (Multiples of ` 100 only ) **
Yearly (Default) (Default 1 time)
** In case of Nippon India Tax Saver Fund, Nippon India Retirement fund - Income Generation Plan & Nippon India Retirement fund- Wealth Creation Plan, the Step up minimum Amount should be ` 500 and in multiples of ` 500/- .
$ Incase the SIP ‘End Date’ is incorrect/ not legible/ not mentioned by the investor, then default end date shall be considered as December 2099. Note: STEP-UP facility is not applicable for SIP Insure registrations.

DECLARATION AND SIGNATURE

I/We would like to invest in above mentioned scheme subject to terms of the Statement of Additional Information (SAI) and Scheme Information Document (SID) and subsequent amendments thereto. I/We have read, understood (before
filling application form) and is/are bound to the details of the SAI and SID including details relating to various services including but not limited to ATM/ Debit Card. I/We have not received nor been induced by any rebate or gifts, directly or
indirectly, in making this investment. I accept and agree to be bound by the said Terms and Conditions including those excluding/ limiting the Nippon Life India Asset Management Limited 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 have read and hereby confirm Instruction no. XIII(A) and also hereby agree to abide by Instruction no. XIII(B). 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 understand that the insurance claim and the payment of the sum insured shall be made directly by Reliance Nippon Life Insurance Company Ltd (RNLIC) subject to the terms and conditions of insurance, read along
with the Certificate of Insurance of the group term insurance policy, Scheme Information Document and Statement of Additional Information. In the event my nominee is minor at the time of claim, I authorise RNLIC to make the payment only
on collection of lawful guardian details under the policy. Signed at_________________________________on this__________________________day of_______________20________.
++ 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. This will override registry on DND / DNDC , as the case may be.
By signing this SIP enrolment form I/We understand that the amount will be debited from the Bank account mentioned in One Time Bank Mandate / Invest Easy - Individuals Mandate Form.

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

HERE (X) Authorised Signatory (X) Authorised Signatory Authorised Signatory
Investors are requested to note that the amount mentioned in One Time Bank Mandate should be the maximum amount that you would like to invest in schemes of NIMF on any transaction day.

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

Reference 1 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

To: 3
D 1
D 1
M 2
M 2
Y 0
Y 9
Y 9
Y

Or Until Cancelled (X)

Signature of Account Holder (x)
Signature of Account Holder Signature of Account Holder
___________________________ ___________________________ ___________________________
Phone No:
Name as in Bank Record
1 ___________________________ Name as in Bank Record
2 ___________________________ Name as in Bank Record
3 ___________________________

ACKNOWLEDGMENT SLIP ( Please retain this slip)

Request for: Registration of Sip Registration of Sip Insure Registration of Micro Sip Application No.:
Name of the Investor Mr/Ms/M/s :
Scheme /Plan/ Option: Time Stamp & Date
Payment Details: Amount ` Instrument No/Cash Deposit Slip No. Date : Drawn on Bank of receiving office