Application No.

B 5028623

UCC 3419404

Reference No. 5028623

Partner 17610-ZAREENA JAMSHED

Partner Center DHANBAD

First Holder Name RANJITA SINHA

Second Holder Name -

Third Holder Name

-

E-WEALTH MF ACCOUNT OPENING FORM

INDIVIDUAL
Th
isp
ag
ei
si
nt
en
tio
na
lly
lef
tb
lan
k
 E-WEALTH MF ACCOUNT OPENING FORM
ARN No.: 0155 Sub-Broker Code & Name: _____________________________________________________________________________
17610-ZAREENA JAMSHED

EUIN No.:_______________________
E395620 Application Date:________________
04/10/2024 Application No:______________________
5028623 UCC No.:_________________
3419404

APPLICANT'S DETAILS

Applicant Name:____________________________________________________________________________________________________________________
RANJITA SINHA

Date of Birth: _________________

07/09/1985 Marital Status: _________________
MARRIED Gender: Male Female Other

Father / Spouse Name:______________________________________________________________________________________________________________

HARI NARAYAN SINHA

Tax Status: _________________________________

INDIVIDUAL PAN No.: _________________________________
FDEPS6281K

KRA KYC Status: Compliant Non- Compliant CKYC Status: Compliant Non- Compliant

Address:___________________________________________________________________________________________________________________________
VILLMURKUM POSTGAMHARIA MURKUM SERAIKELA KHAR

___________________________________________________________________________________________________________________________________
SAWAN GAMHARIANEAR SHIV MANDIR

City: _______________________
SERAIKELA KHARSAWAN State: _______________________
JHARKHAND Country: _______________________
INDIA Pin Code:______________________
832108

Mobile:_____________________________
91 7488010747 Email: _________________________________________________________________________________________
[email protected]

Income Details: Below Rs.1 Lac Rs. 1 - 5 Lacs Rs. 5 - 10 Lacs Rs.10 - 25 Lacs Rs.25 Lacs -1 Crore More Than Rs.1 Crore

Occupation: Agriculturist Business Professional Housewife Not Categorized Self Employed Public Sector

Retired Student Private Sector Service Government Service Others______________________________

Please Specify

Politically Exposed Person / Related to Politically Exposed person ? Yes No

Mode of Holding: Single Anyone or Survivor Joint

SECOND HOLDER’S/GAURDIAN’S DETAILS

Second Holder’s/Gaurdian’s Name:________________________________________________________________________________________________________

-

Date of Birth: _________________

- Marital Status: _________________
- Gender: Male Female Other

Father / Spouse Name:_________________________________________________________________________________________________________________

-

Tax Status: _________________________________

- PAN No.: _________________________________
-

KRA KYC Status: Compliant Non- Compliant CKYC Status: Compliant Non- Compliant

Address:___________________________________________________________________________________________________________________________
-

___________________________________________________________________________________________________________________________________

City: _______________________
- State: _______________________
- Country: _______________________
- Pin Code:______________________
-

Mobile:_____________________________ Email: _________________________________________________________________________________________

-

Income Details: Below Rs.1 Lac Rs. 1 - 5 Lacs Rs. 5 - 10 Lacs Rs.10 - 25 Lacs Rs.25 Lacs -1 Crore More Than Rs.1 Crore

Occupation: Agriculturist Business Professional Housewife Not Categorized Self Employed Public Sector

Retired Student Private Sector Service Government Service Others______________________________

Please Specify

Politically Exposed Person / Related to Politically Exposed person ? Yes No

Relationship with Applicant (if applicant is minor):__________________________________________________________________________________________

Name__________________________________
RANJITA SINHA Name__________________________________
- Name__________________________________
-

Signature Not Verified

Date:
2024-10-07
20:34:48

Sole / First Applicant / Guardian Second Applicant Third Applicant

1
 E-WEALTH MF ACCOUNT OPENING FORM
THIRD HOLDER’S DETAILS

Third Holder’s Name:_____________________________________________________________________________________________________________________

-

Date of Birth: _________________

- Marital Status: _________________
- Gender: Male Female Other

Father/Spouse Name:_________________________________________________________________________________________________________________
-

Tax Status: _________________________________

- PAN No.: _________________________________
-

KRA KYC Status: Compliant Non- Compliant CKYC Status: Compliant Non- Compliant

Address:___________________________________________________________________________________________________________________________
-

___________________________________________________________________________________________________________________________________

City: _______________________
- State: _______________________
- Country: _______________________
- Pin Code:______________________
-

Mobile:_____________________________ Email: _________________________________________________________________________________________

-

Income Details: Below Rs.1 Lac Rs. 1 - 5 Lacs Rs. 5 - 10 Lacs Rs.10 - 25 Lacs Rs.25 Lacs -1 Crore More Than Rs.1 Crore

Occupation: Agriculturist Business Professional Housewife Not Categorized Self Employed Public Sector

Retired Student Private Sector Service Government Service Others______________________________

Please Specify

Politically Exposed Person / Related to Politically Exposed person ? Yes No

Relationship with Applicant (if applicant is minor):__________________________________________________________________________________________

BANK MANDATE DETAILS

Name of Bank:_______________________________________________________________________________________________________________________
PUNJAB NATIONAL BANK

Account Number : _________________________________

0670100100004627 IFSC Code: _____________________________
PUNB0067010 MICR Code: ____________________________
-

Account Type: Savings Current NRE NRO CC OD Others

Bank Address:_______________________________________________________________________________________________________________________
BAIDEHI BHAWAN NR AKAS WANI BHAVAN ADITYAPUR 831013

____________________________________________________________________________________________________________________________________

MF TARIFF SHEET
Transaction type/ Scheme type Purchase/ Switch Redemption SIP

Equity/Balance 0 0 0

Debt 0 0 0

Cash 0 0 0

Others 0 0 0

Note:
1. The above rates would be charged/collected from the client at the time of transaction.
2. Brokerage rate mentioned would be considered in percentage terms.
3. The rates would be inclusive of Service Tax.
4. NJ India Invest Private Limited reserves the right to deduct the brokerage from future transactions, in case of any pending dues.
5. Brokerage structure for "Others" include all schemes not covered under Equity, Debt & Cash.

Name__________________________________
RANJITA SINHA Name__________________________________
- Name__________________________________
-

Signature Not Verified

Date:
2024-10-07
20:34:48

Sole / First Applicant / Guardian Second Applicant Third Applicant

2
 FORM FOR FRESH NOMINATION
Applicable for Individual Unitholders only - whether holding Units Singly or Jointly with other holders
Name of 1st Holder:_____________________________________________________________________________________________________________________
RANJITA SINHA

Name of 2nd Holder:____________________________________________________________________________________________________________________

-

Name of 3rd Holder:_____________________________________________________________________________________________________________________

-

I/We, the above-named holders of ________________________________________________ Mutual Fund Account, do hereby nominate the person(s) more
particularly described hereunder to receive the Units held in the folio in the event of my/our death by cancelling the nomination(s) made by me/us previously
in respect of the units held by me/ us in the Folio/s.

1ST NOMINEE DETAILS

Name of the 1st Nominee*:___________________________________________________________________________
HARI NARAYAN SINHA % of Allocation*:________________
100

PAN of the Nominee$:_____________________________

- D15/11/1955
D M M Y Y Y Y
Date of Birth of Nominee**:____________________________

Nominee Relationship*:________________________________________________________________________________________________________________
FATHER

Name of the Guardian **:_______________________________________________________

- PAN of Nominee Guardian$:____________________________
-

Guardian’s Relationship with Nominee** Mother Father Legal Guardian

Proof of relationship $
Birth Certificate School Leaving Certificate Passport Others
ANEAR SHIV MANDIR, SERAIKELA KHARSAWAN, JHARKHAND, INDIA
Address:___________________________________________________________________________________________________________________________
VILLMURKUM POSTGAMHARIA, MURKUM SERAIKELA KHARSAWAN, GAMHARI

City: _______________________
SERAIKELA KHARSAWAN State: _______________________
JHARKHAND Country: _______________________
INDIA Pin Code:______________________
832108

Nominee Signature$:_____________________

2ND NOMINEE DETAILS

Name of the 2nd Nominee*:___________________________________________________________________________
- % of Allocation*:________________
-

PAN of the Nominee$:_____________________________

- D- D M M Y Y Y Y
Date of Birth of Nominee**:____________________________

Nominee Relationship*:________________________________________________________________________________________________________________
-

Name of the Guardian **:_______________________________________________________

- PAN of Nominee Guardian$:____________________________
-

Guardian’s Relationship with Nominee** Mother Father Legal Guardian

Proof of relationship $
Birth Certificate School Leaving Certificate Passport Others

Address:___________________________________________________________________________________________________________________________
-

City: _______________________
- State: _______________________
- Country: _______________________
- Pin Code:______________________
-

Nominee Signature$:_____________________

3RD NOMINEE DETAILS

Name of the 3rd Nominee*:___________________________________________________________________________
- % of Allocation*:________________
-

PAN of the Nominee :_____________________________

- $ D- D M M Y Y Y Y
Date of Birth of Nominee**:____________________________

Nominee Relationship*:________________________________________________________________________________________________________________
-

Name of the Guardian **:_______________________________________________________

- PAN of Nominee Guardian$:____________________________
-

Guardian’s Relationship with Nominee** Mother Father Legal Guardian

Proof of relationship$ Birth Certificate School Leaving Certificate Passport Others

Address:___________________________________________________________________________________________________________________________
-

City: _______________________
- State: _______________________
- Country: _______________________
- Pin Code:______________________
-

Nominee Signature$:_____________________

Signature Not Verified

Date:
2024-10-07
20:34:48

Signature of the 1st Holder Signature of the 2nd Holder Signature of the 3rd Holder

* Mandatory, $ Optional **Mandatory & Applicable in case the Nominee is a Minor

3
 DECLARATION FORM FOR OPTING OUT OF NOMINATION

D D M M Y Y Y Y
Date:____________________________

To

NJ India Invest Private Limited,

Application Number_______________________________

Sole / First Holder Name: ________________________________________________________________________________________________________________

Second Holder Name: ___________________________________________________________________________________________________________________

Third Holder Name: _____________________________________________________________________________________________________________________

DECLARATION & SIGNATURE

I / We hereby confirm that I / We do not wish to appoint any nominee(s) for my mutual fund units held in my / our mutual fund folio and understand
the issues involved in non-appointment of nominee(s) and further are aware that in case of death of all the account holder(s), my / our legal heirs
would need to submit all the requisite documents issued by Court or other such competent authority, based on the value of assets held in the mutual
fund folio.

Name__________________________________ Name__________________________________ Name__________________________________

Signature of the 1st Holder Signature of the 2nd Holder Signature of the 3rd Holder

4
 FATCA-CRS Declaration - Individuals
(Please consult your professional tax advisor for further guidance on your tax residency, FATCA / CRS Guidance)

SOLE/FIRST HOLDER DETAILS

PAN*: _______________________________________
FDEPS6281K

Name: _____________________________________________________________________________________________________________________________________
RANJITA SINHA

Type of address given at KYC KRA Residential Residential or Business Business Registered Office

State______________________________________________
JHARKHAND

Phone No (with ISD Code): ______________________________________________

91 7488010747

Place of Birth: ______________________________________________

RANCHI

Country of Birth: ______________________________________________

INDIA

Nationality: ______________________________________________
INDIA

Are you a tax resident of any country other than India? Yes No

# If yes, 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, GIIN, CIN, EIN, others, etc.

Country
#
Tax Identifications Number Identification Type
(TIN or Other, please specify)
- - -

- - -

- - -

SECOND HOLDER DETAILS

PAN*: _______________________________________
-

Name: _____________________________________________________________________________________________________________________________________
-

Type of address given at KYC KRA Residential Residential or Business Business Registered Office

State______________________________________________
-

Phone No (with ISD Code): ______________________________________________

-

Place of Birth: ______________________________________________

-

Country of Birth: ______________________________________________

-

Nationality: ______________________________________________
-

Are you a tax resident of any country other than India? Yes No

# If yes, 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, GIIN, CIN, EIN, others, etc.

Country
#
Tax Identifications Number Identification Type
(TIN or Other, please specify)
- - -

- - -

- - -

5
THIRD HOLDER DETAILS

PAN*: _______________________________________
-

Name: _____________________________________________________________________________________________________________________________________
-

Type of address given at KYC KRA Residential Residential or Business Business Registered Office

State______________________________________________
-

Phone No (with ISD Code): ______________________________________________

-

Place of Birth: ______________________________________________

-

Country of Birth: ______________________________________________

-

Nationality: ______________________________________________
-

Are you a tax resident of any country other than India? Yes No

# If yes, 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, GIIN, CIN, EIN, others, etc.

Country
#
Tax Identifications Number Identification Type
(TIN or Other, please specify)
- - -

- - -

- - -

DECLARATION & SIGNATURES

I/We acknowledge and confirm that the information provided above is/are true and correct to the best of my/our knowledge and belief and provided after
necessary consultation with tax professionals. I/We have read and understood the information provided by me/us in this Form is true, correct and
complete. I/We hereby authorize you [NJ AMC/NJ Fund/NJ India/Other group entities] to disclose, share, rely, remit in any form, mode or manner, all / any
of the information provided by me, including all changes, updates to such information as and when provided by me to the Mutual Fund, its Sponsor, Asset
Management Company, trustees, their group companies, any service provider including RTA or any Indian or foreign governmental or statutory or judicial
authorities / agencies including but not limited to the Financial Intelligence Unit-India (FIU-IND), the tax / revenue authorities in India or outside India
wherever it is legally required and other investigation agencies without any obligation of advising me/us of the same.

Signature Not Verified

Date:
2024-10-07
20:34:48

Sole/First Holder Second Holder Third Holder

Place: ____________________________________________
SERAIKELA KHARSAWAN Date:________________________________
04/10/2024

FATCA & CRS TERMS & CONDITIONS

Details under FATCA & CRS : The Central Board of Direct Taxes has notified Rules 114F to 114H, as part of Income tax Rules, 1962 which Rules require
Indian financial institutions such as the Investment Entity/Custodial Institution to seek additional personal ,tax and beneficial owner information and ertain
certifications and documentation from all our account holders. In relevant cases, information will have to be reported to tax authorities/appointed
agencies. Towards compliance, we may also be required to provide information to any institutions such as withholding agents for the purpose of ensuring
appropriate withholding from the account or any proceeds in relation thereto. Should there be any change in any Information provided by you, please
ensure you advise us promptly, i.e within 30 days Please note that you may receive more than one request for information if you have multiple relationships
with NJ India Invest Private Limited or its group entities. Threfore , it is important that you respond to our request, even if you believe you have already
supplied any previously requested information.

Head Office: NJ group, NJ center, Block No. 901 & 902, 6th Floor, 'B' Tower, Udhna Udyog
Nagar Sangh Commercial Complex, Central Road No. 10, Udhna, Surat - 394 210, Gujarat.
Phone: 91 261 4025500.

6
DECLARATION FOR ONLINE E-WEALTH MF ACCOUNT OPENING THROUGH ESIGN
I/We hereby declare that the details provided through the online portal are true and correct to the best of my/our
knowledge and belief. I/We also agree and undertake to inform you of any change(s) therein, immediately.

I/We also request you to consider the uploaded Specimen Signature for any physical correspondence from my/our side.

I /We hereby confirm and agree to open E-Wealth MF Account with NJ INDIA INVEST PRIVATE LIMITED. through
AADHAAR based E Signature mode.

Date: _________________
04/10/2024 Place: __________________________________
SERAIKELA KHARSAWAN

Name__________________________________
RANJITA SINHA Name__________________________________
- Name__________________________________
-

Signature Not Verified

Date:
2024-10-07
20:34:48

Sole / First Applicant / Guardian Second Applicant Third Applicant

7
 BANK MANDATE TERMS & CONDITIONS

(In favour of NJ India Invest Private Limited)

1. Bank Mandate is in favor of “NJ India Invest Private Limited” (Hereinafter 'NJ'), which will be used by NJ in the capacity
of stock broker and depository participant.

2. The Bank details in the Bank Mandate MUST match with bank details updated in Client's E-Wealth Account/E-Wealth MF
Account.

3. For Physical Mandate, Client Signature on bank mandate must be as per bank records. Signature of all bank account
holders required if mode of holding in account is “Joint”.

4. NJ reserves the right to register bank mandate with any mode i.e Auto Debit or ACH.

5. Client bank may charge client Bank accounts for activating any such services. Neither NJ nor its service provider shall be
held responsible or bear any such charges.

6. The Mandate format is subject to change as per the guidelines issued by RBI/Bank or other concerned governmental or
statutory authorities. NJ or its service provider may change the Mandate format without prior notice to the Clients &
Transactions may be rejected by NJ or its service provider or Client's Bank due to any such change. Neither NJ nor its
service provider shall be held responsible for any consequences.

7. The Mandate will be used for collection of all kinds of DP charges including Annual Maintenance Charges, client’s fund
obligation including pay-in and other changes arising out of client account. The Mandate shall cover all collections other
than the Mutual Funds segment.

8. Client shall ensure sufficient balance in bank account for successful processing of Transactions.

9. Client banks may levy any charges to the client bank account if payment debit request submitted by NJ is failed due to
any reason. Neither NJ nor its service provider shall be held responsible for any failure & any charges levied by the bank.

10. These Terms & Conditions cover Physical as well as eMandate both.

11. NJ reserves rights to change any of the Terms and Conditions without prior notice.

12. Any dispute shall be subject to exclusive jurisdiction of Courts at Surat.

RANJITA SINHA
*Client Name:____________________________________________________________________________________________________________

3419404
*Unique Client Code(UCC): ___________________________ *Date: 04/10/2024

Signature Not Verified

Date:
2024-10-07
Client Signature: 20:34:48
 BANK MANDATE TERMS & CONDITIONS

(In favour of Clearing Corporation)

1. Bank Mandate will be in favor of ‘ICCL’ for BSE Clearing Corporation and ‘NCL’ for NSE Clearing Corporation for all mutual
fund transactions of clients.

2. The Bank details in the Bank Mandate MUST match with bank details updated in Client's E-Wealth Account/E-Wealth MF
Account.

3. Client banks may charge for activating any such services from the Client's account. Neither NJ nor its service provider
shall be held responsible or bear any such charges.

4. Client shall ensure sufficient balance in bank account for successful processing of Transactions.

5. Mandate format is subject to change as per the guidelines issued by Clearing Corporation/Stock Exchange or RBI/Bank or
other concerned governmental or statutory authorities. NJ or its service provider may change the Mandate format without
prior notice to the Clients & Transactions may be rejected by NJ or its service provider or Client's Bank due to any such
change. Neither NJ nor its service provider shall be held responsible for any consequences.

6. Payment collection will be done by respective Clearing Corporation for Purchase & SIP transactions done using the
Mandate registered with Clearing Corporation.

7. Mandate will be registered through the service providers of respective Clearing Corporation.

8. The Client authorizes Clearing Corporation to debit the Client Bank account for recovery of any dues of the Client in
regards to mutual fund transactions including recovery of erroneous payments or collections.

9. These Terms & Conditions cover Physical as well as eMandate both.

10. NJ reserves rights to change any of the Terms and Conditions without prior notice.

11. Any dispute shall be subject to exclusive jurisdiction of Courts at Surat.

RANJITA SINHA
*Client Name:____________________________________________________________________________________________________________

*Date:
3419404 04/10/2024
*Unique Client Code(UCC): ___________________________

Client Signature: Signature Not Verified

Date:
2024-10-07
20:34:48
Signature Not Verified

Date:
2024-10-07
20:34:48
Signature Not Verified

Date:
2024-10-07
20:34:48