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Sale of Units at applicable For Office Use

NAV based price.


Market Status

An open-ended Income Scheme

Trade World, ‘B’ Wing, 7th floor, Kamala Mills Compound, S. B. Marg, Lower Parel (W), Mumbai - 400 013.

ARN - 4724
ARN-0155 ARN - 4724
54934

APPLICANT DETAILS

UNIQUE IDENTIFICATION NO. (UIN)


TO BE FILLED IN CAPITAL LETTERS. Pl. use one box for each letter, leaving one box blank between two words Under MAPIN Database
(for Corporate Investors)
EXISTING FOLIO NO. (For existing unitholders )

Name of Sole / 1st applicant/Minor/Karta of HUF/Non-individual Mr. / Mrs. / Miss / Mst / M/s.
Date of Birth

D D M M Y Y Y Y
Name of Parent/ Guardian In case of Minor Mr. / Mrs. / Miss

Name of 2nd applicant Mr. / Mrs. / Miss Date of Birth

D D M M Y Y Y Y
Name of 3rd applicant Mr. / Mrs. / Miss Date of Birth

D D M M Y Y Y Y
PAN / GIR No. * Ward /Circle/Dist
1st applicant
* Compulsory for
2nd applicant Investment amouting to
Rs. 50,000 & above
3rd applicant

CONTACT DETAILS
Indian Address* for Correspondence : Office Residence *NRI s are requested to furnish their Indian address in this section

City District State PIN


Foreign Address in respect of NRI / FII applicants

City Country ZIP


Contact Person for Non-Individual applicants

Tel. No. STD Code Office Residence Fax

Mobile No. E-mail Id.

An open-ended Income Scheme


Trade World, ‘B’ Wing, 7th floor, Kamala Mills Compound, S. B. Marg, Lower Parel (W), Mumbai - 400 013.

SCHEME :

PLAN : OPTION :
(Please mention the scheme Name, Plan & Option in Bold Capital Letters. Please refer to Scheme Details.)
Amt. In Rs. Cheque / DD No. Date Bank Branch
Received from:

57
Amt. In Words

Pin Code Signature & Stamp


BANK ACCOUNT DETAILS (Please Refer Instruction 6)

Bank Name Account Type SB Current NRO NRE

Branch Account No.

Branch
PIN 9 Digit MICR Code
Address
SUBSCRIPTION DETAILS

SCHEME :

PLAN : OPTION :
(Please mention the scheme Name, Plan & Option in Bold Capital Letters. Please refer to Scheme Details.)
# Credited to my bank directly* / through ECS # Cheque to address *Facility available with HDFC Bank & ICICI Bank

Amount Invested DD Commission Net Cheque / DD Amount Please attach


Cheque / DD No. Cheque Date
Rs. (if any) Rs. Rs. Bank Advice /
Documentary proof
for DD Comm.

Cheque/DD Amt. In Words


(Account Type to be furnished by NRI/FII Applicants)
Drawn on Bank Account Type SB Current NRO NRE FCNR

Branch Payable at

E-MAIL & OTHER OPTIONS


I / We wish to receive the following through e-mail I/We would like to apply for : I would like to join :
instead of physical document :
I-Pin for Internet based facilities Recurring Investment Plan
Account Statement through www.reliancemutual.com
Recurring Withdrawal Plan
Quarterly Newsletter / Fact-sheets
T-Pin for Call center facilities Systematic Transfer Plan
Annual Report
Trigger Option
Please Dispatch email the relevant form to me/us

NOMINATION
Nominee's Name : Mr. / Mrs. / Miss /Mst. Date of Birth

D D M M Y Y Y Y
Guardian (In case of Minor Nominee)

Address of Nominee /Guardian

Specimen Signature of
City PIN Nominee/Minor Nominee's Guardian
(OPTIONAL)
DECLARATION & SIGNATURE/S (refer instruction 11) SIGNATURE/S
I/We would like to invest in Reliance .......................................................... subject
to terms of the Offer Document and subsequent amendments thereto. I/We have Sole/ 1st applicant/
read the instructions and the Offer Document before filling the Application Form. Guardian
I/We have understood the details of the scheme and I/We have not received nor Authorised Signatory
been induced by any rebate or gifts, directly or indirectly, in making this investment.
APPLICABLE TO NRIs ONLY: 2nd applicant /
Authorised Signatory
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 /
OrdinaryAccount/FCNR Account. 3rd applicant
Authorised Signatory
Place : Date:

CHECKLIST

Have you filled up the application form in all respects? Have you filled up Guardian's name & date of birth of minor
(for Investment on behalf of minor)
Have all the applicants / signatories signed the application form?
Have you furnished your E-Mail Id & contact tel. Nos.?
Is the amount mentioned is matching with cheque/DD amount?
Have you mentioned Scheme Name on the Cheque & signed the cheque ?
Have you furnished the Bank details / direct credit information correctly?
Is the amount matching with application form?
Have you filled up Scheme/Plan opted ?
Have you put the current date on the cheque ?
Have you furnished the PAN No./ Details
58 Have you attached the supporting documents ?
(for investment of Rs. 50,000 & above)
(For Power of Attorney Applicants & Non Individual investors)
INSTRUCTIONS
1. Please read the Key Information Memorandum and the Offer 7. As per SEBI guidelines, it is mandatory to provide the Applicant’s
Document carefully before investing. Applicants are deemed to PAN/GIR No. and the I.T. Circle/Ward/District, if the amount
have read, understood and accepted the terms subject to which this invested is Rs.50,000/- or more. The application form will not be
accepted in the absence of same . In case the PAN has been applied
offer is being made and bind themselves to the terms upon signing
for and not yet allotted, please write “Applied for / Not allotted’’. In
the Application Form and tendering payment.
case of non assessees, please mention “Not an Assessee”.
2. Please submit separate application & cheque for each Scheme. 8. As per the SEBI guidelines, it is mandatory for investors to mention
3. The Applicants’ name and address must be given in full (P.O. Box their bank account details in the application form. In the absence of
the bank details the application form will not be accepted.
No. alone is not sufficient).
9. Please mention the application serial no. on the reverse of the
4. In case of non-individual applicants, i.e. HUF / Companies / AOP /
cheque/demand draft tendered with the application.
BOI / Trusts / Societies / FIIs etc. the name and telephone number of
the contact person to whom the correspondence should be 10. Cheques/DDs payable locally, crossed and marked “Account
addressed to is to be provided. payee” should be drawn in favour of “Reliance Income Fund” as
the case may be. Out station cheques or cash will not be accepted.
5. In case of applications made under Power of Attorney, the original
11. Individual applicant/s can avail of nomination facility by nominating
Power of Attorney or a duly certified copy thereof duly notarised
a person to receive the proceeds upon the death of the
should be submitted with the application.
unitholder(s). However persons applying on behalf of a minor or on
6. In case of applications made by a Limited Company or by a Body Power of Attorney cannot nominate.
Corporate or a registered society or a trust, a copy of the relevant 12. Signatures can be in English or in any other Indian language.
resolution or authority to make the application, as the case may be, Thumb impressions must be attested by a Judicial
alongwith a certified copy of the Memorandum and Articles of Magistrate/Notary Public under his/her official seal. In case of HUF,
Association or Trust Deed / Bye Laws, whichever is applicable, the Karta should sign on behalf of the HUF.
must be lodged along with the application form or within 10 days of
13. In case of NRI/FII investors the Account Statements/Redemption
submission of the application form at any of the designated centres Cheques / Dividend warrants / Other correspondence will be sent to
of Reliance Mutual Fund or Karvy Computershare Pvt. Ltd. In case, the Indian address.
such documents are not received by the Registrars within the
14. Investors requiring documents to be sent to them through email
prescribed time, the AMC reserves the right to act as deemed fit on a
need to indicate such option by ticking the relevant box.
case to case basis. Applications from NRI/PIO/FII must be
accompanied with Foreign Inward Remittance Certificate (FIRC) / 15. Application along with cheque / DD / Pay order can be submited at
Bankers Certificate certifying that the funds towards payment have the official collection centres of Reliance Mutual Fund or Karvy
been drawn out of funds held in their NRE / NRSR / FCNR Accounts, Computershare Pvt. Ltd.
if the payment is made by way of Pay Order / DD.

59
DESIGNATED INVESTOR SERVICE CENTRES

Reliance Capital Asset Management Limited

CORPORATE OFFICE: HYDERABAD: LUDHIANA:


Kamala Mills Compound, Unit No.7, 6-3-1093, 6th Floor, SCO-122, 1st Floor,
Trade World, ‘B’ Wing, 7th Floor, V V Vintage Boulevard, Feroze Gandhi Market,
Senapati Bapat Marg, Lower Parel (W), Above Food World, (Behind Ludhiana Stock Exchange
Mumbai - 400 013. Rajbhavan Road, Building), Ludhiana 141001..
Hyderabad - 500082
AHMEDABAD: MUMBAI:
107, 1st Floor, Abhijit-I, INDORE: Mittal Chambers, 228,
Mithakhali Six Roads, 216, Starlit Tower, 29/1, Ground Floor, Nariman Point,
Navrangpura, Y. N. Road, Mumbai - 400 021.
Ahmedabad - 380 009. Opp. State Bank of Indore - Head
Office, Indore - 452 009. NEW DELHI:
BARODA: Office No. 405, 4th Floor,
501, Arundeep Complex, JAIPUR: Ashoka Estate,
Near Race Course Circle (South), Office No. 334, 3rd Floor, 24 Barakhamba Road,
Baroda - 390 007. Ganapati Plaza, New Delhi - 110 001.
M I Road, Jaipur - 302 016,
BANGALORE: Rajasthan. NAGPUR:
S 201, Manipal Centre, Office # 2, 3rd Floor,
Dickenson Road, JAMNAGAR: A Block,Poonam Chambers,
Bangalore - 560 042. Shop No. 4-5, Ground Floor, Chhinchwara Road,
“Shilp” Building, Indira Gandhi Marg, Byramji Town,
CHANDIGARH: Jamnagar - 361 001. Nagpur - 440 013.
SCO-127/128, 1st Floor,
Sector 9/C, KANPUR: NASIK:
Chandigarh - 160017.. Unit No. 717, 7th Floor, G-18, Ground Floor,
Krishna Tower, 15/63, Civil Lines, Suyojit Sankul, Sharanpur Road,
CHENNAI: Kanpur - 208 002. Nasik-422 002.
ACE Tower, 2nd Floor,
No. 75, Dr. Radhakrishnan Salai, KOLKATA: PUNE:
Mylapore, Chennai - 600 004 Reliance House, 5th Floor, 105 & 106, First Floor,
34 Jawaharlal Nehru Road, ‘Winners Window’,
COIMBATORE: Kolkata - 700 071. F.C. Road, 1218/2A,
575 C, Shylaja Complex, Behind Vaishali Restaurant
D.B. Road, R.S. Puram, KOCHI : Shivaji Nagar, Pune - 411 004.
Coimbatore - 641 002. 2nd Floor, Thekkekkara Mansion,
Opp. Kavitha Theatre, SURAT:
GOA: M. G. Road, 414, 4th Floor,
Shop No.1, Ground Floor, Kochi - 682 035. Vishvakarma Arcade,
Rayu Chambers, Majura Gate, Ring Road,
Dr. Atmaram Borkar Road, LUCKNOW: Surat - 395001.
Panjim, Goa - 403 001. 11-A, Ground Floor,
Saran Chambers II,
No.5, Park Road,
Lucknow - 226001.

Karvy Computershare Private Limited

Agra l Ahmedabad l Ajmer l Allahabad l Amritsar l Bangalore l Baroda l Bharuch l Bhavnagar l Bhubaneswar l
Chandigarh l Chennai l Cochin l Coimbatore l Dehradun l Dharwad l Durgapur l Erode l Goa l Guntur l Guwahati l
Hubli l Hyderabad l Indore l Jaipur l Jalandhar l Jalgaon l Jamshedpur l Kanpur l Karaikudi l Kolkata l Kota l
Lucknow l Ludhiana l Mangalore l Meerut l Moradabad l Mumbai l Mysore l Nagpur l Nasik l New Delhi l Patna l
Pondicherry l Pune l Raipur l Rajahmundry l Rajkot l Ranchi l Salem l Siliguri l Surat l Tirunelveli l Tirupur
Trichy l Varanasi l Vijayawada

Call : 30301111
60 www.reliancemutual.com

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