One Time Debit Mandate Form NACH / Auto Debit: Mutual Funds

MUTUAL FUNDS
Aditya Birla Sun Life Mutual Fund
One Time Debit Mandate Form NACH / Auto Debit

[Applicable for Lumpsum Additional Purchases as well as SIP Registrations] (PLEASE READ THE INSTRUCTIONS BEFORE FILLING UP THE FORM.)
Request for Registration Registration Cancellation Date D D M M Y Y Y Y
Existing Investor Folio No. Application No.
1. FIRST / SOLE APPLICANT INFORMATION (MANDATORY)

Mobile No. Email Id.
NAME OF FIRST / SOLE APPLICANT Mr. Ms. M/s.
NAME OF THE GUARDIAN (In case of minor) Mr. Ms. M/s.
RELATIONSHIP OF GUARDIAN
NAME OF THE SECOND APPLICANT Mr. Ms. M/s.
NAME OF THE THIRD APPLICANT Mr. Ms. M/s.
FIRST APPLICANT SECOND APPLICANT THIRD APPLICANT
PAN* (Mandatory) PAN* (Mandatory) PAN* (Mandatory)
KYC Mandatory KYC Mandatory KYC Mandatory
GUARDIAN/ POA HOLDER KYC Mandatory I have attached cancelled copy of cheque
PAN* (Mandatory)
I/We understand that this Facility enables the Unit Holder/s of Aditya Birla Sun LIfe Mutual Fund (‘Fund’) to transact with in a simple, convenient and paperless manner by submitting OTM - One Time Mandate registration form to the Fund
which authorizes my/our bank to debit my/our account up to a certain specified limit per day, as and when we wish to transact with the Fund, without the need of submitting cheque or fund transfer letter with every transaction
thereafter. I/We understand that having registered for this Facility it enables starting a Systematic Investment Plan (SIP) or invest lump sum amounts in any Open Ended Scheme of the Fund by sending instructions through Transaction
forms, Online facility, Short Messaging Service (‘SMS’) or any other mode as specified by AMC from time to time. I/We confirm that details provided by me/us are true and correct. I / We have read and understood the Scheme Information
Document / Statement of Additional Information and Key Information Memorandum, Addendum issued from time to time of the Scheme(s) of Aditya Birla Sun Life Mutual Fund.
Name of First Unit Holder Name of Second Unit Holder Name of Third Unit Holder
Signature(s)
First Applicant Second Applicant Third Applicant
(To be signed by All Applicants if mode of operation is Joint)
DEBIT MANDATE-ONE TIME MANDATE / NACH / AUTO DEBIT [Applicable for Lumpsum Additional Purchases as well as SIP Registrations] Please attach a cancelled cheque/cheque copy.
Date D D M M Y Y Y Y
UMRN
(tick✓)
CREATE Sponsor Bank Code Office use only Utility Code Office use only
MODIFY
CANCEL I/We hereby authorize: ADITYA BIRLA SUN LIFE MUTUAL FUND to debit (tick✓
) SB / CA / CC / SB-NRE / SB-NRO / Other
Bank A/c No.:

With IFSC OR MICR
Bank Name & Branch
Bank:
an amount of Rupees `
FREQUENCY Monthly Quarterly Half Yearly Yearly As & when presented DEBIT TYPE Fixed Amount Maximum Amount
Reference 1 Folio No: Mobile
Reference 2 Appln No: Email:

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 bank.
PERIOD
From
1. Sign .............................................................. 2. Sign .............................................................. 3. Sign ..............................................................
to 3 1 1 2 2 0 9 9
or Until Cancelled
Name as in bank records (mandatory) Name as in bank records (mandatory) Name as in bank records (mandatory)
Declaration: This is to confirm that the declaration has been carefully read, understood & made by me/us. I am authorizing Aditya Birla Sun Life Mutual Fund to debit my
account based on the instructions as agreed and signed by me. I have understood that I am authorised to cancel/amend this mandate by appropriately communicating
the cancellation/amendment request to Aditya Birla Sun Life Mutual Fund or the bank where I have authorised the debit.
Acknowledgement Slip (To be filled in by the Investor) ONE TIME DEBIT MANDATE FORM NACH / AUTO DEBIT
Collection Centre /
Request for Registration
Application / Folio No. ABSLAMC Stamp & Signature
Cancellation
Received from Mr. / Ms. __________________________________________________________ Date : _____/_____/___________
Aditya Birla Sun Life AMC Limited (Investment Manager to Aditya Birla Sun Life Mutual Fund) Contact Us:
(Formerly known as Birla Sun Life Asset Management Company Limited) 1800-270-7000
Regn. No.: 109. Regd Office: One Indiabulls Centre, Tower 1, 17th Floor, Jupiter Mill Compound,
841, Senapati Bapat Marg, Elphinstone Road, Mumbai - 400013
+91 22 4356 7000 | care.mutualfunds@adityabirlacapital.com | www.adityabirlasunlifemf.com | CIN: U65991MH1994PLC080811 adityabirlacapital.com
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INSTRUCTIONS FOR ONE TIME MANDATE FORM

• UMRN is auto generated during mandate creation and is mandatory to be updated during amendment and cancellation of mandate (Maximum Length - 20 Alpha
Numeric Characters)
• Date is in DD/MM/YYYY format
• Sponsor bank IFSC/MICR code. left padded with zeroes where necessary. (Maximum length - 11 Alpha Numeric Characters)
• Utility Code of the Service Provider.(Maximum length - 18 Alpha Numeric Characters)
• Name of Service Provider
• Tick on box to select type of action to be initiated
• Tick on box to select type of account to be affected
• Customer’s legal account number, (Maximum length - 35 Alpha Numeric Characters)
• Name of Bank
• IFSC/MICR code of customer bank. (Maximum Length - 11 Alpha numeric Characters for IFSC & 9 Numeric for MICR code)
• Amount payable for service or maximum amount per transaction that could be processed in words
• Amount in ?gures, similar to the amount mentioned in words. (maximum Length - 13 digit Numeric in paise)
• Services Provider generated consumer reference number
• Services Provider generated consumer reference Service Provider generated Scheme/ Plan reference number
• Tick on box to select frequency of transaction
• Validity of mandate with dates in DD/MM/YYYY format
• Name of Customer/s and signature/s as well as seal of company (where required).(Maximum length of Name - 40 Alpha Numeric Characters)
• Undertaking by customer
• Permanent ID of customer e.g. PAN/Aadhaar No.
• Telephone no. with STD code of customer
• 10 digit mobile number of customer
• Mail ID of customer

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MUTUAL FUNDS

Aditya Birla Sun Life Mutual Fund

One Time Debit Mandate Form NACH / Auto Debit

Existing Investor Folio No. Application No.

1. FIRST / SOLE APPLICANT INFORMATION (MANDATORY)

First Applicant Second Applicant Third Applicant

(To be signed by All Applicants if mode of operation is Joint)

Bank A/c No.:

Reference 2 Appln No: Email:

Received from Mr. / Ms. ________________________________________________________ Date : _/_/_________

INSTRUCTIONS FOR ONE TIME MANDATE FORM

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