icici pru common application form

23

4 E-MAIL COMMUNICATION – I/We wish to receive the following via e-mail instead of physical document:

Address

Prudential ICICI AMC Ltd. - ACKNOWLEDGEMENT SLIP (To be filled in by the Investor)Received from:

Signature, Stamp & DateApplication for Units of Prudential ICICI____________________________________________ Option :_____________________________________________

Application No.✄ ✄

1-Dec-2005

Account Statement Quarterly Review & Annual Report Communication on Change of Address, Bank, etc.

MAIN APPLICATION FORM(Please read the instructions before investing)

Use this Form if you are making one time investment. For SIP investments use the separate blue coloured SIP form.

Sub-broker CodeBroker Code Date & Time ofReceipt

Serial Number

Status [Please tick (✓)]

Resident Individual

HUF

Company

Trust

Partnership

Sole Proprietorship

Bank/FI

AOP/BoI

Club/Society

NRI/FII/PIO

Minor

Others (Please specify) _______

_______________________

Name of First Applicant Date of Birth (Mandatory)

Name of Guardian (in case of minor) / Contact Person (In case of Institutional Investors)

Mailing Address (Please provide full address)

Communication

City

Tel.(Res.)

E-Mail

Permanent Account Number (PAN) [Please refer to instruction no.II(b)(4)]

Mr. Ms. M/s.

Tel.(Off.)

D D M M Y

PIN

State

Y Y Y

Mob

Designation of the Contact Person (In case of Institutional Investors)

Name of Second Applicant

Name of Third Applicant

Mr. Ms.

Mr. Ms.

1st Applicant

Mr. Ms.

Bank Particulars (Name of the Bank)

Account Number

Branch Address

Account Type

Savings NROCurrent

City

NRE

Country

Overseas Address (in case of NRIs/FIIs)

City PIN

State Country

2nd Applicant

3rd Applicant

MA

ND

ATO

RY

DETA

ILS

If you have already provided & validated PAN with an existing folio, please mention the Folio No.

If “Mandatory Details” are not provided,your application is liable to be rejected.

1 FOR EXISTING UNITHOLDERS

2 ABOUT YOUDate:

Non-Resident Individual Resident Individual (Please tick (✓) the relevant box)

Mode of holding [Please tick (✓)]

Occupation [Please tick (✓)]

Single

Joint

ProfessionalBusinessRetired

Anyone orSurvivor

HousewifeServiceStudent

Others (Please specify) _____________________________________________________

Guardian(In case of minor)

Folio No.


If you are making a purchase in an existing folio, please mention the folio number in the spaceprovided and proceeds to Step 3. Please note that the applicable details and mode of holdingwill be as per the existing folio.

Folio No.

3 BANK ACCOUNT DETAILS OF FIRST APPLICANT (Refer instruction No.III)

APPLICATION NO.

ARN - 4724 ARN - 4724

user1

Text Box

ARN-0155

user1

Text Box

54934

24

8 YOUR CONFIRMATION

7 NOMINATION DETAILS (Optional)

6 INVESTMENT DETAILS (Refer Instruction No.IV)

5 REDEMPTION / DIVIDEND REMITTANCE (Please refer to instruction no.VIII)

Note: All future communications in connection with this application should be addressed to the nearest Prudential ICICI Customer Service Centre, quoting full name of the firstapplicant, the application serial number, the name of the scheme, the amount invested, date and the place of the Customer Service Centre where application was lodged.

Prudential ICICI AMC Ltd. - ACKNOWLEDGEMENT SLIP (To be filled in by the Investor)Investment Plan Cheque/DD No. Dated Amount (Rs.) Drawn on (Name of Bank & Branch)

The TrusteePrudential ICICI Mutual Fund,I/We have read and understood the offer document(s) of Prudential ICICI MutualFund. I/We apply for the units of the scheme(s) and I/we agree to abide by theterms, conditions, rules and regulations of the scheme. I/We confirm to haveunderstood the terms & conditions. Its investment objectives, investment pattern,fundamental objectives and risk factors applicable to the respective Fund(s).I/We agree to abide by the terms, conditions, rules and regulations of the Plan(s).I/We have understood the details of the scheme and I/we have not received norbeen induced by any rebate or gifts, directly or indirectly, in making thisinvestment.

DD MM YYYYFirst Applicant

Second Applicant

Third ApplicantSIG

NA

TUR

E(S

)

OPTIONS & SUB-OPTIONS (See the Key Features for Scheme specific options & sub-options)[Please tick (✓) the appropriate boxes, only if it is applicable to the scheme/plan in which you wish to invest]

Cumulative/Growth

Amount Paid (A) DD Charges (B) (To be filled in, onlyif the Fund bears the DD Charges) $

Amount Invested (C) = (A) + (B)(To be filled in if the column (B) is applicable to the Scheme/Plan)

Cheque/DD No.

Bank Name & Branch

Monthly

Quarterly

AEP-Regular*

AEP-Appreciation

NRO

Account Type (For NRI Investors)

Rs.

NRE

NAME OF THE SCHEME (1)

* Cumulative – AEP Regular Option : Encashment of Units is subject to declaration of dividend in the respective Scheme(s). $Read the Instruction Number VI(d).

Daily

Weekly

Dividend Payout

Dividend Reinvestment

Fortnighly

Monthly

Rs. Rs.

Cheque/DD Date

P R U D E N T I A L I C I C I

(Please leave one box blank between words)

D D M M Y Y

Quarterly

Half Yearly

Half Yearly

Address of Guardian

Name of the Nominee Date of Birth (If nominee is minor)

Mr. Ms. M/s. D D M M Y Y Y Y

Address of Nominee (Please provide full address)

PINCode

PINCode

Name of the Guardian (If nominee is minor)

I/We hereby nominate the undermentioned Nominee to receive the amounts to my/our credit in event of my/our death. I/We also understand that all payments and settlementsmade to such Nominee and signature of the Nominee acknowledging receipt thereof, shall be a valid discharge by the AMC / Mutual Fund / Trustees.

Signature of Guardian

Relationship with minor

✄ ✄

If you wish to use STP/SWP facility please tick the relevant box and fill in the STP/SWP Application Form on page 27 STP SWP

DIRECT CREDIT OF DIVIDEND/REDEMPTION

Available in ABN Amro Bank, Bank of Punjab, Centurion Bank, Citibank N.A., DeutscheBank, HDFC Bank, Hongkong Bank, ICICI Bank, IDBI Bank, Kotak Bank, StandardChartered Bank, and UTI Bank.

Unitholders having bank account with any of these bank will receive their Redemption/Dividend Payments (if any) directly into their bank account automatically. In caseUnitholders wish to receive a cheque please indicate the preference below.

I want to receive the redemption and dividend proceeds (if any) by way of a cheque. (Please ✓ in this box)

ELECTRONIC CLEARING SERVICE (ECS) FOR DIVIDEND ONLYI authorise Prudential ICICI Mutual Fund to credit my dividend payments through ECS

(Please ✓)Please quote 9 Digit Code No. of your Bank and Branch Corresponding to BankAccount Details given in Section - 3 above. (This number appears on every leaf ofyour chequebook after your cheque number)

IMPORTANT: Please attach a blank “cancelled” Cheque or a clear photocopy of acheque issued by your bank veryfying of the Code No.

FCNR

Prudential ICICI Mutual Fund

15

I. GENERAL INSTRUCTIONS

a) The application form is for Resident Investors/NRIs/FIIs and should be completedin English in BLOCK Letters.

b) The signature(s) should be in English or in any of the Indian languagesspecified in the eighth schedule of the constitution of India. Thumb impressionsmust be attested by a Magistrate or a Notary Public or a Special ExecutiveMagistrate under his/her official seal. Applications by minors should be signedby their guardians. In case of HUF, the Karta should sign on behalf of theHUF.

Signature mismatch cases: While processing the redemption / switch outrequest in case the AMC / Registrar come across a signature mismatch, thenthe AMC/ Registrar reserves the right to process the redemption only on thebasis of supporting documents confirming the identity of the investors. List ofsuch documents would be notified by AMC from time to time on its website.

c) There are two application forms.

i) Systematic Investment Plan (SIP) Form (Blue Colour) – To be used forSIP Investment.

If you wish to apply for SIP through Auto Debit by way of ElectronicClearing Service (ECS) or Standing Instructions to your bank account youneed to fill in the Instruction Form in addition to the SIP Form.

ii) Application Form (Red Colour) – To be used for one time investment.

d) Investors opting for Systematic Transfer Plan (STP) should fill the details inthe space provided on page 27.

i) The minimum amount that can be transferred from one scheme to anotheris Rs.1,000 for a minimum of 6 installments.

ii) STP will be available at weekly (every Monday), monthly (last day of themonth) or quarterly (last day of the quarter) rests as per the standinginstructions of the Unitholder. If any of these dates is a non-business day,the transaction would be processed on the immediate next business day.

iii) For the target schemes, an entry load of 1% of the applicable NAV willbe charged on the amount transferred under the STP facility.

iv) Units so created in the target schemes will, in addition to any existingexit load for normal purchases, have an exit load of 1.25% of theapplicable NAV, if the units are redeemed before completion of 2 yearsfrom the date of each STP transaction.

v) To effect the STP transaction for a particular transaction date as mentionedabove and as applicable for the respective frequency, the request for thesame should be received on or before the last business day of the weekpreceding the week in which such effective transaction date falls. Theunitholder can avail the STP facility for a maximum period of 10 years.

e) The application form number, the scheme name and the name of the applicantshould be mentioned on the reverse of the instrument that accompanies theapplication.

f) The Application completed in all respects along with the cheque/demand draftmust be submitted to the nearest Customer Service Center. Applicationsincomplete in any respect or not accompanied by a cheque or demand draftfor the amount payable are liable to be rejected and the money paid will berefunded without interest.

g) No receipt will be issued for the application money. The Customer ServiceCenters will stamp and return the acknowledgement slip in the applicationform, to acknowledge receipt of the application.

II. UNITHOLDERS INFORMATION

a) Existing Unitholders

Investors already having an account in any of the Prudential ICICI schemes,and making additional investments in the same schemes or any other schemes,should provide their Folio Number in Step 1. The names of the applicants,mode of holding etc. will be as per the folio number provided. Existingunitholders need not fill the details in Step 2 and directly proceed to Step 3.

b) New Applicant

1. Name and address must be given in full (P.O. Box Address is not sufficient).In case of NRI/PIO/FII investors an overseas address must be provided.

2. Name of guardian must be mentioned if the investments are being madeon behalf of a minor. Date of Birth is mandatory in case of minor.

Investments of the existing minor investor on minor attainingmajority: Upon attaining majority, a minor has to write to the fund, giving

his specimen signature duly authenticated by his banker as well his newbank mandate, PAN details, UIN details (if applicable as per prevalentSEBI Guidelines) in order to facilitate the Fund to update its records andpermit the erstwhile minor to operate the account in his own right.

3. In case of an application under Power of Attorney or by a limited company,body corporate, registered society, trust or partnership, etc. the relevantPower of Attorney or the relevant resolution or authority to make theapplication as the case may be, or duly certified copy thereof, along withthe Memorandum and Articles of Association / bye-laws must be lodgedalong with the application form.

Power of Attorney (POA): In case an investor has issued Power of Attorney(POA) for making investments, switches, redemptions etc. under his folio,both the signature of the investor and the POA holder have to be clearlycaptured in the POA document to be accepted as a valid document. Atthe time of making redemption / switches the fund would not be in aposition to process the transaction unless, POA holder’s signature isavailable in the POA or proof of identity alongwith signature is producedalong with the POA.

4. If the application is for Rs. 50,000 or more, then the PAN and IT Circle/Ward/District (if available) of the applicant, parent/guardian in case ofminor and all applicants in case of more than one applicant should bementioned and a copy of the PAN card or Allotment Letter should besubmitted. In case any of the applicants is not an assessee, the factshould be mentioned and Form 60/61 should be submitted along with theapplication.

5. Applicants should indicate their status by ticking the appropriate box.Applications without a tick in the ‘Status’ box will be considered asinvestment by “Others”. Those who select the status as “Others”, theyshould specify their status in the space provided.”

6. Applicants should specify the mode of holding. In case it is not mentioned,the default will be “either or survivor”. In the case of joint holders, thefirst named holder shall receive all the Account Statements, dividend/redemption/refund warrants and any other correspondence sent from timeto time.

7. Name of a contact person should be mentioned in case of the investmentby a Company/Body Corporate/Partnership Firm/Trust/Foreign InstitutionalInvestors (FIIs)/Society.

III. BANK DETAILS

The first Unitholder should provide the name of the bank branch, complete addressof the branch, account type and account number, which is mandatory as perSecurities Exchange Board of India circular IIAMRP/MF/CIR/07/826/98 dated April15, 1998. Applications without this information will be deemed to be incomplete.

IV. INVESTMENT DETAILS

a) Investor has to fill a separate form for each scheme that he wishes to investin.

b) Investor should select only one option (growth/dividend) and correspondingsub-option (e.g. reinvest/payout in case of dividend option) under the scheme(s)wherever applicable by ticking the appropriate box.

c) Investor opting for AEP option (under Income Plan & Monthly Income Plan)should select the sub-option (regular/appreciation) and frequency (monthly/quarterly/half-yearly). For details, please refer to the offer document of therespective schemes.

d) In case, the investor has not selected the option/sub-option for his investments,default option/sub-option as prescribed in the offer document of the relevantscheme will be applied.

e) For minimum application amount, please refer to table given on page 3 to 8.

V. SYSTEMATIC INVESTMENT PLAN (SIP)

a) SIP facility is available in the following schemes:

Prudential ICICI Growth Plan, Prudential ICICI FMCG Fund, Prudential ICICITechnology Fund, Prudential ICICI Balanced Fund, Prudential ICICI MonthlyIncome Plan, Prudential ICICI Power, Prudential ICICI Dynamic Plan,Prudential ICICI Discovery Fund, Prudential ICICI Emerging S.T.A.R. (StocksTargeted At Returns) Fund, Prudential ICICI Tax Plan, Prudential ICICI IndexFund, Prudential ICICI Income Plan, Prudential ICICI Flexible Income Plan,Prudential ICICI Income Multiplier Fund, Prudential ICICI Advisor Series,Prudential ICICI Child Care Plan, Prudential ICICI Long Term Plan andPrudential ICICI Infrastructure Fund.

INSTRUCTIONS FOR FILLING UP THE APPLICATION FORM(S)

Prudential ICICI Mutual Fund

16

b) Investor opting for SIP need to fill the SIP Application Form (Blue Colour). Ifthe payment option is Auto Debit through ECS or Standing Instruction to theBank, investor also need to fill the respective forms on page 19 & 21.

c) Investors opting for SIP investment can subscribe to this facility subject to thecondition that each of the SIP installments including the initial purchase shouldbe of the same amount.

d) Entry load equivalent to 1% of the applicable NAV will be charged on theamount invested under the scheme(s) where SIP facility is available.

e) Amount so invested into the schemes will, in addition to any existing exitload for normal purchases, have an exit load equivalent to 1.25% of theapplicable NAV, if the units are redeemed before completion of 2 years fromthe date of allotment.

f) Issue post dated cheques dated either 1st or 7th or 10th or 15th or 25th ofthe month. A credit confirmation will be sent to the unitholder indicating thenew balance to his or her credit in the account.

g) SIP Auto Debit via ECS (Debit Clearing) is available at the following 25 centres:

Ahmedabad, Bangalore, Baroda, Bhopal, Bhubaneshwar, Chandigarh, Chennai,Coimbatore, Guwahati, Hyderabad, Indore, Jaipur, Kanpur, Kolkata, Lucknow,Ludhiana, Madurai, Mumbai, Nagpur, New Delhi, Panjim, Pune, Surat,Trivandrum and Vijaywada.

h) Existing investors opting for SIP need to provide their Folio Number alongwith SIP details.

VI. MODE OF PAYMENT

a) The cheque/demand draft should be drawn in favor of “Prudential ICICI IncomePlan” or “Prudential ICICI Flexible Income Plan” or “Prudential ICICI GiltFund – Treasury Plan” or “Prudential ICICI Gilt Fund – Investment Plan” or“Prudential ICICI Monthly Income Plan” or “Prudential ICICI Liquid Plan”or “Prudential ICICI Short Term Plan” or “Prudential ICICI Growth Plan” or“Prudential ICICI FMCG Fund” or “Prudential ICICI Balanced Fund” or“Prudential ICICI Tax Plan” or “Prudential ICICI Technology Fund” or“Prudential ICICI Power” or “Prudential ICICI Dynamic Plan” or “PrudentialICICI Floating Rate Plan” or “Prudential ICICI Income Multiplier Fund”or“Prudential ICICI Discovery Fund”or “Prudential ICICI Emerging S.T.A.R.Fund”or “Prudential ICICI Index Fund”or “Prudential ICICI InfrastructureFund”, as the case may be and crossed “Account Payee Only”.

The cheque / demand draft should be payable at the centre where theapplication is lodged. The cheque / demand draft should be drawn on anybank which is situated at and is a member / sub-member of the Bankers’Clearing House. Cheques/ demand drafts drawn on a bank not participatingin the Clearing House will not be accepted.

b) Separate Cheque/Draft is required for each scheme invested.

c) Payments by Stockinvests, cash, postal orders, money orders and outstationcheques will not be accepted.

d) The Fund will reimburse demand draft charges subject to maximum of Rs.10,000/- per transaction for purchase of units by investors residing at locationwhere the AMC Customer Service Centers/Collection Centers are not locatedas per the table below:

Amount of Investment Rate of Charges of Demand Draft(s)

Upto Rs.10,000/- At actuals subject to maximum of Rs.50/-

Above Rs.10,000/- Rs. 2/- per Rs. 1000/-

However, the demand draft charges will not be reimbursed for PrudentialICICI Liquid Fund, Prudential ICICI Short Term Plan, Prudential ICIC Gilt Fund –Treasury Plan and Prudential ICICI Floating Rate Plan.

AMC reserves the right to refuse the reimbursement of demand draft charges,in case of investments made by the same applicant(s) through multipleapplications at its own discretion which will be final and binding on theinvestor.

Investors residing at places other than where the AMC Customer ServiceCenters/ Collection Centers are located, are requested to make the paymentby way of demand draft(s) after deducting bank charges as per the ratesindicated in the above table. It may be noted that additional charges, if any,incurred by the investor over and above the levels indicated above will not beborne by the Fund.

No demand draft charges will be reimbursed by the Fund for purchase ofUnits by investors residing at such locations where the Customer ServiceCenters/Collection Centers of the AMC are located.

e) NRI/FII/PIO Investors

1. Repatriation basis:

Payments by NRIs / FIIs / Persons of Indian Origin residing abroad, may bemade either by way of Indian Rupee drafts or cheques by means of (i)inward remittance through normal banking channels; or (ii) out of fundsheld in NRE/FCNR account payable at par and payable at the cities wherethe Customer Service Centres are located.

In case of Indian Rupee drafts purchased through NRE/ FCNR Account, anaccount debit certificate from the bank issuing the draft confirming thedebit should also be enclosed.

In case the debit certificate is not provided, the AMC reserves the rightto reject the application of the NRI investors.

2. Non Repatriation basis

NRIs or people of Indian origin residing abroad investing on a non-repatriablebasis may do so by issuing cheques/demand drafts drawn on Non-ResidentOrdinary (NRO) account payable at the cities where the Customer ServiceCentres are located.

VII.NOMINATION

1. The nomination can be made only by individuals applying for / holding units ontheir own behalf singly or jointly. Non-individuals including society, trust, bodycorporate, partnership firm, Karta of Hindu Undivided Family, holder of Power ofAttorney cannot nominate. If the units are held jointly, all joint holders will signthe nomination form. Space is provided as a specimen, if there are more jointholders more sheets can be added for signatures of holders of units andwitnesses.

2. A minor can be nominated and in that event, the name and address of theguardian of the minor nominee shall be provided by the unit holder. Nominationcan also be in favour of the Central Government, State Government, a localauthority, any person designated by virtue of his office or a religious or charitabletrust.

3. The Nominee shall not be a trust (other than a religious or charitable trust),society, body corporate, partnership firm, Karta of Hindu Undivided Family or aPower of Attorney holder. A non-resident Indian can be a Nominee subject tothe exchange controls in force, from time to time.

4. Nomination in respect of the units stands rescinded upon the transfer of units.

5. Transfer of units in favour of a Nominee shall be valid discharge by the assetmanagement company against the legal heir.

6. The cancellation of nomination can be made only by those individuals who holdunits on their own behalf singly or jointly and who made the original nomination.

7. On cancellation of the nomination, the nomination shall stand rescinded and theasset management company shall not be under any obligation to transfer theunits in favour of the Nominee.”

VIII. DIRECT CREDIT OF DIVIDEND/REDEMPTION

Prudential ICICI AMC had entered into an arrangement of a direct credit facilityof redemptions/ dividends with certain banks. For the Investors who have anaccount with such banks, the AMC based on advice of the investor/ Unit holdershave been crediting either redemption or dividend payments directly to the bankaccounts of the Unit holders.

Further, the default option for payment of redemption/dividend proceeds for all theprospective investments would be the Direct Credit into their bank account (in casethe investor has provided his bank mandate as one of the banks participating indirect credit arrangement and if he fails to specify the mode of payment).

The AMC may alter the list of the banks participating in direct credit arrangementfrom time to time/ withdraw direct credit facility from the banks, based on itsexperience of dealing with any of such banks or add / withdraw the name of thebank with whom direct credit facility arrangements can be introduced/ discontinuedas the case may be.

IX. E-MAIL COMMUNICATION

Delivering service through web/e-mail helps the Fund to reduce expenses in theFund and is a more efficient delivery channel. When an investor has communicatedhis/her e-mail address and has provided consent for sending communication onlythrough email, the Mutual Fund / Registrars are not responsible for email notreaching the investor and for all consequences thereof. The Investor shall fromtime to time intimate the Mutual Fund / its transfer agents about any changes inthe email address. In case of a large document, a suitable link would be providedand investor can download, save and print these documents. However, investoralways has a right to demand a physical copy of any or all the service deliverableand Fund would arrange to send the same to the investor.

INSTRUCTIONS FOR FILLING UP THE APPLICATION FORM(S) (Contd.)

17

Address

Prudential ICICI AMC Ltd. - ACKNOWLEDGEMENT SLIP (To be filled in by the Investor)Received from:

Signature, Stamp & DateApplication for Units of Prudential ICICI____________________________________________ Option :_____________________________________________

Application No.

Application No.

✄ ✄

SYSTEMATIC INVESTMENT PLAN (SIP) APPLICATION FORM(Please read the instructions before investing)

Use this Form for SIP investment. If you wish to make payment through Auto Debit ECS / Standing Instructionyou also need to fill separate Instruction Form for the same.

Note: All future communications in connection with this application should be addressed to the nearest Prudential ICICI Customer Service Centre, quoting full name of the first applicant,the application serial number, the name of the scheme, the amount invested, date and the place of the Customer Service Centre where application was lodged.

Sub-broker CodeBroker Code Date & Time ofReceipt

Serial Number

1-Dec-2005

1 FOR EXISTING UNITHOLDERS

2 ABOUT YOUName of First Applicant

Name of Guardian (in case of minor) / Contact Person (In case of Institutional Investors)

Mailing Address (Please provide full address)

Permanent Account Number (PAN) [Please refer to instruction no.II(b)(4)]

Designation of the Contact Person (In case of Institutional Investors)

MA

ND

ATO

RY

DETA

ILS

If you have already provided & validated PAN with an existing folio, please mention the Folio No.:

Account Statement Quarterly Review & Annual Report Communication on Change of Address, Bank, etc.

3 BANK ACCOUNT DETAILS OF FIRST APPLICANT (Refer instruction No.III)

Mr. Ms. M/s.

Date:

Date of Birth (Mandatory)

Status [Please tick (✓)]

Resident Individual

HUF

Company

Partnership

Sole -Proprietorship

Trust

Bank/FI

AOP/BoI

Club/Society

NRI/FII/PIO

Minor

Others (Please specify) _______

_______________________

Mode of holding [Please tick (✓)]

Occupation [Please tick (✓)]

Single

Joint

Professional

Business

Retired

Anyone orSurvivor

Housewife

Service

Student

Others (Please specify) ______________________________

If you are making a purchase in an existing folio, please mention the folio number in the spaceprovided and proceeds to Step 3. Please note that the applicable details and mode of holding willbe as per the existing folio.

If “Mandatory Details” are not provided,your application is liable to be rejected.

Folio No.

Folio No.

4 E-MAIL COMMUNICATION – I/We wish to receive the following via e-mail instead of physical document:

A/c. No. SavingsCurrent

Name ofthe Bank

BranchAddress

Bank CityA/c.Type NRO NRE

1st Applicant

2nd Applicant

3rd Applicant

Guardian

Communication

Tel. (Res.)

E-Mail

(Off.) Mob

City PIN

State Country

Mr. Ms.

D D M M Y Y Y Y

Overseas Address (in case of NRIs/FIIs)

City PIN

State Country

Name of Second Applicant

Name of Third Applicant



Mr. Ms.

Mr. Ms.

ARN - 4724 ARN - 4724

user1

Text Box

ARN-0155

user1

Text Box

54934

18

8 YOUR CONFIRMATION

7 NOMINATION DETAILS (Optional)

6 INVESTMENT DETAILS (Refer Instruction No.IV)

Cheque Number From

Prudential ICICI AMC Ltd. - ACKNOWLEDGEMENT SLIP (To be filled in by the Investor)

The TrusteePrudential ICICI Mutual Fund,I/We have read and understood the offer document(s) of Prudential ICICI MutualFund. I/We apply for the units of the scheme(s) and I/we agree to abide by theterms, conditions, rules and regulations of the scheme. I/We confirm to haveunderstood the terms & conditions. Its investment objectives, investment pattern,fundamental objectives and risk factors applicable to the respective Fund(s).I/We agree to abide by the terms, conditions, rules and regulations of thePlan(s). I/We have understood the details of the scheme and I/we have notreceived nor been induced by any rebate or gifts, directly or indirectly, inmaking this investment.

DD MM YYYYFirst Applicant

Second Applicant

Third ApplicantSIG

NA

TUR

E(S

)

OPTIONS & SUB-OPTIONS (See the Key Features for Scheme specific options & sub-options)[Please tick (✓) the appropriate boxes, only if it is applicable to the scheme/plan in which you wish to invest]

Cumulative/GrowthMonthly

Quarterly

AEP-Regular*

AEP-Appreciation

NAME OF THE SCHEME (1)

Monthly Dividend Payout

Dividend ReinvestmentQuarterly

P R U D E N T I A L I C I C I

(Please leave one box blank between words)

Half Yearly

✄ ✄

DIRECT CREDIT OF DIVIDEND/REDEMPTION

Available in ABN Amro Bank, Bank of Punjab, Centurion Bank, Citibank N.A., DeutscheBank, HDFC Bank, Hongkong Bank, ICICI Bank, IDBI Bank, Kotak Bank, StandardChartered Bank, and UTI Bank.

Unitholders having bank account with any of these bank will receive their Redemption/Dividend Payments (if any) directly into their bank account automatically. In caseUnitholders wish to receive a cheque please indicate the preference below.

I want to receive the redemption and dividend proceeds (if any) by way of a cheque. (Please ✓ in this box)

ELECTRONIC CLEARING SERVICE (ECS) FOR DIVIDEND ONLYI authorise Prudential ICICI Mutual Fund to credit my dividend payments through ECS

(Please ✓)Please quote 9 Digit Code No. of your Bank and Branch Corresponding to BankAccount Details given in Section - 3 above. (This number appears on every leaf ofyour chequebook after your cheque number)

IMPORTANT: Please attach a blank “cancelled” Cheque or a clear photocopy of acheque issued by your bank veryfying of the Code No.

SIP Payment Details (You can choose one of the 3 payment options below. Please tick (✓✓✓✓✓) the appropriate box)

OPTION - I : CHEQUE – First Installment Details (to be filled in in case of SIP through cheque)

Cheque No. Cheque Date D D M M Y Y Rs.Amount

Subsequent Installment Details (to be filled in in case of SIP through cheque)

Rs.Single InstallmentAmount

Cheque Dated

1st

Number ofCheques

7th 10th 15th M M Y Y Y Y

Start From

M M Y Y Y Y

End To

Cheque Number From Cheque Number To

Half Yearly

Address of Guardian

Name of the Nominee Date of Birth (If nominee is minor)

Mr. Ms. M/s. D D M M Y Y Y Y

Address of Nominee (Please provide full address)

PINCode

PINCode

Name of the Guardian (If nominee is minor)

I/We hereby nominate the undermentioned Nominee to receive the amounts to my/our credit in event of my/our death. I/We also understand that all payments and settlementsmade to such Nominee and signature of the Nominee acknowledging receipt thereof, shall be a valid discharge by the AMC / Mutual Fund / Trustees.

Signature of Guardian

Relationship with minor

Drawnon Bank Branch

Drawnon Bank Branch

OPTION - II : AUTO DEBIT THROUGH ECS (You only need to tick this box & fill SIP Auto Debit Instruction Form on page 19)

OPTION - III : STANDING INSTRUCTION (You only need to tick this box & fill Standing Instruction Form on page 21)

First Installment Cheque No. Cheque Dated D D M M Y Y

Subsequent Installment Cheque Nos. Cheque Number To

Drawn on Bank, Branch & City

Rs.

Rs.

Payment through Auto Debit ECS Bank Standing Instruction

Drawn on Bank, Branch & City

* Cumulative – AEP Regular Option : Encashment of Units is subject to declaration of dividend in the respective Scheme(s).

25th

5 REDEMPTION / DIVIDEND REMITTANCE (Please refer to instruction no.VIII)

19

Systematic Investment Plan (SIP) Auto Debit Instruction FormBefore filling this Instruction Form please ensure you have filled in the SIP Application Form

ticking ECS Authorisation in SIP payment details (Section 6)

New ApplicationCancellationChange in Bank Account*

PARTICULARS OF BANK ACCOUNT (Mandatory)Bank Account Holders Name

Bank Name

Branch Name

Account Number Account Type Savings Current Cash Credit

9 Digit MICR Code (Please enter the 9 digit number that appears in your cheque next to the cheque number)

I/We hereby declare that the particulars given above are correct and express my willingness to make payments referred above through participation in ECS. If thetransaction is delayed or not effected at all for reasons of incomplete or incorrect information, I/We would not hold the user institution responsible. I/We will alsoinform Prudential ICICI Mutual Fund, about any changes in my bank account. I/We have read and agreed to the terms and conditions mentioned overleaf.

Account Number

This is to inform I/we have registered for the RBI's Electronic Clearing Service (Debit Clearing) and that my paymenttowards my investment in Prudential ICICI Mutual Fund shall be made from my/our below mentioned bank accountwith your bank. I/We authorise the representative carrying this ECS mandate Form to get it verified & executed.

✄ ✄

Authorisation of the Bank Account Holder

APPLICANT AND SIP DETAILSSole / First Applicant’s Name

Application No. Folio No.

Scheme

Plan

Option & Sub Option

Each SIP Amount (Rs.)First SIP Transaction via Cheque No. (Note : Cheque should be drawn on bank, details provided below)

SIP Date 1st 7th 10th 15th 25th

SIP Period From ToMM YYYY MM YYYY

We hereby, authorise Prudential ICICI Mutual Fund and their authorised service providers, to debit my/our following bank account by ECS(Debit Clearing) for collection of SIP payments.

Cheque DetailsCheque No. Date Amount

Broker Code Sub-Broker Code Date & Time of Receipts

First Investment with aCurrent Date Cheque

Scheme ____________________________ Plan __________________________ Option & Sub-option ___________________________________

✄ ✄

Acknowledgement Slip (Auto Debit) - Prudential ICICI Mutual Fund

Name of the Applicant ______________________________________________________________ Application/Folio No. ______________________

Each SIP Amount (Rs.) _________________________________________ SIP Period - FromD D M M Y Y Y Y

SIP Period - ToD D M M Y Y Y Y

Signature, Date & Stamp

1st

Ho

lder

2nd

Hol

der

3rd

Hol

der

1st

Ho

lder

2nd

Hol

der

3rd

Hol

der

I/We hereby apply to the Trustee of Prudential ICICI Mutual Fund for the Systematic Investment Plan (SIP) Enrolment underthe following scheme and agree to abide by the terms and conditions of the plan. [* Please provide a cancelled cheque]

Signatures as in Bank Records


1-Dec-2005

Application to be submitted at least 30days before the commencement of SIP

ARN - 4724 ARN - 4724

user1

Text Box

ARN-0155

user1

Text Box

54934

20

Terms & ConditionsSIP payment through Electronic Clearing Service (Debit Clearing) of the Reserve Bank of India (RBI)

List Cities for SIP Auto Debit via ECS (Debit Clearing)

Ahmedabad, Bangalore, Baroda, Bhopal, Bhubaneshwar, Chandigarh, Chennai, Coimbatore, Guwahati, Hyderabad, Indore, Jaipur, Kanpur,

Kolkata, Lucknow, Ludhiana, Madurai, Mumbai, Nagpur, New Delhi, Panjim, Pune, Surat, Trivandrum and Vijaywada.

1. This facility is offered to the investors having bank accounts in select cities mentioned above. The cities in the list may be modified/updated/changed/removed at any time in future entirely at the discretion of Prudential ICICI Mutual Fund without assigning any reasons orprior notice. If any city is removed, SIP instructions for investors in such cities via ECS (Debit) route will be discontinued without prior notice.

2. New Investors who wish to enroll for SIP through Debit should fill this SIP Auto Debit Form in addition to the SIP Application Form.

3. Existing investors need to provide their Folio No. and need not fill up the SIP Application Form.

4. For new investors, please complete all sections of the SIP Application Form including Section 6.

For minimum application amount to be invested in SIP, risk factors, features etc. please refer to page nos. 3 - 8 of the KeyInformation Memorandum.

The cheques should be drawn in favour of "Prudential ICICI Growth Plan" or "Prudential ICICI FMCG Fund" or "Prudential ICICITechnology Fund" or "Prudential ICICI Balanced Fund" or "Prudential ICICI Monthly Income Plan" or "Prudential ICICI Power"or "Prudential ICICI Dynamic Plan" or "Prudential ICICI Discovery Fund" or "Prudential ICICI Emerging S.T.A.R. (Stocks TargetedAt Returns) Fund" or "Prudential ICICI Tax Plan" or "Prudential ICICI Income Plan" or "Prudential ICICI Flexible Income Plan" or"Prudential ICICI Income Multiplier Fund" or "Prudential ICICI Index Fund" or "Prudential ICICI Infrastructure Fund"and crossed‘‘Account Payee Only’’. The cheques should be payable locally at the centre where the Application is deposited at the Customer ServiceCentres of Prudential ICICI AMC. The cheques should be drawn on any bank which is situated at and is a member / sub-member of theBankers’ Clearing House. Cheques drawn on a bank not participating in the Clearing House will not be accepted.

5. Investors opting for SIP investment can subscribe to this facility subject to the condition that each of the SIP installments including the initialpurchase should be of the same amount.

6. a) Completed Application Form, SIP Auto Debit Form and the first cheque can be submitted on any date of the month andthe same would be processed subject to the condition that there would be a minimum of 30 days period between thesubmission of the application with the current date cheque and the first installment of SIP date.

b) Completed Application Form for Cancellation/Change of Bank Mandate can be submitted on any date of the month andthe same would be processed subject to the condition that there would be a minimum of 30 days period between thesubmission of the application and the SIP date.

7. New investors should mandatorily give a cheque for the first transaction. The cheque should be drawn on the same bank account which isto be registered for ECS (Debit).

8. The bank account provided for ECS (Debit) should participate in local MICR clearing.

9. SIP auto debit is available only on specific dates of the month viz. 1st/7th/10th/15th/25th and in case 1st/7th/10th/15th/25th is a holiday,then next business day. In case the Auto Debit does not take effect for three consecutive times then the SIP would be liabile for cancellation.

10. The applicant will have the right to discontinue SIP at any time he or she so desires by providing a written request at the office of thePrudential ICICI Mutual Fund Customer Service Centres. Notice of discontinuance should be received at least 30 days prior to the date thatit is required to be effected in. The investor will cease to be a part of the SIP on receipt of the written request.

11. SIP will be available only on monthly basis and an entry load equivalent to 1% of the applicable NAV will be charged on the amount investedunder the scheme(s) where SIP facility is available.

Amount so invested into the schemes will, in addition to any existing exit load for normal purchases, have an exit load equivalent to 1.25%of the applicable NAV, if the units are redeemed before completion of 2 years from the date of allotment.

12. The investor agrees to abide by the terms and conditions of ECS facility of Reserve Bank of India (RBI).

13. Investor will not hold Prudential ICICI Mutual Fund, its registrars and other service providers responsible if the transaction is delayed or noteffected or the investor bank account is debited in advance or after the specific SIP date due to various clearing cycles or ECS.

14. Prudential ICICI Mutual Fund, its registrars and other service providers shall not be responsible and liable for any damages/compensation forany loss, damage etc. incurred by the investor. The investor assumes the entire risk of using this facility and takes full responsibility.

15. Prudential ICICI Mutual Fund reserves the right to reject any application without assigning any reason thereof.

21


Application Form No.

ToThe Manager,Bank Name : _________________________________________________________________ Branch __________________________________________

Address: _______________________________________________________________________________________________________________________

Sub: Request for maintenance of a Standing Instruction (SI) for SIP with Prudential ICICI Mutual Fund

I/We,____________________________________________________________________________________________, hereby authorise you

to debit on a monthly basis (as a Standing Instruction) from my/our account number mentioned below (hereinafter referred as "funding account")

for Rs.__________________________ (Rupees _____________________________________________________________ only) and remit

the same on Account of Prudential ICICI Mutual Fund as per the details given below:

Nature of Instruction : Standing Instruction

Scheme Name :

Option :

Sub-option :

Debit Account Number :(For new accounts, Bank will fill up the same)

Name of the Account Holder :

Name of the Beneficiary : Prudential ICICI Mutual Fund Account

Frequency : Monthly SIP Date: 1st 7th 10th 15th 25th

Start Month :

End Month :

Folio Number :(To be filled by Prudential ICICI Mutual Fund) (For new investors)

I/We undertake to keep sufficient funds in the funding account on the date of execution of standing instruction. I/We hereby declare that the particulars givenabove are correct and complete. If the transaction is delayed or not effected at all for reasons of incomplete or incorrect information, I/we would not hold theMutual Fund or the Bank responsible. If the date of debit to my/our account happens to be a non banking/business day as defined in the Offer Document ofthe said Scheme of Prudential ICICI Mutual Fund, execution of the SIP will happen on the previous business day and allotment of units will happen as per theTerms and Conditions listed in the Offer Document of the Mutual Fund.I/We have read and understood the offer document(s) of the Fund. I/We apply for the units of the scheme and I/we agree to abide by the terms, conditions, rulesand regulations of the scheme. I/We confirm to have understood the terms & conditions. Its investment objectives, investment pattern, fundamental objectives andrisk factors applicable to the respective Fund(s). I/We agree to abide by the terms, conditions, rules and regulations of the Plan(s). I/We have understood the detailsof the scheme and I/we have not received nor been induced by any rebate or gifts, directly or indirectly, in making this investment.

Yours faithfully,

For Bank Branch use only:

D D M M Y Y Y YDate:

Signature Verified by: ______________________________________________ Approved by BM: __________________________________________________For CPU Use only:Maintained on: A/c. No.:

Name of the A/c Holder:

SI Start Date: SI End Date: Next SI Date: Amount: _____________________

Maintained by: __________________________________________________

D D M M Y Y Y Y

D D M M Y Y Y Y D D M M Y Y Y Y D D M M Y Y Y Y

Existing Folio No.

Application Form No. Existing Folio No.

1-Dec-2005

Application for Standing Instruction Maintenance for Systematic Investment Plan (SIP)Before filling this Instruction Form please ensure you have filled in the SIP Application Form

ticking Standing Instrcution in SIP payment details (Section 6)

(Month) (Year)2 0

(Month) (Year)2 0

3rd

Hol

der

2nd

Hol

der

1st

Ho

lder

22

Statutory Details: Prudential ICICI Mutual Fund (the Fund) has been set up as a Trust sponsored by Prudential plc (through its wholly owned subsidiary Prudential CorporationHoldings Limited) and ICICI Bank Limited (erstwhile ICICI). Prudential ICICI Trust Limited is the Trustee to the Fund and the Prudential ICICI Asset Management Company Limitedis the Investment Manager to the Fund. Risk Factors: Mutual Funds and securities investments are subject to market risks and there is no assurance or guarantee that theobjectives of the schemes will be achieved. As with any securities investment, the NAV of the Units issued under the schemes can go up or down depending on the factors andforces affecting the capital markets. Past performance of the Sponsors, AMC/Fund does not indicate the future performance of the schemes. The Sponsors are not responsibleor liable for any loss resulting from the operation of the schemes beyond the contribution of an amount of Rs 22.2 lacs collectively made by them towards setting up the Fund andsuch other accretions and additions to the corpus set up by the Sponsors. Please refer to the Addendum / Offer Document for scheme specific risk factors before investing.

Terms & Conditions

SIP through Standing Instruction

1. New Investors who wish to enroll for SIP through Debit should fill this Standing Instruction in addition to the SIP Application Form (BlueColour).

2. All SIP Standing Instruction request submitted on or before the 20th of the month will be processed in the immediately following month.

3. Existing investors need to provide their Folio No. in this Standing Instruction and need not fill up the SIP Application Form.

4. For new investors, please complete all sections of the Application Form including Section 6.

For minimum application amount to be invested in SIP, risk factors, features etc. please refer to page nos. 3 - 8 of the KeyInformation Memorandum.

The cheques should be drawn in favour of "Prudential ICICI Growth Plan" or "Prudential ICICI FMCG Fund" or "Prudential ICICITechnology Fund" or "Prudential ICICI Balanced Fund" or "Prudential ICICI Monthly Income Plan" or "Prudential ICICI Power" or"Prudential ICICI Dynamic Plan" or "Prudential ICICI Discovery Fund" or "Prudential ICICI Emerging S.T.A.R. (Stocks Targeted AtReturns) Fund" or "Prudential ICICI Tax Plan" or "Prudential ICICI Income Plan" or "Prudential ICICI Flexible Income Plan" or"Prudential ICICI Income Multiplier Fund" or "Prudential ICICI Index Fund" or "Prudential ICICI Infrastructure Fund" and crossed‘‘Account Payee Only’’. The cheques should be payable locally at the centre where the Application is deposited at the Customer ServiceCentres of Prudential ICICI AMC. The cheques should be drawn on any bank which is situated at and is a member / sub-member of theBankers’ Clearing House. Cheques drawn on a bank not participating in the Clearing House will not be accepted.

5. Investors opting for SIP investment can subscribe to this facility subject to the condition that each of the SIP installments including the initialpurchase should be of the same amount.

6. The applicant will have the right to discontinue SIP at any time he or she so desires by providing a written request at the office of thePrudential ICICI Mutual Fund Customer Service Centres. Notice of discontinuance should be received by 20th of the month. The investor willcease to be a part of the SIP on receipt of the written request.

7. SIP will be available only on monthly basis and an entry load equivalent to 1% of the applicable NAV will be charged on the amount investedunder the scheme(s) where SIP facility is available.

Amount so invested into the schemes will, in addition to any existing exit load for normal purchases, have an exit load equivalent to 1.25% ofthe applicable NAV, if the units are redeemed before completion of 2 years from the date of allotment.

8. Prudential ICICI Mutual Fund, its registrars and other service providers shall not be responsible and liable for any damages/compensation forany loss, damage etc. incurred by the investor. The investor assumes the entire risk of using this facility and takes full responsibility.

9. Standing Instructions incomplete in any respect are liable to be rejected.

10. SIP is liable for cancellation if direct debit fails for three consecutive times.

27

Systematic Withdrawal Plan (SWP) Application Form(Please read the instructions before filling up the form)

Use this Form if you wish to withdraw your investment systematically.

Monthly; OR

Quarterly

Period of Enrolment from (dd/mm/yyyy) To (dd/mm/yyyy)

Number of Unitsto be withdrawn

Instructions for Systematic Withdrawal Plan (SWP)1. New investors who wish to enrol for SWP should fill this enrolment form in addition to the Application Form.2. Existing investors need to provide the Folio No. and SWP details only.3. You can opt to withdraw on a Monthly/Quarterly basis. Withdrawal will be effected on the 1st Business Day of the month for monthly and quarterly basis and would be

treated as a redemption.4. SWP will terminate automatically, if all the units are withdrawn from the folio or an expiry of the enrolment period whichever is earlier.5. The applicant will have the right to discontinue SWP at any time he or she so desires by providing a written request at the office of the Prudential ICICI Mutual Fund

Customer Service Centres. Notice of discontinuance should be received 10 days prior to the month that it is required to be effected in.

(Please use separate SWP enrolment form for each Scheme/Plan)

Date(dd/mm/yyyy)

I/We hereby apply to the Trustee of Prudential ICICI Mutual Fund for the Systematic Withdrawal Plan (SWP) under the following scheme and agree to abide by the terms andconditions of the plan. I/We have read and understood the contents of the Offer Document and the instruction.

SchemeName: Option

Frequency:

PAN/GIR No.

Application Number Folio Number (For existing Unitholders)

Amount to bewithdrawn

Rs.OR

I/We hereby apply to the Trustee of Prudential ICICI Mutual Fund for the Systematic Transfer Plan (STP) Enrolment under the following schemeand agree to abide by the terms and conditions of the plan.

Eligible Schemes from which you can Transfer: PruICICI Liquid Plan, PruICICI Income Plan,PruICICI Floating Rate Plan, PruICICI Long Term Floating Rate Plan, PruICICI Flexible IncomePlan, PruICICI Short Term Plan, PruICICI Gilt Fund- Investment Plan and Treasury Plan, PruICICIMonthly Income Plan (An open ended fund. Monthly income is not assured and is subject tothe availability of distributable surplus) and PruICICI Income Multiplier Fund.

Eligible Schemes into which you can Transfer: PruICICI Growth Plan, PruICICI Power,PruICICI Tax Plan, PruICICI Dynamic Plan, PruICICI Technology Fund, PruICICI FMCGFund, PruICICI Balanced Fund, PruICICI Discovery Fund, PruICICI Emerging S.T.A.R.(Stocks Targeted At Returns) Fund and Prudential ICICI Infrastructure Fund.

Frequency Monthly QuarterlyAmount Rs.(Minimum of Rs.1,000)

No. of installments(Minimum of 6 installments)

Scheme Name(From where you wishto transfer amount): Plan

Weekly

Instructions for Systematic Transfer Plan (STP)i) The minimum amount that can be transferred from one scheme to another is Rs.1,000.00 for a minimum of 6 installments.ii) STP will be available at weekly, monthly and quarterly rests as per the standing instructions of the Unitholder.iii) Units so created in the target schemes will, in addition to any existing exit load for normal purchases, have an exit load equivalent to 1.25% of the applicable NAV, if the

units are redeemed before completion of 2 years from the date of each STP transaction.iv) The unitholder can avail the STP facility for a maximum period of 10 years.v) The request for STP should be received on or before the last business day of the week preceding the week in which the effective transaction date falls.

Option

Scheme Name(To where you wish totransfer amount): Plan Option

Sole/FirstApplicant

SecondApplicant

ThirdApplicant

Name of theSole/First Applicant

Name of theSecond Applicant

Name of theThird Applicant


SIG

NA

TU

RE

(S)

Sole/FirstApplicant

SecondApplicant

ThirdApplicant




SIG

NA

TU

RE

(S)

Systematic Transfer Plan (STP) Application Form(Please read the instructions before filling up the form)

Use this Form if you wish to transfer your investment systematically from one scheme/plan to another

Sub-broker CodeBroker Code

ARN - 4724 ARN - 4724

user1

Text Box

ARN-0155

user1

Text Box

54934

28

Prudential ICICI AMC Ltd. - ACKNOWLEDGEMENT SLIP (To be filled in by the investor)

Folio / Application No. First Holder Name

Received request for Trigger facility under Scheme Plan Option

switching into the Scheme ________________________________ Plan____________________ Option _________________________________________________________

In respect of Trigger Option (please ✓) NAV Appreciation Trigger : On NAV (Switchout Scheme) reaching Rs. _____________ per unit switch the investment /NAV Stop-Loss Trigger : On NAV (Switchout Scheme) reaching Rs. _______________________ per unit switch the investment /

Specific Date Trigger : On the day of

I / We have received, read and understood the offer document/key information memorandum.1. Trigger will require folio number in case of existing investors or application form number in case

of new investor.2. Trigger facility will switch all the units in the above mentioned scheme within the

respective Folio Number of the investor.3. Entry and Exit loads for the scheme(s) shall be applicable as mentioned in the the relevant Offer

Document(s)/Addendum(s). The same will also be applicable for SIP / STP / SWP.4. Tigger facility is available in all the Schemes of Prudential ICICI Mutual Fund except SPIcE and

Index Fund.5. For the switch to happen the minimum purchase/redemption criteria should be met else the trigger

will not be effected.6. Trigger facility on each scheme will require a separate/independent Trigger request form to be

filled. If an investor holds similar schemes in two folios, they will have to register separately for itmentioning the folio number.

INSTRUCTIONS7. Target scheme, where units will be switched if option/sub-options are not selected, it will be

switched to the default option (available under the Target Schemes).8. Switch will be implemented on the day the trigger condition is satisfied. The Trigger is a one time

operation and will cease once it is exercised.9. Once switch is done exercising trigger option, the same will not be reversed whatsoever and it

will be final and binding.10. If trigger is not activated and/or implemented due to reasons, which are beyond the control of

PruICICI AMC, the AMC would not be held responsible. Trigger facility is only a facility extendedby the AMC for the convenience of the unit holders and does not form part of any scheme/fundobjectives.

11. AMC reserves the right to amend/terminate this facility at any time, keeping in view business/operational exigencies.

I/We have read & understood and agree to abide by the terms and conditions and optfor the Trigger facility.

Specific NAV Trigger:NAV Appreciation Trigger : On NAV (Switchout Scheme) reaching Rs. (Rupees in words ___________________________________________________________________________________________________________________________) per unit.

NAV Stop-Loss Trigger : On NAV (Switchout Scheme) reaching Rs. ___ (Rupees in words ___________________________________________________________________________________________________________________________) per unit.

DETAILS OF TRANSACTION ON WHICH TRIGGER OPTIONS NEED TO BE EXERCISED/CANCELLED

Mention the complete name of the scheme along with the plan. Please tick (✓) or fill the appropriate boxe(s) or column(s)

Options & sub-options

Cumulative/Growth AEP-Regular* Monthly Half YearlyAEP-Appreciation Quarterly

Dividend Payout Daily Fortnighly Quarterly

Dividend Reinvestment Weekly Monthly Half Yearly* Cumulative – AEP Regular Option : Encashment of Units is subject to declaration of

dividend in the respective Scheme(s).

SWITCH TO (Name of the Scheme)

(Please leave one column blank between words)

Trigger Application/Cancellation Form(Please read the instructions carefully before filling up the form and use separate application form for each transaction)

Use this form, if you wish to switch units from one scheme to another based on appreciation/stop-loss on your investment or on a specific date.

(Please leave one column blank between words)

Options & sub-options

Cumulative/Growth AEP-Regular* Monthly Half YearlyAEP-Appreciation Quarterly

Dividend Payout Daily Fortnighly Quarterly

Dividend Reinvestment Weekly Monthly Half Yearly

* Cumulative – AEP Regular Option : Encashment of Units is subject to declaration ofdividend in the respective Scheme(s).

SWITCH FROM (Name of the Scheme)

P R U D E N T I A L I C I C I P R U D E N T I A L I C I C I


TRIGGER [Please tick (✓) the appropriate box] Registration Cancellation(In case of cancellation, the section ‘‘SWITCH TO’’ and ‘‘TRIGGER OPTIONS’’ need not be filled in)

D D M M Y Y Y YDate:

Sole/FirstApplicant

SecondApplicant

ThirdApplicant




SIG

NA

TU

RE

(S)

NAME(S) AND SIGNATURE(S) OF THE APPLICANT(S)

TRIGGER OPTIONS (In case of multiple triggers ticked, one whose condition is fulfilled first will be exercised and balance, if any, will be nullified)

D D M M Y Y Y Y

Signature, Stamp & Date

Switch the investment:

(NAV per unit should be mention only in multiple of Re. 1)

D D M M Y Y Y YSpecific Date Trigger : On the day of

(Please retain this slip for all the future correspondence with Prudential ICICI MF in relevance to this Trigger.)

icici pru common application form

Documents