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HSBC Mutual FundPlease read the instructions before filling the Application Form
Common Application Form
Application No.: WDISTRIBUTOR INFORMATION (Only empanelled Distributors / Brokers will be permitted to distribute Units of HSBC Mutual Fund)
Distributor / Broker ARN Sub-Broker Code Registrar Serial No
Mailing Address of Sole / First Applicant [P.O. Box Address is not sufficient]
1 EXISTING UNIT HOLDER INFORMATION (Please fill in your Folio No. and then proceed to section 3)Please note that applicant details and mode of holding will be as per existing Folio Number.
FolioNo.
I/We wish to receive the following documents via e-mail in lieu of physical document(s) [Please (4)] Account Statement All other Statutory Communications Marketing Updates
ACKNOWLEDGEMENT SLIP (To be filled by the investor)
Personal Details of Sole / First Applicant
Name of Sole / First Applicant
Contact Person and Designation (in case of Non-individual Investors) / Name of Guardian (in case of Minor)
Name of Second Applicant
Name of Third Applicant
Date of Birth
Overseas Address in case of NRIs / FIIs (in addition to mailing address)
City State Pin Code
Phone O Extn. Fax
R Mobile
Received from
Mr Ms M/s
Mr Ms M/s
Mr Ms M/s
Mr Ms M/s
State Country Zip Code
City
Signature, Stamp & Date
an application for Units of
alongwith Cheque / DD No. Dated
Drawn on (Bank)
for Rs. (in figures)
Mr Ms M/s
D D M M Y Y Y Y
Would you like a PIN assigned? (please 4 ) (ref. instruction 2e)
I/We wish to receive updates via SMS on my mobile [Please (4)]
2 NEW APPLICANT INFORMATION (Please fill in Block Letters)
E-MAIL COMMUNICATION
3 MANDATORY INFORMATION
STATUS(of First Applicant (please 4 )
Resident Individual Partnership Company HUF FII NRI Trust Society AOP BOI On behalf of Minor Others
OCCUPATION(please 4 )
PoliticianBureaucratMoney Service BureauDealers in High ValueCommodities (Arms,Bullion, Jewellery, etc.)
3A
PSU/GovernmentEmployeeMilitary OfficialRelative /Associate /Advisor of aboveScientist
Indian PrivateCompany EmployeeDoctorLawyerTeacherMultinational Employee
Agriculture / FisheryInformation TechnologyTelecommunicationBanking / FinancialInstitutionHousewife
JewellerStudentRetiredOther BusinessOther ServiceOther Professional
Mode of Holding (please 4 ) Single Joint Anyone or Survivor
PAN DETAILS (Mandatory if amount of purchase is Rs. 50,000 or more) irrespective of mode of holding
* Irrespective of the mode of holding, in addition, proof of PAN (copy of PAN Card / PAN letter / Copy of IT Assessment Order / Copy of IT Notice or such other Correspondence fromthe Income-tax Department) is required to evidence the PAN quoted above for all holders where the amount of Investment is INR 50,000 or more. Please also refer to instruction 2c. In casePAN is not available, please provide Form 60 / Form 61, duly filled up, with necessary proof as specified therein.
Sole / First Applicant Second Applicant Third Applicant
PAN proof Form 60 Form 61 Enclosed PAN proof Form 60 Form 61 PAN proof Form 60 Form 61
3B
PAN*
Application Form without occupation details is liable to be rejected.
Name of Sole /First Unit Holder
Application No.: W
5 PAYMENT OPTIONS (ref. instruction 3b)
Cheque /DD* No. Date A/c. No.
Bank Branch
Cheque / DD DD Charges TotalAmount (Rs.) (Rs.) Amount (Rs.)
Please ensure there is only one Cheque / DD per application form
The Trustees, HSBC Mutual FundHaving read and understood the contents of the Offer Document(s) and Addenda of the Scheme(s) issued tilldate, I / We hereby apply to the Trustees of HSBC Mutual Fund for units of the Scheme / Plan / Option asindicated above and agree to abide by the terms, conditions, rules and regulations of the Scheme. I / We haveunderstood the details of the Scheme and I / We have not received nor been induced by any rebate or gifts,directly or indirectly, in making this investment. I / We hereby authorise HSBC Mutual Fund, its InvestmentManager and its Agents to disclose details of my / our investment to my/our bank(s) / HSBC Mutual Fund’sBank(s) and / or Distributor / Broker / Investment Advisor and to verify my / our bank details provided byme / us. *I/We confirm that I am/we are Non-Residents of Indian Nationality / Origin and that the funds areremitted from abroad through approved banking channels or from my / our NRE / NRO / FCNR Account. I / Weconfirm that the details provided by me / us are true and correct. I / We hereby declare that the amount beinginvested by me/us in the Scheme(s) of HSBC Mutual Fund is derived through legitimate sources and is notheld or designed for the purpose of contravention of any Act, Rules, Regulations or any statute or legislationor any other applicable laws or any Notifications, Directions issued by any governmental or statutory authorityfrom time to time.
*Applicable to NRI Date:
Sole / FirstApplicant
SecondApplicant
ThirdApplicant
SIG
NA
TU
RE
S
7 DECLARATION AND SIGNATURES
I/We and * do
hereby nominate the person more particularly described hereunder / and / cancel the nomination made by me / us on the
day of in respect of units held by me / us under Folio No. (* strike out which is not applicable)
To be furnished in case Nominee is a Minor (delete if not applicable)Name ofGuardian
Address ofGuardian
PANSignature ofGuardian
Name and Address of Nominee
Name
Address
Date of Birth (in case Nominee is a minor)
PAN
6 NOMINATION / CANCELLATION OF NOMINATION (To be filled in by Individual(s) applying singly or jointly)
Applications from investors resident in USA and Canada shall be rejected.
BANK ACCOUNT DETAILS (Mandatory for Existing and New Applicants as per SEBI Guidelines)
A/c. No.
Please provide the following details relating to the Sole / First Holder for Redemption / Dividend Warrants.
A/c. Type (please 4 ) Resident : Current Savings Non-Resident : NRO NRE
4A INVESTMENT DETAILS (Please refer to the Ready Reckoner Table on page 14) (Please 4 )
The Dividend Option (Reinvestment or Payout) chosen will beapplied to all Units held in the Scheme in the Folio.
SchemeName
Daily Weekly Monthly QuarterlyPlan
Option Regular Institutional Institutional Plus
Sub-option Growth* Dividend Reinvestment Dividend Payout
DividendFrequency
Name of the Bank
H S B C
Branch Address
City
For investors who wish to opt for SIP please fill up the enclosed SIP Application Form and SIP Auto Debit Form
4B SIP AUTO DEBIT FACILITY
* Default Sub-option, if not ticked.
3C
For NRI Investors Only (please 4 ) NRO NRE
* Please mention the application no. on the reverse of the Cheque / DD. Cheque/DD must be drawn in favourof the Name of Scheme or its abbreviation, as applicable and crossed ‘account payee only’. Please refer to theReady Reckoner Table on page 14 for the complete list of scheme names and abbreviations.
The details of the bank account provided above pertain to my / our own bank account in my / our name Yes No. If No, my relationship with the bank accountholder is Spouse Child Parent Relative Sibling Friend Others. Application Form without this information is liable to be rejected.
INVESTOR SERVICE CENTRES*
HSBC MUTUAL FUND INVESTOR SERVICE CENTRES :l Ahmedabad : Tel: 079 26468001 l Bangalore : Tel: 080 41186519 l Chandigarh : Tel: 0172 5008119/21 l Chennai : Tel: 044 42008719 l Coimbatore : Tel: 9894477319, 9893477321l Hyderabad : Tel: 040 55739805 l Indore : Tel: 9893477319, 9893477321 l Jaipur : Tel: 0141 3230719 l Kochi : Tel: 9895477319, 9895477321 l Kolkata : Tel: 033 22139919 l Mumbai : Tel: 022 66668819l New Delhi : Tel: 011 41490719 l Pune : Tel: 020 26134283For details of HSBC Investor Service Centres, please refer to inside back cover.CAMS INVESTOR SERVICE CENTRES : TEL.: 1-800-425-2267
For details of CAMS Investor Service Centres, please refer to inside back cover.* ISCs will also be collection centres. Please contact our ISCs for an updated list of Official Points of Acceptance.
Contact us at hsbcmf@hsbc.co.in Visit us at www.hsbcinvestments.co.in
COLLECTION CENTRES CAMS COLLECTION CENTRES: TEL.: 1-800-425-2267
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