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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.

Broker Code Sub-broker Code Date & Time of Serial Number


Receipt
ARN - 4724
ARN-0155 ARN - 4724
54934

APPLICATION NO.

1 FOR EXISTING UNITHOLDERS


If you are making a purchase in an existing folio, please mention the folio number in the space
provided and proceeds to Step 3. Please note that the applicable details and mode of holding Folio No.
will be as per the existing folio. Date:
2 ABOUT YOU
Name of First Applicant Date of Birth (Mandatory)
Mr. Ms. M/s. D D M M Y Y Y Y
Name of Guardian (in case of minor) / Contact Person (In case of Institutional Investors) Status [Please tick (✓)]
Mr. Ms. Resident Individual Bank/FI

Designation of the Contact Person (In case of Institutional Investors) HUF AOP/BoI

Company Club/Society
Mailing Address (Please provide full address) NRI/FII/PIO
Trust

Partnership Minor

Sole Proprietorship
City PIN
Others (Please specify) _______
State Country _______________________
Communication
Tel. Tel.
(Res.) (Off.) Mob

E-Mail
Overseas Address (in case of NRIs/FIIs)

City PIN

State Country
Name of Second Applicant Resident Individual Non-Resident Individual (Please tick (✓) the relevant box) Mode of holding [Please tick (✓)]
Mr. Ms. Single Anyone or
Survivor
Name of Third Applicant Resident Individual Non-Resident Individual (Please tick (✓) the relevant box) Joint
Mr. Ms. Occupation [Please tick (✓)]
Permanent Account Number (PAN) [Please refer to instruction no.II(b)(4)] Professional Housewife
1st Applicant Guardian
(In case of minor) Business Service
Retired Student
2nd Applicant
MANDATORY DETAILS

Others (Please specify) _______


_______________________
3rd Applicant _______________________
If you have already provided & validated PAN with an existing folio, please mention the Folio No. Folio No.

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


Bank Particulars (Name of the Bank)

Branch Address
City
Account Number Account Type
If “Mandatory Details” are not provided,
Current Savings NRO NRE your application is liable to be rejected.

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

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

✄ ✄
Application No.
Prudential ICICI AMC Ltd. - ACKNOWLEDGEMENT SLIP (To be filled in by the Investor)
Received from:

ress
Add

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

23
1-Dec-2005
5 REDEMPTION / DIVIDEND REMITTANCE (Please refer to instruction no.VIII)
DIRECT CREDIT OF DIVIDEND/REDEMPTION ELECTRONIC CLEARING SERVICE (ECS) FOR DIVIDEND ONLY
Available in ABN Amro Bank, Bank of Punjab, Centurion Bank, Citibank N.A., Deutsche I authorise Prudential ICICI Mutual Fund to credit my dividend payments through ECS
Bank, HDFC Bank, Hongkong Bank, ICICI Bank, IDBI Bank, Kotak Bank, Standard (Please ✓)
Chartered Bank, and UTI Bank. Please quote 9 Digit Code No. of your Bank and Branch Corresponding to Bank
Unitholders having bank account with any of these bank will receive their Redemption/ Account Details given in Section - 3 above. (This number appears on every leaf of
your chequebook after your cheque number)
Dividend Payments (if any) directly into their bank account automatically. In case
Unitholders 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. IMPORTANT: Please attach a blank “cancelled” Cheque or a clear photocopy of a
(Please ✓ in this box) cheque issued by your bank veryfying of the Code No.

6 INVESTMENT DETAILS (Refer Instruction No.IV)


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
OPTIONS & SUB-OPTIONS (See the Key Features for Scheme specific options & sub-options)
NAME OF THE SCHEME (1)
[Please tick (✓) the appropriate boxes, only if it is applicable to the scheme/plan in which you wish to invest]
AEP-Regular* Monthly Half Yearly
P R U D E N T I A L I C I C I Cumulative/Growth
AEP-Appreciation Quarterly

Dividend Payout Daily Fortnighly Quarterly

(Please leave one box blank between words) Dividend Reinvestment Weekly Monthly Half Yearly

Amount Paid (A) DD Charges (B) (To be filled in, only Amount Invested (C) = (A) + (B)
if the Fund bears the DD Charges) $ (To be filled in if the column (B) is applicable to the Scheme/Plan)

Rs. Rs. Rs.


Bank Name & Branch

Cheque/DD No. Cheque/DD Date Account Type (For NRI Investors)

D D M M Y Y NRO NRE FCNR


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

7 NOMINATION DETAILS (Optional)


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 settlements
made to such Nominee and signature of the Nominee acknowledging receipt thereof, shall be a valid discharge by the AMC / Mutual Fund / Trustees.
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)

PIN
Code
Name of the Guardian (If nominee is minor) Relationship with minor

Address of Guardian Signature of Guardian

PIN
Code

8 YOUR CONFIRMATION
The Trustee DD MM YYYY
Prudential ICICI Mutual Fund, First Applicant
SIGNATURE(S)

I/We have read and understood the offer document(s) of Prudential ICICI Mutual
Fund. I/We apply for the units of the scheme(s) and I/we agree to abide by the
terms, conditions, rules and regulations of the scheme. I/We confirm to have
understood the terms & conditions. Its investment objectives, investment pattern, Second Applicant
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 nor
been induced by any rebate or gifts, directly or indirectly, in making this Third Applicant
investment.

✄ ✄
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)

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
24 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.
Prudential ICICI Mutual Fund

INSTRUCTIONS FOR FILLING UP THE APPLICATION FORM(S)

I. GENERAL INSTRUCTIONS his specimen signature duly authenticated by his banker as well his new
a) The application form is for Resident Investors/NRIs/FIIs and should be completed bank mandate, PAN details, UIN details (if applicable as per prevalent
in English in BLOCK Letters. SEBI Guidelines) in order to facilitate the Fund to update its records and
permit the erstwhile minor to operate the account in his own right.
b) The signature(s) should be in English or in any of the Indian languages
specified in the eighth schedule of the constitution of India. Thumb impressions 3. In case of an application under Power of Attorney or by a limited company,
must be attested by a Magistrate or a Notary Public or a Special Executive body corporate, registered society, trust or partnership, etc. the relevant
Magistrate under his/her official seal. Applications by minors should be signed Power of Attorney or the relevant resolution or authority to make the
by their guardians. In case of HUF, the Karta should sign on behalf of the application as the case may be, or duly certified copy thereof, along with
HUF. the Memorandum and Articles of Association / bye-laws must be lodged
along with the application form.
Signature mismatch cases: While processing the redemption / switch out
request in case the AMC / Registrar come across a signature mismatch, then Power of Attorney (POA): In case an investor has issued Power of Attorney
the AMC/ Registrar reserves the right to process the redemption only on the (POA) for making investments, switches, redemptions etc. under his folio,
basis of supporting documents confirming the identity of the investors. List of both the signature of the investor and the POA holder have to be clearly
such documents would be notified by AMC from time to time on its website. captured in the POA document to be accepted as a valid document. At
the time of making redemption / switches the fund would not be in a
c) There are two application forms.
position to process the transaction unless, POA holder’s signature is
i) Systematic Investment Plan (SIP) Form (Blue Colour) – To be used for available in the POA or proof of identity alongwith signature is produced
SIP Investment. along with the POA.
If you wish to apply for SIP through Auto Debit by way of Electronic 4. If the application is for Rs. 50,000 or more, then the PAN and IT Circle/
Clearing Service (ECS) or Standing Instructions to your bank account you Ward/District (if available) of the applicant, parent/guardian in case of
need to fill in the Instruction Form in addition to the SIP Form. minor and all applicants in case of more than one applicant should be
ii) Application Form (Red Colour) – To be used for one time investment. mentioned and a copy of the PAN card or Allotment Letter should be
d) Investors opting for Systematic Transfer Plan (STP) should fill the details in submitted. In case any of the applicants is not an assessee, the fact
the space provided on page 27. should be mentioned and Form 60/61 should be submitted along with the
application.
i) The minimum amount that can be transferred from one scheme to another
is Rs.1,000 for a minimum of 6 installments. 5. Applicants should indicate their status by ticking the appropriate box.
Applications without a tick in the ‘Status’ box will be considered as
ii) STP will be available at weekly (every Monday), monthly (last day of the investment by “Others”. Those who select the status as “Others”, they
month) or quarterly (last day of the quarter) rests as per the standing should specify their status in the space provided.”
instructions of the Unitholder. If any of these dates is a non-business day,
the transaction would be processed on the immediate next business day. 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, the
iii) For the target schemes, an entry load of 1% of the applicable NAV will
first named holder shall receive all the Account Statements, dividend/
be charged on the amount transferred under the STP facility.
redemption/refund warrants and any other correspondence sent from time
iv) Units so created in the target schemes will, in addition to any existing to time.
exit load for normal purchases, have an exit load of 1.25% of the
applicable NAV, if the units are redeemed before completion of 2 years 7. Name of a contact person should be mentioned in case of the investment
from the date of each STP transaction. by a Company/Body Corporate/Partnership Firm/Trust/Foreign Institutional
Investors (FIIs)/Society.
v) To effect the STP transaction for a particular transaction date as mentioned
above and as applicable for the respective frequency, the request for the III. BANK DETAILS
same should be received on or before the last business day of the week The first Unitholder should provide the name of the bank branch, complete address
preceding the week in which such effective transaction date falls. The of the branch, account type and account number, which is mandatory as per
unitholder can avail the STP facility for a maximum period of 10 years. Securities Exchange Board of India circular IIAMRP/MF/CIR/07/826/98 dated April
e) The application form number, the scheme name and the name of the applicant 15, 1998. Applications without this information will be deemed to be incomplete.
should be mentioned on the reverse of the instrument that accompanies the IV. INVESTMENT DETAILS
application.
a) Investor has to fill a separate form for each scheme that he wishes to invest
f) The Application completed in all respects along with the cheque/demand draft in.
must be submitted to the nearest Customer Service Center. Applications
incomplete in any respect or not accompanied by a cheque or demand draft b) Investor should select only one option (growth/dividend) and corresponding
for the amount payable are liable to be rejected and the money paid will be sub-option (e.g. reinvest/payout in case of dividend option) under the scheme(s)
refunded without interest. wherever applicable by ticking the appropriate box.

g) No receipt will be issued for the application money. The Customer Service c) Investor opting for AEP option (under Income Plan & Monthly Income Plan)
Centers will stamp and return the acknowledgement slip in the application should select the sub-option (regular/appreciation) and frequency (monthly/
form, to acknowledge receipt of the application. quarterly/half-yearly). For details, please refer to the offer document of the
respective schemes.
II. UNITHOLDERS INFORMATION d) In case, the investor has not selected the option/sub-option for his investments,
a) Existing Unitholders default option/sub-option as prescribed in the offer document of the relevant
scheme will be applied.
Investors already having an account in any of the Prudential ICICI schemes,
and making additional investments in the same schemes or any other schemes, e) For minimum application amount, please refer to table given on page 3 to 8.
should provide their Folio Number in Step 1. The names of the applicants, V. SYSTEMATIC INVESTMENT PLAN (SIP)
mode of holding etc. will be as per the folio number provided. Existing
unitholders need not fill the details in Step 2 and directly proceed to Step 3. a) SIP facility is available in the following schemes:

b) New Applicant Prudential ICICI Growth Plan, Prudential ICICI FMCG Fund, Prudential ICICI
Technology Fund, Prudential ICICI Balanced Fund, Prudential ICICI Monthly
1. Name and address must be given in full (P.O. Box Address is not sufficient). Income Plan, Prudential ICICI Power, Prudential ICICI Dynamic Plan,
In case of NRI/PIO/FII investors an overseas address must be provided. Prudential ICICI Discovery Fund, Prudential ICICI Emerging S.T.A.R. (Stocks
2. Name of guardian must be mentioned if the investments are being made Targeted At Returns) Fund, Prudential ICICI Tax Plan, Prudential ICICI Index
on behalf of a minor. Date of Birth is mandatory in case of minor. Fund, Prudential ICICI Income Plan, Prudential ICICI Flexible Income Plan,
Investments of the existing minor investor on minor attaining Prudential ICICI Income Multiplier Fund, Prudential ICICI Advisor Series,
majority: Upon attaining majority, a minor has to write to the fund, giving Prudential ICICI Child Care Plan, Prudential ICICI Long Term Plan and
Prudential ICICI Infrastructure Fund.

15
Prudential ICICI Mutual Fund

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

b) Investor opting for SIP need to fill the SIP Application Form (Blue Colour). If e) NRI/FII/PIO Investors
the payment option is Auto Debit through ECS or Standing Instruction to the 1. Repatriation basis:
Bank, investor also need to fill the respective forms on page 19 & 21.
Payments by NRIs / FIIs / Persons of Indian Origin residing abroad, may be
c) Investors opting for SIP investment can subscribe to this facility subject to the made either by way of Indian Rupee drafts or cheques by means of (i)
condition that each of the SIP installments including the initial purchase should inward remittance through normal banking channels; or (ii) out of funds
be of the same amount. held in NRE/FCNR account payable at par and payable at the cities where
d) Entry load equivalent to 1% of the applicable NAV will be charged on the the Customer Service Centres are located.
amount invested under the scheme(s) where SIP facility is available. In case of Indian Rupee drafts purchased through NRE/ FCNR Account, an
e) Amount so invested into the schemes will, in addition to any existing exit account debit certificate from the bank issuing the draft confirming the
load for normal purchases, have an exit load equivalent to 1.25% of the debit should also be enclosed.
applicable NAV, if the units are redeemed before completion of 2 years from In case the debit certificate is not provided, the AMC reserves the right
the date of allotment. to reject the application of the NRI investors.
f) Issue post dated cheques dated either 1st or 7th or 10th or 15th or 25th of 2. Non Repatriation basis
the month. A credit confirmation will be sent to the unitholder indicating the NRIs or people of Indian origin residing abroad investing on a non-repatriable
new balance to his or her credit in the account. basis may do so by issuing cheques/demand drafts drawn on Non-Resident
g) SIP Auto Debit via ECS (Debit Clearing) is available at the following 25 centres: Ordinary (NRO) account payable at the cities where the Customer Service
Centres are located.
Ahmedabad, Bangalore, Baroda, Bhopal, Bhubaneshwar, Chandigarh, Chennai,
VII. NOMINATION
Coimbatore, Guwahati, Hyderabad, Indore, Jaipur, Kanpur, Kolkata, Lucknow,
Ludhiana, Madurai, Mumbai, Nagpur, New Delhi, Panjim, Pune, Surat, 1. The nomination can be made only by individuals applying for / holding units on
Trivandrum and Vijaywada. their own behalf singly or jointly. Non-individuals including society, trust, body
corporate, partnership firm, Karta of Hindu Undivided Family, holder of Power of
h) Existing investors opting for SIP need to provide their Folio Number along Attorney cannot nominate. If the units are held jointly, all joint holders will sign
with SIP details. the nomination form. Space is provided as a specimen, if there are more joint
VI. MODE OF PAYMENT holders more sheets can be added for signatures of holders of units and
witnesses.
a) The cheque/demand draft should be drawn in favor of “Prudential ICICI Income
Plan” or “Prudential ICICI Flexible Income Plan” or “Prudential ICICI Gilt 2. A minor can be nominated and in that event, the name and address of the
Fund – Treasury Plan” or “Prudential ICICI Gilt Fund – Investment Plan” or guardian of the minor nominee shall be provided by the unit holder. Nomination
“Prudential ICICI Monthly Income Plan” or “Prudential ICICI Liquid Plan” can also be in favour of the Central Government, State Government, a local
or “Prudential ICICI Short Term Plan” or “Prudential ICICI Growth Plan” or authority, any person designated by virtue of his office or a religious or charitable
“Prudential ICICI FMCG Fund” or “Prudential ICICI Balanced Fund” or trust.
“Prudential ICICI Tax Plan” or “Prudential ICICI Technology Fund” or 3. The Nominee shall not be a trust (other than a religious or charitable trust),
“Prudential ICICI Power” or “Prudential ICICI Dynamic Plan” or “Prudential society, body corporate, partnership firm, Karta of Hindu Undivided Family or a
ICICI Floating Rate Plan” or “Prudential ICICI Income Multiplier Fund”or Power of Attorney holder. A non-resident Indian can be a Nominee subject to
“Prudential ICICI Discovery Fund”or “Prudential ICICI Emerging S.T.A.R. the exchange controls in force, from time to time.
Fund”or “Prudential ICICI Index Fund”or “Prudential ICICI Infrastructure 4. Nomination in respect of the units stands rescinded upon the transfer of units.
Fund”, as the case may be and crossed “Account Payee Only”.
5. Transfer of units in favour of a Nominee shall be valid discharge by the asset
The cheque / demand draft should be payable at the centre where the management company against the legal heir.
application is lodged. The cheque / demand draft should be drawn on any
6. The cancellation of nomination can be made only by those individuals who hold
bank which is situated at and is a member / sub-member of the Bankers’
units on their own behalf singly or jointly and who made the original nomination.
Clearing House. Cheques/ demand drafts drawn on a bank not participating
in the Clearing House will not be accepted. 7. On cancellation of the nomination, the nomination shall stand rescinded and the
asset management company shall not be under any obligation to transfer the
b) Separate Cheque/Draft is required for each scheme invested.
units in favour of the Nominee.”
c) Payments by Stockinvests, cash, postal orders, money orders and outstation VIII. DIRECT CREDIT OF DIVIDEND/REDEMPTION
cheques will not be accepted.
Prudential ICICI AMC had entered into an arrangement of a direct credit facility
d) The Fund will reimburse demand draft charges subject to maximum of Rs. of redemptions/ dividends with certain banks. For the Investors who have an
10,000/- per transaction for purchase of units by investors residing at location account with such banks, the AMC based on advice of the investor/ Unit holders
where the AMC Customer Service Centers/Collection Centers are not located have been crediting either redemption or dividend payments directly to the bank
as per the table below: accounts of the Unit holders.
Amount of Investment Rate of Charges of Demand Draft(s) Further, the default option for payment of redemption/dividend proceeds for all the
prospective investments would be the Direct Credit into their bank account (in case
Upto Rs.10,000/- At actuals subject to maximum of Rs.50/-
the investor has provided his bank mandate as one of the banks participating in
Above Rs.10,000/- Rs. 2/- per Rs. 1000/- direct credit arrangement and if he fails to specify the mode of payment).
However, the demand draft charges will not be reimbursed for Prudential The AMC may alter the list of the banks participating in direct credit arrangement
ICICI Liquid Fund, Prudential ICICI Short Term Plan, Prudential ICIC Gilt Fund – from time to time/ withdraw direct credit facility from the banks, based on its
Treasury Plan and Prudential ICICI Floating Rate Plan. experience of dealing with any of such banks or add / withdraw the name of the
AMC reserves the right to refuse the reimbursement of demand draft charges, bank with whom direct credit facility arrangements can be introduced/ discontinued
in case of investments made by the same applicant(s) through multiple as the case may be.
applications at its own discretion which will be final and binding on the IX. E-MAIL COMMUNICATION
investor.
Delivering service through web/e-mail helps the Fund to reduce expenses in the
Investors residing at places other than where the AMC Customer Service Fund and is a more efficient delivery channel. When an investor has communicated
Centers/ Collection Centers are located, are requested to make the payment his/her e-mail address and has provided consent for sending communication only
by way of demand draft(s) after deducting bank charges as per the rates through email, the Mutual Fund / Registrars are not responsible for email not
indicated in the above table. It may be noted that additional charges, if any, reaching the investor and for all consequences thereof. The Investor shall from
incurred by the investor over and above the levels indicated above will not be time to time intimate the Mutual Fund / its transfer agents about any changes in
borne by the Fund. the email address. In case of a large document, a suitable link would be provided
No demand draft charges will be reimbursed by the Fund for purchase of and investor can download, save and print these documents. However, investor
Units by investors residing at such locations where the Customer Service always has a right to demand a physical copy of any or all the service deliverable
Centers/Collection Centers of the AMC are located. and Fund would arrange to send the same to the investor.

16
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 Instruction
you also need to fill separate Instruction Form for the same.

Broker Code Sub-broker Code Date & Time of Serial Number

ARN - 4724
Receipt
ARN-0155
ARN - 4724
54934

Application No.
1 FOR EXISTING UNITHOLDERS
If you are making a purchase in an existing folio, please mention the folio number in the space
provided and proceeds to Step 3. Please note that the applicable details and mode of holding will Folio No.
be as per the existing folio.
Date:
2 ABOUT YOU
Name of First Applicant Date of Birth (Mandatory)
Mr. Ms. M/s. D D M M Y Y Y Y
Name of Guardian (in case of minor) / Contact Person (In case of Institutional Investors) Status [Please tick (✓)]
Mr. Ms. Resident Individual Trust
Designation of the Contact Person (In case of Institutional Investors) HUF Bank/FI
Company AOP/BoI
Mailing Address (Please provide full address)
Partnership Club/Society
Sole - NRI/FII/PIO
Proprietorship
Minor
City PIN
Others (Please specify) _______
State Country
_______________________
Communication
Tel. (Res.) (Off.) Mob

E-Mail
Overseas Address (in case of NRIs/FIIs)

City PIN

State Country
Name of Second Applicant Resident Individual Non-Resident Individual (Please tick (✓) the relevant box) Mode of holding [Please tick (✓)]
Mr. Ms. Single Anyone or
Survivor
Name of Third Applicant Resident Individual Non-Resident Individual (Please tick (✓) the relevant box)
Joint
Mr. Ms.
Occupation [Please tick (✓)]
Permanent Account Number (PAN) [Please refer to instruction no.II(b)(4)]
Professional Housewife
1st Applicant Guardian
MANDATORY DETAILS

Business Service
2nd Applicant Retired Student

3rd Applicant Others (Please specify) _______


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

If “Mandatory Details” are not provided,


3 BANK ACCOUNT DETAILS OF FIRST APPLICANT (Refer instruction No.III)
your application is liable to be rejected.
Name of Branch
the Bank Address
A/c.
Bank City A/c. No. Type Current Savings NRO NRE

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

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

✄ ✄
Application No.
Prudential ICICI AMC Ltd. - ACKNOWLEDGEMENT SLIP (To be filled in by the Investor)
Received from:

ress
Add

Application for Units of Prudential ICICI____________________________________________ Option :_____________________________________________ Signature, Stamp & Date
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.
17
1-Dec-2005
5 REDEMPTION / DIVIDEND REMITTANCE (Please refer to instruction no.VIII)
DIRECT CREDIT OF DIVIDEND/REDEMPTION ELECTRONIC CLEARING SERVICE (ECS) FOR DIVIDEND ONLY
Available in ABN Amro Bank, Bank of Punjab, Centurion Bank, Citibank N.A., Deutsche I authorise Prudential ICICI Mutual Fund to credit my dividend payments through ECS
Bank, HDFC Bank, Hongkong Bank, ICICI Bank, IDBI Bank, Kotak Bank, Standard (Please ✓)
Chartered Bank, and UTI Bank. Please quote 9 Digit Code No. of your Bank and Branch Corresponding to Bank
Unitholders having bank account with any of these bank will receive their Redemption/ Account Details given in Section - 3 above. (This number appears on every leaf of
your chequebook after your cheque number)
Dividend Payments (if any) directly into their bank account automatically. In case
Unitholders 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. IMPORTANT: Please attach a blank “cancelled” Cheque or a clear photocopy of a
(Please ✓ in this box) cheque issued by your bank veryfying of the Code No.

6 INVESTMENT DETAILS (Refer Instruction No.IV)


OPTIONS & SUB-OPTIONS (See the Key Features for Scheme specific options & sub-options)
NAME OF THE SCHEME (1)
[Please tick (✓) the appropriate boxes, only if it is applicable to the scheme/plan in which you wish to invest]

P R U D E N T I A L I C I C I AEP-Regular* Monthly Half Yearly


Cumulative/Growth
AEP-Appreciation Quarterly

Dividend Payout
Monthly Quarterly Half Yearly
Dividend Reinvestment
(Please leave one box blank between words)
* Cumulative – AEP Regular Option : Encashment of Units is subject to declaration of dividend in the respective Scheme(s).
✓ ) the appropriate box)
SIP Payment Details (You can choose one of the 3 payment options below. Please tick (✓
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 Amount Rs.

Drawn
Branch
on Bank
Subsequent Installment Details (to be filled in in case of SIP through cheque) Cheque Number From Cheque Number To
Single Installment Number of
Amount Rs. Cheques
Cheque Dated Start From End To
1st 7th 10th 15th 25th M M Y Y Y Y M M Y Y Y Y
Drawn
Branch
on Bank
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)
7 NOMINATION DETAILS (Optional)
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 settlements
made to such Nominee and signature of the Nominee acknowledging receipt thereof, shall be a valid discharge by the AMC / Mutual Fund / Trustees.
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)

PIN
Code
Name of the Guardian (If nominee is minor) Relationship with minor

Address of Guardian Signature of Guardian

PIN
Code
8 YOUR CONFIRMATION
The Trustee DD MM YYYY
Prudential ICICI Mutual Fund, First Applicant
SIGNATURE(S)

I/We have read and understood the offer document(s) of Prudential ICICI Mutual
Fund. I/We apply for the units of the scheme(s) and I/we agree to abide by the
terms, conditions, rules and regulations of the scheme. I/We confirm to have
understood the terms & conditions. Its investment objectives, investment pattern, Second Applicant
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 nor been induced by any rebate or gifts, directly or indirectly, in Third Applicant
making this investment.

✄ ✄
Prudential ICICI AMC Ltd. - ACKNOWLEDGEMENT SLIP (To be filled in by the Investor)
First Installment Cheque No. Cheque Dated D D M M Y Y Rs.

Drawn on Bank, Branch & City

Subsequent Installment Cheque Nos. Cheque Number From Cheque Number To Rs.

Drawn on Bank, Branch & City

18 Payment through Auto Debit ECS Bank Standing Instruction


Systematic Investment Plan (SIP) Auto Debit Instruction Form
Before filling this Instruction Form please ensure you have filled in the SIP Application Form
ticking ECS Authorisation in SIP payment details (Section 6)

ARN - 4724
ARN-0155
ARN - 4724
54934

Broker Code Sub-Broker Code Date & Time of Receipts


First Investment with a Application to be submitted at least 30 New Application
Current Date Cheque days before the commencement of SIP Cancellation
I/We hereby apply to the Trustee of Prudential ICICI Mutual Fund for the Systematic Investment Plan (SIP) Enrolment under Change in Bank Account*
the following scheme and agree to abide by the terms and conditions of the plan. [* Please provide a cancelled cheque]
APPLICANT AND SIP DETAILS
Sole / 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 Cheque Details
SIP Period From To Cheque No. Date Amount
MM 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.
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 the
transaction 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 also
inform Prudential ICICI Mutual Fund, about any changes in my bank account. I/We have read and agreed to the terms and conditions mentioned overleaf.

Signatures as in Bank Records


2nd Holder

3rd Holder
1st Holder

✄ ✄
Authorisation of the Bank Account Holder
This is to inform I/we have registered for the RBI's Electronic Clearing Service (Debit Clearing) and that my payment
towards my investment in Prudential ICICI Mutual Fund shall be made from my/our below mentioned bank account
with your bank. I/We authorise the representative carrying this ECS mandate Form to get it verified & executed. Account Number
Signatures as in Bank Records
2nd Holder

3rd Holder
1st Holder

✄ ✄
Acknowledgement Slip (Auto Debit) - Prudential ICICI Mutual Fund

Name of the Applicant ______________________________________________________________ Application/Folio No. ______________________


D D M M Y Y Y Y D D M M Y Y Y Y
Each SIP Amount (Rs.) _________________________________________ SIP Period - From SIP Period - To
Signature, Date & Stamp
Scheme ____________________________ Plan __________________________ Option & Sub-option ___________________________________

19
1-Dec-2005
Terms & Conditions
SIP 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 or
prior 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 Key
Information Memorandum.
The cheques should be drawn in favour of "Prudential ICICI Growth Plan" or "Prudential ICICI FMCG Fund" or "Prudential ICICI
Technology 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
At 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 Service
Centres of Prudential ICICI AMC. The cheques should be drawn on any bank which is situated at and is a member / sub-member of the
Bankers’ 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 initial
purchase 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 and
the same would be processed subject to the condition that there would be a minimum of 30 days period between the
submission 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 and
the same would be processed subject to the condition that there would be a minimum of 30 days period between the
submission 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 is
to 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 the
Prudential ICICI Mutual Fund Customer Service Centres. Notice of discontinuance should be received at least 30 days prior to the date that
it 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 invested
under 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 not
effected 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 for
any 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.

20
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)

Application Form No.

Existing Folio No.


Date: D D M M Y Y Y Y

To
The 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 : 2 0
(Month) (Year)

End Month : 2 0
(Month) (Year)

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 given
above 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 the
Mutual 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 of
the 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 the
Terms 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, rules
and regulations of the scheme. I/We confirm to have understood 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 nor been induced by any rebate or gifts, directly or indirectly, in making this investment.
Yours faithfully,
Signatures as in Bank Records
2nd Holder

3rd Holder
1st Holder

For Bank Branch use only: Application Form No. Existing Folio No.

Signature Verified by: ______________________________________________ Approved by BM: __________________________________________________


For CPU Use only:
Maintained on: D D M M Y Y Y Y A/c. No.:
Name of the A/c Holder:
SI Start Date: D D M M Y Y Y Y SI End Date: D D M M Y Y Y Y Next SI Date: D D M M Y Y Y Y Amount: _____________________
Maintained by: __________________________________________________

21
1-Dec-2005
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 (Blue
Colour).

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 Key
Information Memorandum.

The cheques should be drawn in favour of "Prudential ICICI Growth Plan" or "Prudential ICICI FMCG Fund" or "Prudential ICICI
Technology 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 At
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 Service
Centres of Prudential ICICI AMC. The cheques should be drawn on any bank which is situated at and is a member / sub-member of the
Bankers’ 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 initial
purchase 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 the
Prudential ICICI Mutual Fund Customer Service Centres. Notice of discontinuance should be received by 20th of the month. The investor will
cease 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 invested
under 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.

8. Prudential ICICI Mutual Fund, its registrars and other service providers shall not be responsible and liable for any damages/compensation for
any 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.

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 Corporation
Holdings Limited) and ICICI Bank Limited (erstwhile ICICI). Prudential ICICI Trust Limited is the Trustee to the Fund and the Prudential ICICI Asset Management Company Limited
is 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 the
objectives 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 and
forces affecting the capital markets. Past performance of the Sponsors, AMC/Fund does not indicate the future performance of the schemes. The Sponsors are not responsible
or 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 and
such 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.

22
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

I/We hereby apply to the Trustee of Prudential ICICI Mutual Fund for the Systematic Transfer Plan (STP) Enrolment under the following scheme
and agree to abide by the terms and conditions of the plan.
Application Number Folio Number (For existing Unitholders) Broker Code Sub-broker Code

ARN - 4724
ARN-0155 ARN - 4724
54934
Eligible Schemes from which you can Transfer: PruICICI Liquid Plan, PruICICI Income Plan, Eligible Schemes into which you can Transfer: PruICICI Growth Plan, PruICICI Power,
PruICICI Floating Rate Plan, PruICICI Long Term Floating Rate Plan, PruICICI Flexible Income PruICICI Tax Plan, PruICICI Dynamic Plan, PruICICI Technology Fund, PruICICI FMCG
Plan, PruICICI Short Term Plan, PruICICI Gilt Fund- Investment Plan and Treasury Plan, PruICICI Fund, PruICICI Balanced Fund, PruICICI Discovery Fund, PruICICI Emerging S.T.A.R.
Monthly Income Plan (An open ended fund. Monthly income is not assured and is subject to (Stocks Targeted At Returns) Fund and Prudential ICICI Infrastructure Fund.
the availability of distributable surplus) and PruICICI Income Multiplier Fund.

Scheme Name Scheme Name


(From where you wish (To where you wish to
to transfer amount): Plan Option transfer amount): Plan Option

Amount Rs. No. of installments


Frequency Weekly Monthly Quarterly (Minimum of Rs.1,000) (Minimum of 6 installments)
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.

Name of the Sole/First

SIGNATURE(S)
Sole/First Applicant Applicant

Name of the Second


Second Applicant Applicant

Name of the Third


Third Applicant Applicant

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.

Date
(dd/mm/yyyy)
(Please use separate SWP enrolment form for each Scheme/Plan)
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 and
conditions of the plan. I/We have read and understood the contents of the Offer Document and the instruction.
Application Number Folio Number (For existing Unitholders)
PAN/
GIR No.

Scheme
Name: Option

Monthly; OR Number of Units Amount to be


Frequency: OR Rs.
Quarterly to be withdrawn withdrawn

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

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.

Name of the Sole/First


SIGNATURE(S)

Sole/First Applicant Applicant

Name of the Second


Second Applicant Applicant

Name of the Third


Third Applicant Applicant
27
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.

Application Number Folio Number (For existing Unitholders)

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

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)
SWITCH FROM (Name of the Scheme) SWITCH TO (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

(Please leave one column blank between words) (Please leave one column blank between words)
Options & sub-options Options & sub-options
Cumulative/Growth AEP-Regular* Monthly Half Yearly Cumulative/Growth AEP-Regular* Monthly Half Yearly
AEP-Appreciation Quarterly AEP-Appreciation Quarterly
Dividend Payout Daily Fortnighly Quarterly Dividend Payout Daily Fortnighly Quarterly
Dividend Reinvestment Weekly Monthly Half Yearly Dividend Reinvestment Weekly Monthly Half Yearly
* Cumulative – AEP Regular Option : Encashment of Units is subject to declaration of
* Cumulative – AEP Regular Option : Encashment of Units is subject to declaration of
dividend in the respective Scheme(s).
dividend in the respective Scheme(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)
Switch the investment:
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.
(NAV per unit should be mention only in multiple of Re. 1)

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

INSTRUCTIONS
I / We have received, read and understood the offer document/key information memorandum. 7. Target scheme, where units will be switched if option/sub-options are not selected, it will be
1. Trigger will require folio number in case of existing investors or application form number in case switched to the default option (available under the Target Schemes).
of new investor. 8. Switch will be implemented on the day the trigger condition is satisfied. The Trigger is a one time
2. Trigger facility will switch all the units in the above mentioned scheme within the operation and will cease once it is exercised.
respective Folio Number of the investor. 9. Once switch is done exercising trigger option, the same will not be reversed whatsoever and it
3. Entry and Exit loads for the scheme(s) shall be applicable as mentioned in the the relevant Offer will be final and binding.
Document(s)/Addendum(s). The same will also be applicable for SIP / STP / SWP. 10. If trigger is not activated and/or implemented due to reasons, which are beyond the control of
4. Tigger facility is available in all the Schemes of Prudential ICICI Mutual Fund except SPIcE and PruICICI AMC, the AMC would not be held responsible. Trigger facility is only a facility extended
Index Fund. by the AMC for the convenience of the unit holders and does not form part of any scheme/fund
5. For the switch to happen the minimum purchase/redemption criteria should be met else the trigger objectives.
will not be effected. 11. AMC reserves the right to amend/terminate this facility at any time, keeping in view business/
6. Trigger facility on each scheme will require a separate/independent Trigger request form to be operational exigencies.
filled. If an investor holds similar schemes in two folios, they will have to register separately for it I/We have read & understood and agree to abide by the terms and conditions and opt
mentioning the folio number. for the Trigger facility.

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


Name of the Sole/First
SIGNATURE(S)

Sole/First Applicant Applicant

Name of the Second


Second Applicant Applicant

Name of the Third


Third Applicant Applicant

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 D D M M Y Y Y Y

(Please retain this slip for all the future correspondence with Prudential ICICI MF in relevance to this Trigger.) Signature, Stamp & Date
28

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