APPLICATION NO.

S-1306/19
COMMON APPLICATION FORM FOR EQUITY ORIENTED SCHEMES (Please fill in BLOCK Letters)
ARN & Name of Distributor Branch Code Sub-Broker ARN Code Sub-Broker Code EUIN* Reference No.
(only for SBG) (Employee Unique Identification Number)

Declaration for "execution-only" transaction (only where EUIN box is left blank) (Refer Instruction 1 (p))
* I/We hereby confirm that the EUIN box has been intentionally left blank by me/us as this is an “execution-only” transaction without any interaction or advice by the employee/relationship manager/sales person of the above
distributor or notwithstanding the advice of in-appropriateness, if any, provided by the employee/relationship manager/sales person of the distributor and the distributor has not charged any advisory fees on this transaction.

SIGNATURE(S)
1st Applicant / Guardian / Authorised Signatory 2nd Applicant / Authorised Signatory 3rd Applicant / Authorised Signatory
Upfront commission shall be paid directly by the investor to the AMFI registered Distributors based on the investors’ assessment of various factors including the service rendered by the distributor
TRANSACTION CHARGES FOR APPLICATIONS THROUGH DISTRIBUTORS/AGENTS ONLY (SEE NOTE 15)
In case the subscription amount is Rs. 10,000/- or more and if your Distributor has opted to receive Transaction Charges, Rs. 150 (for first time mutual fund investor) or Rs. 100/- (for
investor other than first time mutual fund investor) will be deducted from the subscription amount and paid to the distributor. Units will be issued against the balance amount invested.

EXISTING FOLIO NO.  NAME

1. FIRST APPLICANT DETAILS
Name

(Mr. / Ms. / M/s.)
(in case of Minor)
D h a n y a M
(Name should be as per PAN )
Name of Guardian

Relationship of Guardian Father Mother Legal Guardian [Please mandatorily enclose the document evidencing the relationship of Minor with Guardian]
PAN/PEKRN NO.
(Enclose KYC Acknowledgement)  A J Y P H 8 7 5 5 R Date of Birth 1D 3 D / M0 M
2 /Y 1Y 9 Y9 Y1
KIN
(CKYC Identification No.)

Email ID
 [email protected] Telephone (O)

Mobile No.
 1234567589 Telephone (R)

Country Code

Correspondence H o u s e N o 7 8 9
Address of
1st Applicant
 X Y Z S t r e e t
City C o c h i n
State TIME STAMP HERE
Pin 6 8 2 , 0 2 k e r a l a
✓ ) ) Indian by Default
Address for Correspondence for NRI Applicants only ( Please (✓ Foreign
Foreign Address
(Mandatory for NRI / FII )

City

Zip Country

2. MODE OF HOLDING (Please ✓ )

Single Joint Anyone or Survivor
3. JOINT APPLICANT DETAILS
Second Applicant Third Applicant
Name (Name should be as
per PAN)

PAN /PEKRN
(Enclose KYC Acknowledgement)
KIN
(CKYC Identification No.)

4. BANK ACCOUNT (Pay Out)

Name of Bank
Details of First Applicant (Mandatory to attach bank account proof in case the payout bank account is different from the source/investment bank account)

H D F C B A N K
Branch Name P A L A R I V A T T O M B R A N C H
and Address


City C O C H I N Pin 6 8 2 , 0 2
Account No. 2524041527463 Account Type (Please ✓)
Savings NRO FCNR
IFS Code I F S C 0 0 0 0 2 3 (Please provide a copy of CANCELLED cheque leaf)
Current NRE Others
9 digit MICR Code 6 8 4 2 4 6 8 9
TEAR HERE
Sponsor : State Bank of India
Investment Manager : SBI Funds Management Pvt. Ltd. ACKNOWLEDGEMENT SLIP APPLICATION NO.
(A Joint Venture between SBI & AMUNDI) To be filled in by the Investor
(To be filled in by the First applicant/Authorized Signatory) :
Received from : Signature,
Date &
Scheme Name ✓)
Plan (✓ ✓)
Option (✓ ✓)
Dividend Facility(✓ Cheque/ DD Amount (Rs.) Bank and Branch Cheque / DD No. & Date Stamp
Regular Growth Reinvestment Payout
Direct Dividend Transfer
Attachments All purchases are subject to realisation of cheque / demand draft
5. FATCA & CRS INFORMATION: For Individuals / Proprietor (Mandatory). Non-Individual investors should mandatorily fill separate FATCA/CRS & UBO Form (Annexure-1).
Is the applicant(s) Country of Birth / Nationality / Tax Residency other than “India” ?
1.First Applicant (including Minor) 1. Second Applicant 1. Third Applicant
 Yes No Yes
 No Yes
 No
If “YES”, please provide the following information (mandatory):
1. Details 1.First Applicant (including Minor) 1. Second Applicant 1. Third Applicant
Country of Birth

Place/City of Birth

Nationality

Country of Tax Residency 1

Tax Payer Ref. ID No^

Identification Type
[TIN or Other, Please specify]

Country of Tax Residency 2

Tax Payer Ref. ID No.2

Identification Type
[TIN or Other, Please specify]

Country of Tax Residency 3

Tax Payer Ref. ID No. 3

Identification Type
[TIN or Other, Please specify]
^ In case Tax Identification Number is not available, kindly provide its functional equivalent. If no TIN is yet available or has not yet been issued, please provide an explanation and attach
this to the form. (Please attach additional sheets if necessary and mention all countries in which applicant is a tax resident & provide relevant details)

6. INVESTMENT AND PAYMENT DETAILS

One time Investment Systematic Investment Plan (SIP) (Please submit SIP Enrolment & OTM Form)

Scheme Name SBI FOCUSED EQUITY FUND

Plan (Please ✓ ) Regular Direct In case of Dividend Transfer facility, please mention target scheme along with plan/option.

Option (Please ✓ ) Growth Dividend Frequency

Scheme / Plan / Option
Dividend Facility (Please ✓ ) Reinvestment Payout Transfer

Payment Mode Cheque DD (Third Party Declaration Mandatory) Fund Transfer RTGS

Cheque / D.D. No. & Date Cheque / DD Amount (Rs.) Drawn on Bank and Branch

15486997 &13/02/2021 500.00 HDFC & PALARIVATTOM

7. TAX STATUS (Please ✓ )

Resident Individual Pension and Retirement Fund Government Body NGO
Resident Minor (through Guardian) Financial Institutions Society
LLP
NRI (Repatriable) Public Limited Company Trust
PIO
NRI (Non-Repatriable) Private Limited Company NPS Trust
NRI– Minor (Repatriable) Body Corporate Fund of Fund NPO
[Please specify]
NRI – Minor (Non-Repatriable) Partnership Firm Gratuity Fund
Sole-Proprietor FII / FPI AOP Others
HUF Bank BOI [Please specify]

8. DEMAT ACCOUNT DETAILS (OPTIONAL)

If you wish to hold units in Demat mode, please provide below details and enclose Latest Client Master / Demat Account Statement
Please ensure that the sequence of names as mentioned in the application form matches with that of the account held with the Depository Participant.

National Securities Depository Limited (NSDL) Central Depository Services (India) Limited (CDSL)
Depository Depository
Participant Name Participant Name Muthoottu Mini Financiers Ltd.
DP ID No. I N Beneficiary Account No.
Beneficiary Account No. Mention the demat account no. here

Please note wherever units are allotted in Demat Mode, Statement of Account will be issued by the Depository concerned.

TEAR HERE
Any communication in connection with this application should be addressed to the Registrar or the Invesment Manager
Investment Manager : Registrar:
SBI Funds Management Pvt. Ltd. Computer Age Management Services Pvt. Ltd.,
(A Joint Venture between SBI & AMUNDI) SEBI Registration No. : INR000002813)
9th Floor, Crescenzo, C-38 & 39, TOLL FREE NO : 1800 425 5425
Rayala Towers, 158, Anna Salai,Chennai – 600 002
G Block, Bandra Kurla Complex, Website : www.sbimf.com
Email: [email protected]
Bandra (East), Mumbai – 400 051
Tel: 022- 61793511 Website: www.camsonline.com
Email: [email protected]
9. OTHER PERSONAL INFORMATION – (Please ✓ )
First Applicant 1. Second Applicant 1. Third Applicant
Gender Male Female Other Male Female Other Male Female Other

Father's Name ASHOK KUMAR

Spouse's Name

Date of Birth D D M M Y Y Y Y D D M M Y Y Y Y D D M M Y Y Y Y
Occupation Professional Business Professional Business Professional Business
(Please ✓ )
Government Service Agriculturist Government Service Agriculturist Government Service Agriculturist
Private Sector Service Retired Private Sector Service Retired Private Sector Service Retired
Public Sector Service Housewife Public Sector Service Housewife Public Sector Service Housewife
Student Forex Dealer Student Forex Dealer Student Forex Dealer
Doctor Doctor Doctor
Others Others Others

Gross Annual Income in Rs. Below 1 Lac 1-5 Lacs Below 1 Lac 1-5 Lacs Below 1 Lac 1-5 Lacs
(Please ✓ ): 5-10 Lacs 10-25 Lacs 5-10 Lacs 10-25 Lacs 5-10 Lacs 10-25 Lacs
25 Lacs - 1 Cr. > 1 Cr. 25 Lacs - 1 Cr. > 1 Cr. 25 Lacs - 1 Cr. > 1 Cr.

OR Networth in Rs.
Networth as of date D M M Y Y Y Y D M M Y Y Y Y
D D D D M M Y Y Y Y

Politically Exposed Person [PEP] Yes No Related to PEP Yes No Related to PEP Yes No Related to PEP
Type of address given at KRA Residential Business Reg. Office Residential Business Reg. Office Residential Business Reg. Office

10. NOMINATION : I wish to nominate the following person/s to receive the proceeds in the event of my death. (With effect from 01/04/2011, for individual investors applying with
single holding, Nomination is mandatory. However, in case you do not wish to nominate please sign in point 11)
Nominee 1 Nominee 2 Nominee 3
Name of the Nominee ASHOK KUMAR
Name of the Guardian
(In case Nominee is Minor)

Allocation % (Mandatory if more than one Nominee)

Relationship with Nominee FATHER

Date of Birth* (Mandatory if Nominee is Minor) D D M M Y Y Y Y D D M M Y Y Y Y D D M M Y Y Y Y

Signature of Nominee/Guardian
(*Mandatory in case of Minor Nominee)
⊗ ⊗ ⊗
11. NOMINATION : I do not wish to nominate any person at the time of making the investment.

Signature

12.INSTITUTIONAL INVESTORS ADDITIONAL INFORMATION

Name of Contact Person
Is the entity involved / providing any of the following services Yes No Gaming / Gambling / Lottery Services (e.g. Casinos, Betting Syndicates) Yes No
For Foreign Exchange / Money Changer Services Yes No Money Lending / Pawning Yes No
NOTE: Non-Individual investors should mandatorily fill separate FATCA/CRS & UBO Form (Annexure-I) alongwith this form.
13. GO-GREEN INITIATIVE:
As part of Go-Green initiative, issuance of physical copy of scheme-wise annual reports or abridged summary is limited to those investors whose email id is not available and
who specifically opt to receive it in physical form. Please tick here only if you wish to receive the same in physical mode
14. DECLARATION : I/We confirm that the information provided in this form is true & accurate. I/We have read and understood the contents of all the scheme related documents and I/We hereby confirm and declare
that (i) I/We have not received or been induced by any rebate or gifts, directly or indirectly, in making this investment; (ii) the amount invested/to be invested by me/us in the scheme(s) of SBI Mutual Fund (“the Fund”) is derived
through legitimate sources and is not held or designed for the purpose of contravention of any act, rules, regulations or any statute or legislation or any other applicable laws or any notifications, directions issued by any
governmental or statutory authority from time to time; (iii) the money invested by me in the schemes of the Fund do not attract the provisions of Foreign Contribution Regulations Act (“FCRA”); (iv) I/We am/are aware that a U.S.
person (within the definition of the term ‘US Person’ under the US Securities laws) / resident of Canada are not eligible for investments with the Fund and I/We am/are not a U.S. person/resident of Canada; (v) the ARN holder
has disclosed to me/us all the commissions (in the form of trail commission or any other mode), payable to him/her for the different competing schemes of various mutual funds from amongst which a scheme of the Fund is being
recommended to me/us; (vi) * as per the Memorandum and Articles of Association of the Company, Bye laws, Trust Deed or Partnership Deed and resolutions passed by the Company / Firm / Trust, I/We am/are authorised to
enter into the transactions for and on behalf of the Company/Firm/Trust; (vii) ** I/We am/are Non Resident of Indian Nationality/Origin and that funds for the subscriptions have been remitted from abroad through approved banking
channels or from my/our Non Resident External/Ordinary account/FCNR Account; (viii) all information provided in this application form together with its annexures is/are true and correct to the best of my/our knowledge and belief
and I/We shall be liable in case any of the specified information is found to be false or untrue or misleading or misrepresenting; (ix) that we authorize you to disclose, share, remit in any form, mode or manner, all / any of the
information provided by me/ us, including all changes, updates to such information as and when provided by me/ us to the Fund, its Sponsor, AMC, trustees, their employees/RTAs or any Indian or foreign governmental or statutory
or judicial authorities/agencies including but not limited to SEBI, the Financial Intelligence Unit-India, the tax/revenue authorities in India or outside India wherever it is legally required and other such regulatory/investigation
agencies or such other third party, on a need to know basis, without any obligation of advising me/us of the same; (x) I/ We shall keep you forthwith informed in writing about any changes/modification to the information provided
or any other additional information as may be required by you from time to time; (xi) Towards compliance with tax information sharing laws, such as FATCA and CRS: (a) the Fund may be required to seek additional personal,
tax and beneficial owner information and certain certifications and documentation from investors. I/We ensure to advise you within 30 days should there be any change in any information provided; (b) In certain circumstances
(including if the Fund does not receive a valid self-certification from me) the Fund may be obliged to share information on my account with relevant tax authorities; (c) I/We am aware that the Fund may also be required to provide
information to any institutions such as withholding agents for the purpose of ensuring appropriate withholding from the account or any proceeds in relation thereto; (d) as may be required by domestic or overseas regulators/
tax authorities, the Fund may also be constrained to withhold and pay out any sums from my/our account or close or suspend my account(s) and (e) I/We understand that I am / we are required to contact my tax advisor for any
questions about my/our tax residency; (f) I have understood the information requirements of this Form (read along with the FATCA/CRS Instructions) and hereby confirm that the information provided by me/us on this Form including
the taxpayer identification number is true, correct, and complete. I also confirm that I have read and understood the FATCA Terms and Conditions below and hereby accept the same. (xii) If the name given in the Application
is not matching PAN, application may liable to get rejected or further transactions may be liable to get rejected. By using this application I/We agree to issue a cheque in favor of the facility ‘SBI Multi Select’ which will be
invested as per the option selected/ mentioned under clause (5) of the form.
* Applicable to other than Individuals / HUF; ** Applicable to NRIs;

SIGNATURE(S)
(ALL Applicants ⊗
must sign) ⊗ ⊗
1st Applicant / Guardian / Authorised Signatory 2nd Applicant / Authorised Signatory 3rd Applicant / Authorised Signatory

Date Place