COMMON TRANSACTION FORM INCLUDING OTM FACILITY (For existing Unitholders only)

BROKER CODE (ARN CODE)/ SUB-BROKER ARN CODE Employee Unique SUB-BROKER CODE
RIA/PMRN CODE# Identification No. (EUIN) (As allotted by ARN holder)
#By mentioning RIA/PMRN code, I/we authorize you to share with the Investment Adviser the details of my/our transactions in the scheme(s) of ICICI Prudential Mutual Fund.
Declaration for "execution-only" transaction (only where EUIN box is left blank)
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 of Sole/First Holder Signature of Second Holder Signature of Third Holder

FOLIO NO. (Mandatory): TAX STATUS: MODE OF HOLDING:
1st Holder
s)
older( tus*
(Mandatory)
h PAN* ta
f Unit KYC S
ame o
2nd Holder

3rd Holder N
* PAN & KYC are mandatory for all applicants including NRIs.
LEI Date of Birth (1st Holder) D D M M Y Y Y Y
Number (Mandatory for ICICI Prudential Retirement Fund & ICICI Prudential Child Care Fund) -
Legal Entity Identifier Number is for Transaction value of INR 50 crore and above. See Instruction No. V) (Refer Instruction No. I on page 2)
(Cheque/DD to be drawn in favour of “Name of the Scheme”). In case you do not mention Plan and/or Option units will be allotted under
Additional Purchase Request default option as per respective scheme information documents.

Scheme Name PLAN: OPTION:

Payment Mode (Please tick any one only): (Please refer Instruction III) OTM (One Time Bank Mandate) Cheque DD Fund Transfer RTGS/NEFT
Cheque/DD/Instrument No. __________________________________ Payment Date/Instrument Date: _____ / _____ / _______ Amount (Rs.) : ___________________________
Bank Name**: _______________________________________________________ Branch: _______________________________ City: _____________________________________
Bank ** Please refer to Account Savings Current NRO NRE FCNR
A/c No.** instruction no.2 Type
Others ___________________________ (Please specify)

I/We hereby confirm having initiated the Transfer / RTGS for transfer of INR ___________________________________ from our account no. __________________________________ with ________________

_________________________ (Bank) to your account no. _______________________________with___________________________________ (Bank). Payment Reference No. ______________________________

Documents attached to avoid Third Party Payment Rejection where applicable: In case, the additional purchase amount is `10,000 or above and distributor has opted to receive transaction charges, `100/-
Bank Certificate - for DD Third Party Declaration will be deducted from the Purchase amount and paid to the distributor. Units shall be allotted for the balance amount only.
For third party investment/pre-funded instrument, please fill in a separate declaration form as available with AMC.
Switch Request (Please refer to the SID of the scheme you are switching from and to) I wish to switch: Rs. or Units
From To
(Scheme) (Scheme)
Plan: (Option) Plan: (Option)

Have you invested long enough ? Redemption Request (Please refer Instruction IV) :
• Longer investment time period may allow your money the Benefit of
BEFORE YOU

Please
Compounding. Rs. or Units
REDEEM

Redeem
• We recommend you check your investment horizon against your financial
Scheme
goals and not to get swayed by short term market movements.
• Have you been invested long enough to avoid any short term capital gain Plan
tax and exit load charges ?
Option
Consult your financial advisor for the appropriate investment horizon!
If you have registered for multiple bank account facility in the above folio please specify the bank details in which you wish to receive the redemption proceeds. The bank account should be
one of the registered bank account in the folio else the payout will be released to the default bank account registered for the folio.

Bank Name Bank A/c No.

Contact details of First/Sole applicant

Mobile Number and/or Land Line Number

E-mail Address

As per the press release dated April 11, 2017 issued by Ministry of Finance, the AMC has blocked/freezed the folios opened between 1st July 2014 to 31st August 2015 where FATCA self certification is not
provided. The AMC shall not process any transaction which is initiated by the Investor in such folio(s) unless FATCA self-certification is provided by the Investor and due diligence is completed by the AMC.

YOUR CONFIRMATION/DECLARATION: I/We have read and understood the contents of the Scheme Information Document(s)/Key Infromation Memorandum(s) & Statement of Additional
Information(s) of the Scheme(s) and agree to abide by the terms, conditions, rules and regulations of the Scheme(s) as on the date of this transaction. The ARN holder has disclosed to
me/us all the commissions (in the form of trail commission or any other mode), payable to him for the different competing Schemes of various Mutual Funds from amongst which the
Scheme is being recommended to me/us. I/We hereby confirm that I/we have not been offered/communicated any indicative portfolio and/or any indicative yield for this investment. I/We
interested in receiving promotional material from the AMC via mail, SMS, telecall, etc. I/we declare that the email address provided in the form belongs to me/us or to spouse, dependent
children or dependent parents (applicable to individual investors only).

Signature(s)
First Holder Second Holder Third Holder

(Please See Overleaf)

Folio No. ............................................................................................................. Purchase Redeem Switch Date: .................................................

Scheme ............................................................................................................................................................................. Amount Rs. ....................................................................... or Units .........................................................

From Scheme (in case of switch) ........................................................................................................................ To Scheme .......................................................................................................................................................

COMMON TRANSACTION FORM INCLUDING OTM FACILITY (Contd.)

INSTRUCTIONS:
I. DATE OF BIRTH (DOB)
1) Date of birth of the First Unit Holder is mandatory for subscribing to the units of the Scheme, alongwith a copy of proof of date of birth as detailed in point (d) evidencing date of birth
of the First Unit holder.
2) AMC reserves the right to process the application where only date of birth is provided in the application form or the date of birth is retrievable from other sources.
3) Age shall be computed with reference to years completed on the date of allotment.
4) Acceptable Documents for Proof of date of Birth: Self attested copy of PAN, Passport, Driving licence or any other documents issued by Government departments of foreign
jurisdictions and letter issued by Foreign Embassy or Mission in India; Identity card with applicants name and date of birth issued by any of the following: Central/ State Government
Departments, Statutory/Regulatory Authorities, Public Sector Undertakings, Scheduled Commercial Banks, Public Financial Institutions, Colleges affiliated to Universities, Professional
Bodies such as ICAI, ICWAI, ICSI, Bar Council, etc., to their Members. AMC reserves right to reject or process the application or ask for additional documentation subject to internal
verification.

II. PURCHASE REQUEST:

1) In case of fresh/additional purchases, if the name of a particular Scheme/Plan on the application form/transaction slip differs from the name on the Cheque/Demand Draft, then ICICI
Prudential Asset Management Company Limited (the AMC) will process the application and allot units at the applicable Net Asset Value, under the Scheme/Plan which is mentioned
on the application form/transaction slip duly signed by the investor(s). The AMC reserves the right to call for other additional documents as may be required, for processing such
transactions. The AMC also reserves the right to reject such transactions.
2) If the Plan name is not mentioned on the application form/transaction slip, then the units will be allotted under the Plan mentioned on the Cheque/Demand Draft. The Plan/Option that
will be considered in such cases if not specified by the customer will be the default option of the Plan as per the SID.
3) Change in IDCW Sub-option due to additional request or on a basis of investor request, will be applicable to all existing units in the IDCW Option of the scheme under the respective
folio.

III. ADDITIONAL PURCHASE THROUGH OTM FACILITY:

1) Investor can invest through OTM facility registered in the folio and does not have to provide any cheque or transfer details.
2) Bank details need to be provided if transaction is through OTM mode, if no bank details are mentioned or no OTM mandate is registered for the given bank details then default bank
mandate under OTM facility will be considered to debit the purchase amount
3) The units shall be allotted based on the day on which funds are credited to AMC’s collection account by the service provider/ bank. This is subject to compliance with the time stamping
provision as contained in the SEBI (mutual funds) regulations, 1996.
4) Purchase transaction or any other subsequent transaction may be liable for rejection at banker's end, if the frequency for the registered OTM is other than "As and when presented"
and/ or if the purchase amount is other than fixed amount or more than maximum amount registered in the mandate.
5) AMC reserves right to reject or process the application subject to internal verification.

IV. REDEMPTION/SWITCH REQUEST:

1) If an investor submits a redemption/switch request mentioning both the Number of Units and the Amount to be redeemed/switched in the transaction slip, then the AMC reserves the
right to process the redemption/switch for the Number of units and not for the amount mentioned. If an investor submits a redemption/switch request by mentioning Number of Units
or Amount to be redeemed and the same is higher than the balance Units/Amount available in the folio under the Scheme, then the AMC reserves the right to process the
redemption/switch request for the available balance in the folio under the Scheme of the investor.
2) If an investor/unitholder submits a redemption request mentioning only the name of the Scheme/Plan and Folio Number but not mentioning the units and the amount for redemption,
the Fund shall assume that the redemption request is for all the units under the stated folio from the Scheme/Plan and the option mentioned on the redemption request and shall
redeem all the units.
3) Incase of investment in the name of Minor, payment for investment must be from the bank account of the minor or from a joint account of the minor where the joint holder should be
same as the guardian mentioned in the folio or else the transaction is liable to be rejected.
4) Incase of guardian bank account updated in the folio, please arrange to update the bank account of the minor or a joint account of the minor where the joint holder should be same as
the guardian mentioned in the folio before placing the redemption. This will ensure seamless payment of redemption/dividend amount.

V. As per the RBI circular "Introduction of Legal Entity Identifier for Large Value Transactions in Centralised Payment Systems" vide notification RBI/2020-21/82 DPSS.CO.OD
No.901/06.24.001/2020-21 dated 5th January 2021. RBI vide this notification has decided to introduce the LEI system for all payment transactions of value INR 50 crore and above undertak-
en by entities (non-individuals) using Reserve Bank-run Centralised Payment Systems viz. Real Time Gross Settlement (RTGS) and National Electronic Funds Transfer (NEFT).
From April 1, 2021, 20-digit Legal Entity Identifier (LEI) information is included while initiating any transaction of value INR 50 crore and above by entities (non-Individual).

In case there is any change in your KYC information please update the same by using the prescribed ‘KYC Change Request Form’, available on our
website www.iciciprumf.com under the downloads section, and submit the same at the Point of Service of any KYC Registration Agency.