COMMON TRANSACTION FORM M,RAEAS$tr

Mutual Fund

Name & Broker Code/ARNIRIA Code Sub Agent Code ISC Date Time Stamp/Reference No.

rN420001 41 40

Folio No.: Name of 1'. Unit HoIdeT: SIEMENS INFoRMATIoN SYSTEMS LII\,1ITED EMPLoYEES PRoVIDENT FUND

KYC compliance status: Please (,/ ) E2" Applicant [3'" Applicant

E
B
Scheme
Nilirae Asset Large cap Fund
I ll Regular Plan I Div. Payout I D v frequency*
| fr oirect etan [t G,owrh (Deraulr;
I Div. Reinvestment (Defaull)
.Dividend
frequency is applicable only for l\,4irae Asset Cash l\,4anagement Fund & Mirae Asset Savings Fund.
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Payment Type: Please (,/ ) ENon-Third Party Payment IfnirU Pa(y Payment (Please attach 'Third Party Payment Declaration Form')

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Core Banking AJc No.: 0 0 0 3 1 0 0 0 oislz ?l j ar",ryp" please('11 [lrnr f]cunRENr EIsAVtNGs [sno
o / DD / Net Purchase Drawn on Bank / Pay-ln Bank A/c No.
6
c
cheque / DD / urR No. & Date II 3i1':1.:l9leque
RTGS / NEFT in figures (t) Amount Branch (For Cheque Only)
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5 7250000 HDFC BANK LIMITED
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,g TRANSACTION CHARGES (Refer Instruction No. 11 of the KIM): ln case, the additional purchase amount is < 10,000 or above and distributor has opted to receive
transaction charges, < 1001will be deducted from the Purchase amount and paid to the distributor. U nits shall be allotted forthe balance amount only.
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c National Securities Depository Limited (NSDL) Central Depository Services (lndia) Limited (CDSL)
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DP Name: HDFC BANK LIVITED DP Name:
s 16 DiqitAJC No.

Enclosures: Please (/ ) E Client Masters List (CML)

E Transaction cum Holding Statement Oe]iverV lnstruction Slip (DlS)
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L
Scheme
] E *"9r,u. t,nn n Div. Payout f] Div frequency'

tDividend frequency is applicable

only for Mirae Asset Cash l\,4anagement Fund & Mirae Asset Savings Fund.

Amount (in figures) ({): Or All Units

Or Units (in figures): !
Amount (in words) (t):
Direct Credit to other than Default Bank Account: I / We request you to directly credit the proceeds to my
for this transaction, which is one of the multiple bank already registered under the folio.

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From Scheme | [-'1 Plan Reoular Payout
ttffi$Sffi&ffiffitr
j fr ]
I Div.
] f] o,u frequency'
o,,l.t eru. ! Growtn I Div. Reinvestmenl I

Amount (in figures) ({): Or Units (in figures): orAll Unitsfl

Amount (in words) ({}:
To Scheme ] f] Resular Plan j I I niv. Payout Dlv frecuencv"
IE Direct Plan i E Growth (Defaultl I E Div. Reinvestment (Deiault) _E
.Dividend frequency is applicable only for Mirae
Asset Cash Management Fund & l\,4irae Asset Savings Fund

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Folio No-: E Additional Purchase

I Redemptlon
!srit"t Date;__ I jl-f] l
Scheme: or Units:
Frorn Scheme (in case of switch): To Scheme: