UNIT TRUST OF INDIA
13, Sir Vithaldas Thackersey Marg,
Mumbai 400 020

Name

Code No.

C.C.CODE

Tel. No.

C.A.CODE

FILL IN ALL THE PARTICULARS IN BLOCK LETTERS. USE ONE BOX FOR AN ALPHABET LEAVING A BOX BLANK AFTER EACH WORD. DO NOT SPLIT THE WORD. USE NEXT LINE.

Dear Sirs,
I/We have read the contents of the offer document & instructions and I/We hereby apply for Monthly Income Plan - 2000(Third) as under :

( If no option is ticked, the investment will be deemed to be under the
monthly income option )

1 Business
2 Service
3 Profession
4 Agriculture
5 Retired
6 Housewife
7 Student
8 Others

In my/ our individual capacity (Please fill in the nomination form) (1)
On behalf of minor as Father / Mother / Lawful guardian (2)
Karta / Manager of HUF (14)
For the benefit of Mentally Handicapped Adult ( Please fill the declaration form)
Partnership Firm (13)
Society (11) / Eligible Trust (6)
Provident Fund Trusts (21)
Body Corporate (7)
Company (5)
Section 25 Company (18)
Scheduled Commercial Banks (20)
Dist. Co-op Banks/ State Co-op Banks/ Regional Rural / Land Development Banks (8)

NRI (3)
On behalf of NRI minor as Father /
Mother / Lawful guardian (4)
Karta of non-resident HUF (15)
OCB - Company (9)
OCB - Trust (10)

Holding Basis

Singly
Jointly
Anyone or Survivor

Investment under section
54EA
(Available only in respect of long term capital assets transferred before 1st April, 2000, as per Finance Act, 2000)

Mode of Payment

Residents Cash Cheque DD Switchover
NRIs / OCBs NRE Cheque NRO Cheque Rupee DD Switchover

Amount Paid Rs.

Bank Draft/ NRE/NRO/Cheque No.

Drawn on (Bank Name) :

Dated

Amount Rs.

Branch

(in words) Rs.

City

Name of Applicant/ Minor/ Karta of HUF/ Non-Individual

Full Name of Father/ Husband of the Applicant

Full Name of Parent/ Guardian (in case of Minor) / mentally handicapped person

Date of Birth of the
First Applicant / Minor

Tel. No. of the Applicant :

e-mail :

Only Address (DO NOT REPEAT NAME) in full of Applicant/ Parent OR Guardian of Minor / Foreign address of the 1st NRI applicant (Post box alone is not sufficient)

DISTRICT

STATE

Country (in the case of NRIs)

PIN / ZIP

Tax Payer's P.A.N. or G.I.R. No.*

I.T. Circle/ Ward/ District*

* To be filled in, in case of investment of Rs.50,000/- and above

Full Name of Second Applicant / Alternate Parent as Father, Mother of the Minor

Full Name of Third Applicant

(In case the application is made by Non-individuals or for the benefit of mentally handicapped adult, second & third applicants are not allowed)

BANK PARTICULARS OF INVESTOR
( It is mandatory to furnish bank particulars, failing which application will not be accepted )

A/c No.

Savings

Current

NRE

NRO

Name of the Bank & Branch

9 digit Code No. of the Bank Branch                                               as appearing on the MICR cheque issued by the Bank. **

** For investor who is at a place where payment can be made through ECS. Please attach a photo copy of a cheque or blank cancelled cheque issued by your bank for verifying the accuracy of the MICR Code No.

I/ We wish to make a nomination and do hereby nominate the following person to receive the amount payable on my/ our death.
( Persons applying on behalf of Minor / Power of Attorney Holder / Partnership Firm / Karta of HUF & Non-Individuals cannot nominate )

NAME

The nominee is minor whose guardian is

Note : An NRI can also be nominated.

(Applicant cannot be guardian)
Resident Minor NRI Minor

I am a NRI / We are all NRIs                 
I / We am / are Indian Nationals
The First Applicant is an NRI. Other(s) is/ are Resident Indian
I / We am/are Nationals of :                                                                                          and of Indian origin.
                                                                             (Name of Country)

It is declared that for the proposed purchase of Units of Monthly Income Plan - 2000 (Third), I have purchased:
Rupee DD against foreign currency OR
have drawn cheque on my / our NRE account No.                                                         with the bank mentioned overleaf.
I / We undertake to provide further details of source of funds, if called for by the Trust.

To be despatched to my foreign address as mentioned overleaf
To be despatched at my relative's address in India as given below

To be credited to my NRE A/c NRO A/c Relative's bank A/c as given below

Name and Address of relative in India

PIN

Telephone No. of relative :

E_mail address of relative :

Bank particulars of relative in India (in case of income distribution to relative's bank a/c)

A/c No.

Savings

Current

Name of the Bank & Branch

9 digit Code No. of the Bank Branch as appearing on the MICR cheque issued by the Bank. **

** Please attach a photo copy of a cheque or blank cancelled cheque issued by your bank for verifying the accuracy of the MICR Code No.

Signature of P.A. Holder

Signature/ Thumb impression

(In case the application is signed by Power of Attorney Holder)

1st Applicant / Parent / Guardian

P.A. Registration No.

Signature/ Thumb impressions of 2nd Applicant/ Alternate Parent

(If Registered with the UTI ISL)

Date:

Place:

Signature/ Thumb impressions of 3rd Applicant

be filled in if Application is signed by THUMB IMPRESSION

Name/Address of
1st Witness

(if applicant has signed by Thumb Impression)

Signature of witness

Name/Address of
2nd Witness

(if applicant has signed by Thumb Impression)

Signature of witness

To be filled in if Application is from Non-Individuals

Name of 1st Authorised Signatory

Designation

Name of 2nd Authorised Signatory

Designation

Name of 3rd Authorised Signatory

Designation

I declare that the statement made and the information furnished are true and correct. I agree to be the alternate applicant.

Name of the alternate applicant :

Address :

Date :

-------------------------------------(PLEASE CUT HERE)---------------------------

Received from :

Sr No.

Shri / Smt / Kumari / M/s

Address

PIN

Agent's Name

Code No.

an application under*

(If no option is ticked, the investment will be deemed to be under Monthly Income option)

alongwith cash / cheque# / draft# / NRE/ NRO cheque#/ draft# No.

dated

drawn on

for Rs.

(in words) Rs.

Date

(Stamp of UTI Offices / F.O./ C.C./Bank alongwith receiving official's signature)

# Cheques and drafts are subject to realisation.

Note:

1. In case of non-fulfilment of Trust's requirement the application money will be refunded without any interest.
2. In case you do not receive the Membership Advice within six weeks from the date of closure of the sale, you may please write quoting serial No., Date of Acknowledgement and the name of the accepting authority to the Registrars:

All communications relating to issue of Membership Advice/ Unit Certificate, income distribution warrant, nomination, claims, change in name & address, repurchase, maturity payment, etc. should be addressed to the concerned Registrars.