COMMON APPLICATION FORM

PLEASE FILL ALL FIELDS WITH BLACK BALL POINT, IN BLOCK LETTERS AND ALL FIELDS ARE MANDATORY
Investors must read the KIM, Instructions and Product Labeling on front page before completing this Form. Application No:

1 DISTRIBUTOR INFORMATION (Refer Instruction No. 1) FOR OFFICE USE ONLY

Sub-Agent Code/ Date/Time
Distributor ARN/ RIA Sub Agent ARN Code EUIN No. CO Code MO Code Sales Code
Bank Branch Code of Receipt

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.
I/We hereby confirm that the EUIN box has been intentionally left blank by me/us as this transaction is executed
without any interaction or advice by the employee/relationship manager/sales person of the above distributor/sub Sole/1st applicant/Guardian/ 2nd applicant/Authorised 3rd applicant/Authorised
broker or notwithstanding the advice of in-appropriateness, if any, provided by the employee/relationship Authorised Signatory/POA Signatory Signatory
manager/sales person of the distributor/sub broker.

2 TRANSACTION CHARGES FOR APPLICATIONS THROUGH DISTRIBUTORS/AGENTS ONLY (Refer Instruction No. 1(a))
In case the purchase / subscription amount is ` 10,000 or more and your Distributor has opted to receive Transaction Charges, the same are deductible I confirm that I am a First time investor across Mutual Funds.
as applicable from the purchase/ subscription amount and payable to the Distributor. Units will be issued against the balance amount invested. I confirm that I am an existing investor in Mutual Funds.

3 EXISTING UNIT HOLDER INFORMATION [Please fill in your Folio Number and proceed to Scheme and Payment Details] (Refer Instruction No. 2(a))
Folio No.

4 MODE OF HOLDING & KIN/ KYC DETAILS (Refer Instruction No. 9(a & b))
Single Joint Anyone or Survivor (Default)
First Applicant KYC Identification Number (KIN) Proof Enclosed KRA KYC Proof Enclosed
Second Applicant KYC Identification Number (KIN) Proof Enclosed KRA KYC Proof Enclosed
Third Applicant KYC Identification Number (KIN) Proof Enclosed KRA KYC Proof Enclosed

5 FIRST APPLICANT'S DETAILS Mr. Ms. M/s (Refer Instruction No. 2(b))
st
Name (1 )

Date of Birth D D M M Y Y PAN Nationality Country of Birth

Status of First/ Sole Applicant [Please tick (P

)] Individual Non - Individual [For Non - individual - please attach FATCA, CRS & Ultimate Beneficial Ownership (UBO) Self
Certification Form] (Refer Instruction No. 14 & 15) (Mandatory)
Resident Individual NRI-Repatriation NRI-Non Repatriation Partnership Trust HUF AOP PIO Company FIIs Minor through guardian BOI OCI
Body Corporate LLP Society / Club Foreign National Resident in India FPI Sole Proprietorship Non Profit Organisation (please specify)
Others____________________________

For Investments "On behalf of Minor" Birth Certificate School Certificate Passport Other Relationship with minor Father Mother Legal Guardian
NAME OF GUARDIAN (in case of First/ Sole Applicant is a Minor)/ NAME OF CONTACT PERSON - DESIGNATION (in case of non-individual Investors)/ POA HOLDER/ SOLE PROPRIETOR DETAILS
Mr. Ms. M/s
Designation PAN KYC Proof Enclosed Mobile +91
Please note that your address and contact details will be updated as per your KYC/ CKYC records.
Mailing address

Landmark
City State Pin Code

Email ID Mobile +91 Tel.

Overseas address (for FIIs/ NRIs/ PIOs)
Mailing address

Landmark City
State Country Zip Code

SECOND APPLICANT'S DETAILS Mr. Ms. Nationality Country of Birth Mobile +91
nd
Name (2 )

PAN Email ID

THIRD APPLICANT'S DETAILS Mr. Ms. Nationality Country of Birth Mobile +91
rd
Name (3 )

PAN Email ID

ACKNOWLEDGEMENT SLIP (TO BE FILLED IN BY THE SOLE/FIRST APPLICANT) Application No:

Received from: Mr. / Ms. / M/s_______________________________________________________ an application for allotment of units

under Scheme________________________________, Plan_________________________, Option _________________________
Cheque/DD No______________________Dated____/____/________ Amount (`) _________________________________ Drawn
on Bank and Branch ________________________________________________.
Please note: All unit allotments are subject to realization of cheques/Demand Drafts and subject to the terms and conditions of relevant Scheme Information Document and Stamp, Signature & Date
Statement of Additional Information.
6 ADDITIONAL KYC DETAILS (Mandatory) (Refer Instruction No. 2(c))
st nd rd
Occupation details for 1 Applicant 2 Applicant 3 Applicant Guardian Politically Exposed Person (PEP) details: Is a PEP Related to PEP Not Applicable
Private Sector Service 1st Applicant
Public Sector Service 2nd Applicant
Government Service 3rd Applicant
Business Guardian
Professional
Authorised Signatory/ Partners/ Directors/ Others
Agriculturist
AADHAR CARD NUMBER (Refer Instruction No. 2(b)9)
Retired
Housewife 1st Applicant
Student 2nd Applicant
Proprietorship 3rd Applicant
Others (Please specify) Guardian
Foreign Exchange / Money Changer Services Gaming / Gambling / Lottery / Casino Services
Non-Individual Investors involved/ providing any of the mentioned services
Money Lending / Pawning None of the above
Gross Annual Income Range (in Rs.) 1st Applicant 2nd Applicant 3rd Applicant Guardian Gross Annual Income Range (in Rs.) 1st Applicant 2nd Applicant 3rd Applicant Guardian
Below 1 lac 10-25 lac
1-5 lac 25 lac- 1 cr
5-10 lac > 1 cr

OR Networth in Rs. (Mandatory as on

for Non Individual) (not older
than 1 year) DD MM YYYY

EMAIL COMMUNICATION INFORMATION (Refer Instruction No. 7)

I/We wish to receive the following document(s) physically in lieu of Email. Account Statement News Letter Annual Report Other Statutory Information

7 FATCA & CRS INFORMATION (for Individual including Sole Proprietor) (Self Certification) (Refer Instruction No. 14)

The below information is required for all applicant(s)/ guardian

Address Type: Residential or Business Residential Business Registered Office (for address mentioned in form/existing address appearing in Folio)
Is the applicant(s)/ guardian's Country of Birth / Citizenship / Nationality / Tax Residency other than India? Yes No
If Yes, please provide the following information [mandatory]
Please indicate all countries in which you are resident for tax purposes and the associated Tax Reference Numbers below.

Category First Applicant (including Minor) Second Applicant/ Guardian Third Applicant

Place/ City of Birth

Country of Birth

Country of Tax Residency

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.
8 BANK ACCOUNT DETAILS - Mandatory (Payout Bank - If left blank, application will be rejected) (Refer Instruction No. 3)

Name of the Bank

Account Number A/C Type (Please ü

) Savings Current NRE NRO FCNR Others ___
FI-KIM/07112017

Branch Address
City State PIN Code

MICR Code (Please enter the 9 digit number that appears after your cheque number) Cancelled copy of a cheque required in case of
investments not through cheque
IFSC Code (RTGS/NEFT) (11 Character code appearing on your cheque leaf)

FOR MORE INFORMATION

BOI AXA Mutual Fund
Add: B/204, Tower 1, Peninsula Corporate Park, Ganpatrao Kadam Marg, Lower Parel, Mumbai 400013
Call us at (Toll Free) Alternate Number Email us at Website
1800-103-2263 & 1800-266-2676 020-4011 2300 & 020-6685 4100 [email protected] www.boiaxa-im.com
 9 SCHEME AND PAYMENT DETAILS (Payment through Cash/Non-MICR Cheques/Outstation Cheques not accepted) (Refer Instruction No.4 & 8)

Scheme Name

Plan Option

Sub Option Dividend Frequency

Investment Amount (`) DD Charges if any (`) Net Amount (`)

Cheque/ DD No. Drawn Bank Branch/City

Account Type* S/B NRE* Current NRO FCNR* *Kindly provide photocopy of the payment Instrument or Foreign Inward remittance Certificate (FIRC) evidencing source of funds
Please (ü
) RTGS Fund Transfer Letter dated Bank A/c No.

REDEMPTION / DIVIDEND REMITTANCE (Refer Instruction No. 5)

Electronic Payment (It is the responsibility of the Investor to ensure the correctness of the IFSC code/ MICR code for Electronic Payout at recipient/destination branch corresponding to the Bank details.)
Cheque Payment

10 DEMAT ACCOUNT DETAILS – (Please ensure that the sequence of names as mentioned in the application form matches with that of the account held with the Depository Participant).
(If Demat Account details are provided below, units will be allotted by default in electronic mode only) (Refer Instruction No. 10)

DP Name
National Securities Depository Limited (NSDL)
DP ID No. I N Beneficiary Account No.

DP Name
Central Depository Services (India) Limited (CDSL)
Target ID No.

11 NOMINATION DETAILS for Individuals [Minor / HUF / POA Holder / Non Individuals cannot Nominate] (Refer Instruction No. 6)

[Please (P
) and sign] I/We do not wish to Nominate

Sole/1st Applicant/Guardian 2nd Applicant 3rd Applicant

OR
I/We wish to nominate as under:

Proportion (%) in which

Relationship Date of Birth Name and Address of Guardian Signature of Nominee
the units will be shared by
Name and Address of Nominee(s) with (Optional)/ Guardian of
each Nominee
Applicant (to be furnished in case the Nominee is a minor) Nominee (Mandatory)
(should aggregate to 100%)

Nominee 1

Nominee 2

Nominee 3

12 DECLARATION
I/We have read and understood the contents of the Scheme Information Document and Statement of
Additional Information of BOI AXA Mutual Fund including the section on Who cannot invest and
Prevention of Money Laundering. I/We hereby apply for Allotment/Purchase of Units in the Scheme and
SIGN HERE
agree to abide by the terms and conditions applicable thereto. I/We hereby declare that I/We am /are (Please write Application Form No. / Folio No.
authorised to make this investment and that the amount invested in the Scheme is through legitimate on the reverse of the Cheque / Demand Draft /
sources only and does not involve and is not designed for the purpose of any contravention or evasion of
any Act, Rules, Regulations, Notifications or Directions issued by any regulatory authority in India. I/We Payment Instrument.)
hereby authorise BOI AXA Mutual Fund, its Investment Manager and its agents to disclose details of my
investment to my bank(s)/BOI AXA Mutual Fund and /or Distributor /Broker / Investment Advisor. I/We
have neither received nor been induced by any rebate or gifts, directly or indirectly, in making this
investment. I/We declare that the information given in this application form is correct, complete and truly
stated. First/ Sole Applicant/
I/We are aware that the information provided/collected in this application form is necessary in relation to Guardian/ PoA/
operation of my/our investment account. I/We hereby give consent for sharing my/our data/information Authorised Signatory
with any third party as may be required by BOI AXA Mutual Fund for the purpose of providing services to
me/us or for opening, continuing and operating my/our investment account/folio.
I/ We confirm that the ARN holder has disclosed to me/us all the commissions (in the form of trail SIGN
commission or any other mode), payable to him by the different competing Schemes of various Mutual
Funds from amongst which the Scheme is being recommended to me/us.
I/We request BOI AXA Mutual Fund to update my/our following details for the above Folios. I/we authorize
BOI AXA Mutual Fund, BOI AXA Investment Managers Pvt. Ltd./ Registrars to refer these details to any of
the appropriate authorities including Unique Identification Authority of India (UIDAI)/ KYC Registration
SIGNATURE(S)

Agency/Authentication Agencies etc. and also authorize such agencies / service providers including
UIDAI to share the data as per their records, for verification purpose. In case of any correction/change in Second Applicant/
name/address/mobile number/date of birth etc. recorded with UIDAI, please update the change with Authorised Signatory
UIDAI’s Aadhaar Self Service Update Portal, currently, https://ssup.uidai.gov.in/web/guest/update and
also with BOI AXA MF.
I/we authorize BOI AXA Mutual Fund, BOI AXA Investment Managers Pvt. Ltd./ Registrars to refer these SIGN
details to any of the appropriate authorities including Unique Identification Authority of India (UIDAI) /KYC
Registration Agency/Authentication Agencies etc. and also authorize such agencies / service providers
including UIDAI to share the data as per their records, for verification purpose.
I/WE HEREBY CONFIRM THAT I/WE HAVE NOT BEEN OFFERED/ COMMUNICATED ANY INDICATIVE
PORTFOLIO AND/ OR ANY INDICATIVE YIELD BY THE FUND/ AMC/ ITS DISTRIBUTOR FOR THIS
INVESTMENT.
Applicable to NRI only: I /We confirm that I am/we are Non-Resident Indian/Person of Indian Origin and Third Applicant/
that I/We have remitted funds from abroad through approved banking channels or from funds in my/our Authorised Signatory
NRE/NRO/FCNR Account. I/We undertake that all additional purchases made under this Folio will also be
from funds received from abroad through approved banking channels or from funds in my/our
NRE/NRO/FCNR Account.
SIGN
CERTIFICATION: I / We 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 is
true, correct, and complete. I / We also confirm that I / We have read and understood the FATCA & CRS
Terms and Conditions above and hereby accept the same.
CHECKLIST (Please submit the following documents with your application (where applicable). All documents should be original/ true copies Certified by a Director/Trustee/Company
Secretary/Authorized signatory/ Notary Public).

Document Checklist Individual Company Society Partnership Investment through Trusts NRI FII HUF AOP & Demat
Firms POA BOI Holder
PAN Card [Micro investments, Investor(s) from Sikkim, üüü ü ü üüüüüü
government officials specifically exempt] & KYC Acknowledgement
Resolution/ Authorisation to invest üü ü ü ü ü
List of authorised signatories with specimen signatures üü ü ü ü ü ü
Memorandum & Articles of Association ü
Trust Deed ü
Bye-laws ü
Partnership Deed ü
Notorised POA (signed by investor and POA Holder) ü
Bank Account Proof (Latest available) üüü ü ü üüüüü
Demat Statement (Latest available) ü
Client Master Statement (Latest available) ü
HUF Deed ü
Overseas Auditor's Certificate & SEBI Regn. Certificate ü
UBO üü ü ü üüü
FATCA & CRS üüü ü ü üüüüüü
Aadhaar Card Number üüü ü ü üü üüü

Investor Service Centres

FOR ONGOING TRANSACTION Jayendra Ganj, Lashkar, Gwalior, M.P.- 474 009. • Hubli: CTS 483/A1/A2, Gr floor, Sri Ram Plaza, Club
Road, Behind Kotak Mahindra Bank, Hubli - 580 023. • Hyderabad: 8-2-609/K, Karvy House, Avenue 4,
BOI AXA Mutual Fund Branches - Investor Service Centers (ISC) Street No.1, Banjara Hills, Hyderabad - 500 034. • Indore: 19/1, New Palasia, Balaji Corporate-203, 204 &
• Ahmedabad - Shop No.:- 405, 4th Floor, Zodiac Plaza, H. L. College Road, Navrangpura, Ahmedabad - 205, 2nd Floor, Above ICICI Bank, Near Curewell Hospital, Janjeerwala Square, Indore, Madhya Pradesh
380 009. • Bangalore - 957, Regus Business Centre, Bangalore Pvt. Ltd., Level 9, Raheja Towers, 26 - 27, - 452 001. • Jabalpur: 43, Naya Bazar, Opposite shyam talkies Jabalpur (M.P.) 482 001. • Jaipur: S-16 A,
Mahatma Gandhi Road, Bangalore - 560 001. • Bhopal - F. F. 16, Part B, Mansarover Complex, Near 3Rd Floor Land Mark, Opposite Jaipur Club Mahavir Marg, C- Scheme Jaipur - 302 001. • Jalandhar: 1st
Habibganj Railway Station, Bhopal - 462 016. • Chandigarh - 205, Megabyte Business Centre, SCO-333- Floor, Shanti Towers, SCO No. 37, PUDA Complex, Opposite Tehsil Complex, Jalandhar - 144001.
334, Ist Floor, Sec-35B Chandigarh - 160 022. • Chennai - Cabin No. 203, Apeejay Business Center No: • Jamshedpur: 2nd Floor, R R Square, SB Shop Area, Near Reliance Foot Print & Hotel - BS Park Plaza,
39/12, Haddows Road, Nungambakkam, Chennai - 600 034. • Hyderabad - Cabin No. 23, Apeejay Main Road, Bistpur, Jamshedpur 831001. • Jodhpur: 203, Modi Arcade; Chupasni Road, Jodhpur - 342
Business Centre, Tresorie, The Park, 22 Rajbhavan Road, Somajiguda, Hyderabad - 500 082. • Jaipur - 001. • Kanpur: 15/46,Ground Floor, Opp: Muir Mills, Civil Lines, Kanpur - 208 001. • Kolhapur: 605/1/4 E
Office no.154, 1st Floor, Ganpati Plaza,M I Road, Jaipur - 302 001. • Kolkata - Cabin 06, Block - A, 8th Ward, Near Sultane Chambers, Shahupuri 2nd Lane Kolhapur - 416 001. • Kolkata: Apeejay House
Floor, Apeejay House, 15 Park Street, Kolkata - 700 016. • Lucknow - Office No-504, 5th Floor, Sriram (Beside Park Hotel), 15 Park Street, C Block, 3rd Floor, Kolkata - 700 016. • Lucknow: 1st Floor, A. A.
Tower, 13 Ashok Marg, Hazratganj, Lucknow - 226 001. • Mumbai - B/204, Tower 1, Peninsula Corporate Complex, Thaper House, 5 Park Road, Hazratganj, Lucknow - 226 001. • Ludhiana: SCO - 136, First
Park, Ganpatrao Kadam Marg, Lower Parel, Mumbai - 400 013. • New Delhi - Room No. 610, Avanta Floor Above Airtel Show Room, Feroze Gandhi Market, Ludhiana - 141 001. • Madurai: Rakesh Towers,
Business Center, 4th Floor, Statesman House, Barakhamba Road, Connaught Place, New Delhi - 110 30-C, Bye Pass Road Ist Floor, Opp Nagappa Motors, Madurai - 625 010. • Moradabad: Om Arcade,
001. • Pune - Apeejay Business Centre, 1st Floor, Pride House, S.No. 108/7, Shivajinagar, University Parker Road, Above Syndicate Bank, Chowk Tari Khana, Moradabad - 244001. • Mumbai (Andheri): 6 &
Road, Pune - 411 016. • Vadodara - 118, 1st Floor, Siddharth Complex, R C Dutt Road, Alkapuri, Vadodara 7, 131 Andheri Industrial Estate Veera Desai Road, Andheri (West) Mumbai- 400053. • Mumbai
- 390 005. (Borivali): Karvy Computershare Pvt. Ltd. Gomati Smuti, Ground Floor, Jambli Gully, Near Railway
Station, Borivali (West), Mumbai - 400 092 • Mumbai (Chembur): Shop No 4, Ground Floor, Shram Saflya
Karvy Computershare Private Limited Locations - Investor Service Centers (ISC) Bldg N G Acharya Marg, Chembur Mumbai - 400071. • Mumbai (Fort): Office number: 01/04 24/B, Raja
Bahadur Compound Ambalal Doshi Marg, Behind Bombay Stock Exchange, Fort Mumbai - 400 001.
• Agra: F-1, Ist Floor, Deepak Wasan Plaza, Above HDFC Bank, Sanjay Place, Agra - 282 002. • Mumbai (Thane): 101, Yashwant Tower, Ram Maruti Road, Opp. Pooja Hotel, Naupada, Thane, Mumbai
• Ahmedabad: 201,Shail Building, Opp : Madhusudhan House, Nr. Navrangpura Telephone Exchange; - 400 602. • Mumbai (Vashi): Shop No. 43-A, Ground Floor, Vashi Plaza Sector-17 Near Apna Bazar,
Navrangpura Ahmedabad - 380 006. • Allahabad: Rsa Towers, 2nd Floor, Above Sony TV Showroom, 57, Vashi, Mumbai-400705. • Mumbai (Vile Parle): 104, Sangam Arcade, V P Road, Opposite Railway
S P Marg, Civil Lines, Allahabad - 211001. • Amritsar: 72-A, Taylor'S Road, Aga Heritage Gandhi Ground, Station, Above Axis Bank ATM, Vile Parle (West), Mumbai - 400 056. • Muzaffarpur: 1st Floor, Shukla
Amritsar - 143 001. • Anand: B/ 42, Vaibhav Commercial Center, Nr TVS Down Town Shrow Room, Grid Complex, Near ICICI Bank, Civil Court Branch, Company Bagh, Muzaffarpur - 842 001. • Nagpur: Plot
Char Rasta, Anand - 388 001. • Asansol: 114/71, G.T. Road, Near Sony Centre, Bhanga Pachil, Asansol - No.2/1, House no. 102/1, Mangaldeep Apartment, Mata Mandir Road, Opp. Khandelwal Jewellers,
713 303. • Aurangabad: Ramkunj Niwas, Railway Station Road Near Osmanpura Circle Aurangabad- Dharampeth, Nagpur - 440 010. • Nasik: S-12, Second Floor, Suyojit Sankul, Sharanpur Road Nasik - 422
431005. • Bangalore: 59, ‘Skanda’ Puttanna Road, Basavanagudi, Bangalore - 560 004. • Belgaum: CTS 002. • New Delhi: 305, 3rd Floor New Delhi House, Bara Khamba Road Connaught Place New Delhi - 110
No 3939/ A2 A1, Above Raymonds Show Room, Beside Harsha Appliances, Club Road, Belgaum - 590 001. • Noida: 307 Jaipuria Plaza; D 68 A, 2nd Floor Opp Delhi Public School, Sector 26 Noida - 201 301.
001. • Bhagalpur: 2nd Floor, Chandralok Complex, Ghantaghar, Radha Rani Sinha Road, Bhagalpur - • Panipat: 1st Floor, Krishna Tower Above Amertex, G.T. Road, Panipat - 132 103. • Panjim: Flat No.1-A,
812 001. • Bhopal: Kay Kay Business Centre, 133, Zone I, M P Nagar, Bhopal - 462 011. • Bhubaneswar: H. No. 13/70, Timotio Bldg, Heliodoro Salgado Road, Next to Navhind Bhavan (Market Area) Panjim - 403
2nd & 3rd Floor, Janardan, House, A 181, Saheed Nagar, Bhubaneswar - 751 007. • Bokaro: B-1, 1st 001. • Patna: 3A, 3rd floor, Anand Tower, Beside Chankya Cinema Hall; Exhibition Road, Patna - 800 001.
Floor, City Centre, Sector- 4, Near Sona Chandi-Jewellers, Bokaro - 827 004. • Calicut: 2nd Floor • Pune: Mozaic Bldg, CTS No.1216/1, Final Plot No.576/1 TP, Scheme No.1, F C Road, Bhamburda,
Soubhagya Shopping Complex Arayidathpalam, Mavoor Road Calicut- 673004. • Chandigarh: SCO- Shivaji Nagar, Pune - 411 004. • Raipur: Office No - S-13, 2nd Floor, Raheja Tower, Fafadih Chowk, G E
2423-2424 1ST Floor, Above TVS showroom, Sec 22C Chandigarh - 160 022. • Chennai: Flat No F11, Road, Raipur - 492 001. • Rajkot: 302, Metro Plaza, Near Moti Tanki Chowk, Rajkot - 360 001. • Ranchi:
First Floor, Akshya Plaza,(Erstwhile Harris Road), Opp Chief City Metropolitan Court, #108, Adhithanar Room No. 307, 3Rd Floor, Commerce Towers, Beside Mahabir Towers, Main Road, Ranchi - 834 001.
Salai, Egmore, Chennai - 600 002. • Cochin: Building Nos.39 Ali Arcade, 1st Floor, Near Atlantis Junction, • Shillong: Mani Bhawan, Lower Thana Road, Police Bazar, Shillong - 793 001. • Siliguri: Nanak
Kizhvana Road, Panampili Nagar, Cochin - 682 036. Ernakulum District. • Coimbatore: 3rd Floor,Jaya Complex, Near Church Road, Sevoke Road, Siliguri - 734 001. • Solapur: Block No. 06, Vaman Nagar,
Enclave, 1056-1057, Avinashi Road, Coimbatore - 641 018. • Dehradun: Kaulagarh Road, Near Sirmour Opp. D-Mart, Jule Solapur, Solapur, Maharashtra - 413004. • Surat: G-6 Empire State Building, Near
Marg, Above Reliance Webworld, Dehradun - 248 001. • Dhanbad: 208, New Market, 2Nd Floor, Katras Parag House,Udhna Darwaja Ring Road Surat - 395 002. • Udaipur: 201-202, Madhav Chambers, Opp G
Road, Bank More, Dhanbad - 826 001. • Gandhinagar: Plot No. - 945/2, Sector - 7/C, Gandhinagar - 382 P O, Chetak Circle, Udaipur - 313001. • Ujjain: 101, Aastha Tower, 13/1, Dhanwantri Marg, Free Gunj
007. • Ghaziabad: 1st Floor, C-7, Lohia Nagar, Ghaziabad - 201 001. • Gorakhpur: Above V.I.P. House, Ujjain - 456 010. • Vadodara: 203, Corner point, Jetalpur Road, Vadodara - 390 007. • Varanasi: D-
Ajdacent A.D. Girls Inter College, Bank Road Gorakpur - 273 001. • Gurgaon: Shop No. 18, Ground Floor, 64/132, KA 1st Floor, Anant Complex, Sigra, Varanasi - 221 010. • Vijayawada: 39-10-7, Opposite
Sector – 14 Opp. Akd Tower, Near Huda Office Gurgaon- 122001. • Guwahati: 1st Floor, Bajrangbali Municipal Water Tank, Labbipet, Vijayawada - 520 010. • Visakhapatnam: Door No: 48-8-7, Dwaraka
Building, Near Bora Service Station, GS Road, Guwahati - 781 007. • Gwalior: 2nd Floor- Rajeev Plaza, Dimond, Ground Floor, Srinagar, Visakhapatnam - 530016.
FI-KIM/07112017

AMC Website: www.boiaxa-im.com is also an Investor Service Centre (for online transactions) for individual investors only.
Note:
1. Investors desiring to purchase/ redeem Units in the Schemes through the Stock Exchange Facility may do so through Eligible Stock Brokers. Eligible Stock Brokers are considered
as Official Points of Acceptance for transactions through Stock Exchange Facility.
2. Investors who are holding Units in Demat mode may transact only through the Stock Exchange Facility. Further, such Unit holders must submit their nonfinancial requests such as
change in bank mandate, address, etc only to their Depository Participants.
FOR NON-INDIVIDUALS - SUPPLEMENTARY KNOW YOUR CLIENT (KYC),
FATCA, CRS & ULTIMATE BENEFICIAL OWNERSHIP (UBO)
SELF CERTIFICATION FORM

Name of the entity

Type of address given at KRA Residential or Business Residential Business Registered Of?ce
“Address of tax residence would be taken as available in KRA database. In case of any change, please approach KRA & notify the changes"

Folio Number / /
PAN Date of incorporation D D M M Y Y Y Y
City of incorporation Country of incorporation
Entity Constitution Type (Please tick as appropriate) Partnership Firm HUF Private Limited Company Public Limited Company Society AOP/BOI Trust Liquidator
Limited Liability Partnership Arti?cial Juridical Person Others specify
Please tick the applicable tax resident declaration:

1. Is “Entity” a tax resident of any country other than India Yes No (If yes, please provide country/ies in which the entity is a resident for tax purposes and the associated Tax ID number below.)

Country Tax Identi?cation Number

%
Identification Type (TIN or Other, please specify)

%
In case Tax Identi?cation Number is not available, kindly provide its functional equivalent$.
In case TIN or its functional equivalent is not available, please provide Company Identi?cation number or Global Entity Identi?cation Number or GIIN, etc.
In case the Entity's Country of Incorporation / Tax residence is U.S. but Entity is not a Speci?ed U.S. Person, mention Entity's exemption code here

ADDITIONAL KYC INFORMATION

Gross Annual Income (Rs.) Below 1 Lac 1 - 5 Lacs 5 - 10 Lacs 10 - 25 Lacs >25 Lacs - 1 Crore >1 Crore
OR
Net-worth (Mandatory for Non-Individuals) ` as on D D M M Y Y Y Y (Not older than 1 year)

Politically Exposed Person (PEP) Status* (Also applicable for authorised signatories/ Promoters/ Karta/ Trustee/ Whole time Directors) PEP Related to PEP Not Applicable

Is the entity involved in any of the mentioned services: Foreign exchange/ Money changer Gaming/ Gambling/ Lottery (Casinos, betting syndicates)
(Please tick as appropriate) Money lending/ Pawning Not applicable
*PEP are defined as individuals who are or have been entrusted with prominent public functions in a foreign country, e.g., Heads of States or of Governments, senior politicians, senior Government/judicial/ military officers,
senior executives of state owned corporations, important political party officials, etc.

FATCA & CRS Declaration (Please consult your professional tax advisor for further guidance on FATCA & CRS classi?cation)

PART A (to be ?lled by Financial Institutions or Direct Reporting NFEs)

We are a, GIIN
Financial institution 6 Note: If you do not have a GIIN but you are sponsored by another entity, please provide your sponsor's GIIN above and indicate your sponsor's name below
OR Name of sponsoring entity
7
Direct reporting NFE
(please tick as appropriate)

GIIN not available (please tick as applicable) 10

Applied for Not required to apply for - please specify 2 digits sub-category Not obtained - Non-participating FI
If the entity is a ?nancial institution,

PART B (please ?ll any one as appropriate “to be ?lled by NFEs other than Direct Reporting NFEs”)
1
1 Is the Entity a publicly traded company (that is, a company whose Yes (If yes, please specify any one stock exchange on which the stock is regularly traded)
shares are regularly traded on an established securities market)
Name of stock exchange
2
2 Is the Entity a related entity of a publicly traded company (a company Yes (If yes, please specify name of the listed company and one stock exchange on which the stock is regularly traded)
whose shares are regularly traded on an established securities market)
Name of listed company
Nature of relation: Subsidiary of the Listed Company or Controlled by a Listed Company
Name of stock exchange
3 Is the Entity an active3NFE Yes
Nature of Business
Please specify the sub-category of Active NFE (Mention code-refer 2c of Part D)
4
4 Is the Entity a passive NFE Yes
Nature of Business
1
Refer 2a of Part C | 2 Refer 2b of Part C | 3 Refer 2c of Part C | 4 Refer 3(ii) of Part C | 6 Refer 1 of Part C | 7Refer 3(vii) of Part C | 10 Refer 1A of Part C
 UBO Declaration (Mandatory for all entities except, a Publicly Traded Company or a related entity of Publicly Traded Company)
Category (Please tick applicable category) Unlisted Company Partnership Firm Limited Liability Partnership Company Unincorporated association / body of individuals Private Trust
Public Charitable Trust Religious Trust Others
Please list below the details of controlling person(s), con?rming ALL countries of tax residency / permanent residency / citizenship and ALL Tax Identi?cation Numbers for EACH controlling person(s).
(Please attach additional sheets if necessary)
Owner-documented FFI's should provide FFI Owner Reporting Statement and Auditor's Letter with required details as mentioned in Form W8 BEN E (Refer 3(vi) of part C)
Details UBO1 UBO2 UBO3
Name
PAN
UBO Code (Refer 3(iv) (A) of Part C)
Country of Tax residency*
Tax ID No.%
Tax ID Type
Address

Zip Zip Zip

State State State
Country Country Country

Address Type Residence Registered office Business Residence Registered office Business Residence Registered office Business
City of Birth
Country of birth
Occupation Type Service Business Others Service Business Others Service Business Others
Nationality
Father's Name
Gender Male Female Others Male Female Others Male Female Others
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
Percentage of Holding (%)^
# Additional details to be ?lled by controlling persons with tax residency / permanent residency / citizenship / Green Card in any country other than India:
* To include US, where controlling person is a US citizen or green card holder
%In case Tax Identi?cation Number is not available, kindly provide functional equivalent
^Attach valid documentary proof like Shareholding pattern duly self attested by Authorized Signatory / Company Secretary
4
Refer 3(iii) of Part C | 11 Refer 3(iv) (A) of Part C

FATCA - CRS Terms and Conditions

The Central Board of Direct Taxes has notified Rules 114F to 114H, as part of the Income-tax Rules, 1962, which Rules require Indian financial institutions such as the Bank to seek additional personal, tax
and beneficial owner information and certain certifications and documentation from all our account holders. In relevant cases, information will have to be reported to tax authorities/ appointed agencies.
Towards compliance, we 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.
Should there be any change in any information provided by you, please ensure you advise us promptly, i.e., within 30 days.
Please note that you may receive more than one request for information if you have multiple relationships with BOI AXA Mutual Fund or its group entities. Therefore, it is important that you respond to our
request, even if you believe you have already supplied any previously requested information.
If you have any questions about your tax residency, please contact your tax advisor. If any controlling person of the entity is a US citizen or resident or green card holder, please include United States in the
foreign country information field along with the US Tax Identification Number.
$It is mandatory to supply a TIN or functional equivalent if the country in which you are tax resident issues such identifiers. If no TIN is yet available or has not yet been issued, please provide an explanation
and attach this to the form.

CERTIFICATION
I / We have understood the information requirements of this Form (read along with the FATCA & CRS Instructions) and hereby con?rm that the information provided by me / us on this
Form is true, correct, and complete. I / We also con?rm that I / We have read and understood the FATCA& CRS Terms and Conditions below and hereby accept the same.
Name

Designation

Signatures Signatures Signatures

Date D D M M Y Y Y Y Place
 PART C FATCA Instructions & De?nitions
1 Financial Institution (FI) - The term FI means any financial institution that is a Depository Institution c. Active NFE : (is any one of the following):
Custodial Institution, Investment Entity or Specified Insurance company, as defined. Code Sub-category
• Depository institution: is an entity that accepts deposits in the ordinary course of banking or similar 01 Less than 50 percent of the NFE's gross income for the preceding financial year is
business. passive income and less than 50 percent of the assets held by the NFE during the
• Custodial institution is an entity that holds as a substantial portion of its business, holds financial assets preceding financial year are assets that produce or are held for the production of
for the account of others and where it's income attributale to holding financial assets and related passive income;
financial services equals or exceeds 20 percent of the entity's gross income during the shorter of 02 The NFE is a Governmental Entity, an International Organization, a Central Bank , or
(i) The three financial years preceding the year in which determination is made; or an entity wholly owned by one or more of the foregoing;
(ii) The period during which the entity has been in existence, whichever is less. 03 Substantially all of the activities of the NFE consist of holding (in whole or in part) the
• Investment entity is any entity: outstanding stock of, or providing financing and services to, one or more
subsidiaries that engage in trades or businesses other than the business of a
• That primarily conducts a business or operates for or on behalf of a customer for any of the Financial Institution, except that an entity shall not qualify for this status if the entity
following activities or operations for or on behalf of a customer functions as an investment fund, such as a private equity fund, venture capital fund,
(I) Trading in money market instruments (cheques, bills, certificates of deposit, derivatives, etc.); leveraged buyout fund, or any investment vehicle whose purpose is to acquire or
foreign exchange; exchange, interest rate and index instruments; transferable securities; or fund companies and then hold interests in those companies as capital assets for
commodity futures trading; or investment purposes;
(ii) Individual and collective portfolio management; or 04 The NFE is not yet operating a business and has no prior operating history, but is
(iii) Investing, administering or managing funds, money or financial asset or money on behalf of other investing capital into assets with the intent to operate a business other than that of a
persons; Financial Institution, provided that the NFE shall not qualify for this exception after
the date that is 24 months after the date of the initial organization of the NFE;
or
05 The NFE was not a Financial Institution in the past five years, and is in the process of
• The gross income of which is primarily attributable to investing, reinvesting, or trading in financial assets, if
liquidating its assets or is reorganizing with the intent to continue or recommence
the entity is managed by another entity that is a depository institution, a custodial institution, a specified
operations in a business other than that of a Financial Institution;
insurance company, or an investment entity described above.
06 The NFE primarily engages in financing and hedging transactions with, or for,
An entity is treated as primarily conducting as a business one or more of the 3 activities described above, or
Related Entities that are not Financial Institutions, and does not provide financing or
an entity's gross income is primarily attributable to investing, reinvesting, or trading in financial assets of
hedging services to any Entity that is not a Related Entity, provided that the group of
the entity's gross income attributable to the relevant activities equals or exceeds 50 percent of the entity's
any such Related Entities is primarily engaged in a business other than that of a
gross income during the shorter of :
Financial Institution;
(i) The three-year period ending on 31 March of the year preceding the year in which the determination is
07 Any NFE that fulfills all of the following requirements:
made;
• It is established and operated in India exclusively for religious, charitable,
or
scientific, artistic, cultural, athletic, or educational purposes; or it is established
(ii) The period during which the entity has been in existence. and operated in India and it is a professional organization, business league,
The term “Investment Entity” does not include an entity that is an active non-financial entity as per codes chamber of commerce, labor organization, agricultural or horticultural
03, 04, 05 and 06 - refer point 2c.) organization, civic league or an organization operated exclusively for the
• Specified Insurance Company: Entity that is an insurance company (or the holding company of an promotion of social welfare;
insurance company) that issues, or is obligated to make payments with respect to, a Cash Value Insurance • It is exempt from income tax in India;
Contract or an Annuity Contract. • It has no shareholders or members who have a proprietary or beneficial interest
• FI not required to apply for GIIN: in its income or assets;
A. Reasons why FI not required to apply for GIIN: The applicable laws of the NFE's country or territory of residence or the NFE's
Code Sub-category formation documents do not permit any income or assets of the NFE to be
distributed to, or applied for the benefit of, a private person or non-charitable Entity
01 Governmental Entity, International Organization or Central Bank other than pursuant to the conduct of the NFE's charitable activities, or as payment
02 Treaty Qualified Retirement Fund; a Broad Participation Retirement Fund; a Narrow of reasonable compensation for services rendered, or as payment representing the
Participation Retirement Fund; or a Pension Fund of a Governmental Entity, International fair market value of property which the NFE has purchased; and
Organization or Central Bank The applicable laws of the NFE's country or territory of residence or the NFE's
03 Non-public fund of the armed forces, an employees' state insurance fund, a gratuity fund or a formation documents require that, upon the NFE's liquidation or dissolution, all of its
provident fund assets be distributed to a governmental entity or other non-profit organization, or
04 Entity is an Indian FI solely because it is an investment entity escheat to the government of the NFE's country or territory of residence or any
political subdivision thereof.
05 Qualified credit card issuer
Explanation.- For the purpose of this sub-clause, the following shall be treated as
06 Investment Advisors, Investment Managers& Executing Brokers fulfilling the criteria provided in the said sub-clause, namely:-
07 Exempt collective investment vehicle (I) an Investor Protection Fund referred to in clause (23EA);
08 Trustee of an Indian Trust (II) a Credit Guarantee Fund Trust for Small Industries referred to in clause 23EB;
09 FI with a local client base and
10 Non-registering local banks (III) an Investor Protection Fund referred to in clause (23EC), of section 10 of the
11 FFI with only Low-Value Accounts Act;
12 Sponsored investment entity and controlled foreign corporation 3. Other definitions
13 Sponsored, Closely Held Investment Vehicle (i) Related entity
14 Owner Documented FFI An entity is a 'related entity' of another entity if either entity controls the other entity, or the two
entities are under common control For this purpose, control includes direct or indirect
2. Non-financial entity (NFE) - Foreign entity that is not a financial institution ownership of more than 50% of the votes and value in an entity.
Types of NFEs that are regarded as excluded NFE are: (ii) Passive NFE
a. Publicly traded company (listed company) The term passive NFE means
A company is publicly traded if its stock are regularly traded on one or more established securities (i) any non-financial entity which is not an active non-financial entity including a publicly
markets traded corporation or related entity of a publicly traded company; or
(Established securities market means an exchange that is officially recognized and supervised by a (ii) an investment entity defined in clause (b) of these instructions
governmental authority in which the securities market is located and that has a meaningful annual value (iii) a withholding foreign partnership or withholding foreign trust;
of shares traded on the exchange)
(Note: Foreign persons having controlling interest in a passive NFE are liable to be reported for
b. Related entity of a publicly traded company tax information compliance purposes)
The NFE is a related entity of an entity of which is regularly traded on an established securities market; (iii) Passive income
The term passive income includes income by way of :
(1) Dividends,
(2) Interest
(3) Income equivalent to interest,
 PART D FATCA Instructions & De?nitions (Contd.)
(4) Rents and royalties, other than rents and royalties derived in the active conduct of a business conducted, (v) any organization exempt from taxation under section 501(a) of the U.S. Internal Revenue
at least in part, by employees of the NFE Code or an individual retirement plan as defined in section 7701(a)(37) of the U.S. Internal
(5) Annuities Revenue Code;
(6) The excess of gains over losses from the sale or exchange of financial assets that gives rise to passive (vi) any bank as defined in section 581 of the U.S. Internal Revenue Code;
income (vii) any real estate investment trust as defined in section 856 of the U.S. Internal Revenue Code;
(7) The excess of gains over losses from transactions (including futures, forwards, options and similar (viii) any regulated investment company as defined in section 851 of the U.S. Internal Revenue
transactions) in any financial assets, Code or any entity registered with the U.S. Securities and Exchange Commission under the
(8) The excess of foreign currency gains over foreign currency losses Investment Company Act of 1940 (15 U.S.C. 80a-64);
(9) Net income from swaps (ix) any common trust fund as defined in section 584(a) of the U.S. Internal Revenue Code;
(10) Amounts received under cash value insurance contracts (x) any trust that is exempt from tax under section 664(c) of the U.S. Internal Revenue Code or
that is described in section 4947(a)(1) of the U.S. Internal Revenue Code;
But passive income will not include,in case of a non-financial entitythat regularly acts as a dealer in
financial assets, any income from any transaction entered into in the ordinary course of such dealer's (xi) a dealer in securities, commodities, or derivative financial instruments (including notional
business as such a dealer. principal contracts, futures, forwards, and options) that is registered as such under the laws
of the United States or any State;
(iv) Controlling persons
(xii) a broker as defined in section 6045(c) of the U.S. Internal Revenue Code; or
Controlling persons are natural persons who exercise control over an entity and includes a beneficial
owner under sub-rule (3) of rule 9 of the Prevention of Money-Laundering (Maintenance of Records) (xiii) any tax-exempt trust under a plan that is described in section 403(b) or section 457(g) of the
Rules, 2005.In the case of a trust, the controlling person means the settl or, the trustees, the protector (if U.S. Internal Revenue Code.
any), the beneficiaries or class of beneficiaries, and any other natural person exercising ultimate effective (vi) Owner documented FFI
control over the trust. In the case of alegalar rangement other than a trust, controlling person means An FFI meets the following requirements:
persons in equivalent or similar positions.
(a) The FFI is an FFI solely because it is an investment entity;
Pursuant to guidelines on identification of Beneficial Ownership issued vide SEBI circular no.
CIR/MIRSD/2/2013 dated January 24, 2013, persons (other than Individuals) are required to provide (b) The FFI is not owned by or related to any FFI that is a depository institution, custodial
details of Beneficial Owner(s) ('BO'). Accordingly, the Beneficial Owner means 'Natural Person', who, institution, or specified insurance company;
whether acting alone or together, or through one or more juridical person, exercises control through (c) The FFI does not maintain a financial account for any non participating FFI;
ownership or who ultimately has a controlling ownership interest of / entitlements to: (d) The FFI provides the designated withholding agent with all of the documentation and
i. More than 25% of shares or capital or profits of the juridical person, where the juridical person is a agrees to notify the withholding agent if there is a change in circumstances; and
company; (e) The designated withholding agent agrees to report to the IRS (or, in the case of a
ii. More than 15% of the capital or profits of the juridical person, where the juridical person is a reporting Model 1 IGA, to the relevant foreign government or agency thereof) all of the
partnership; information described in or (as appropriate) with respect to any specified U.S. persons
or and (2). Notwithstanding the previous sentence, the designated withholding agent is not
required to report information with respect to an indirect owner of the FFI that holds its
iii. More than 15% of the property or capital or profits of the juridical person, where the juridical person is interest through a participating FFI, a deemed-compliant FFI (other than an owner-
an unincorporated association or body of individuals. documented FFI), an entity that is a U.S. person,an exempt beneficial owner, or an
Where the client is a trust, the financial institutionshall identify the beneficial owners of the client and take excepted NFE.
reasonable measures to verify the identity of such persons, through the identity of the settler of the trust, the (vii) Direct reporting NFE
trustee, the protector, the beneficiaries with 15% or more interest in the trust and any other natural person
exercising ultimate effective control over the trust through a chain of control or ownership. A direct reporting NFFE means a NFFE that elects to report information about its direct or
indirect substantial U.S. owners to the IRS.
Where no natural person is identified the identity of the relevant natural person who holds the position of senior
(viii) Exemption code for U.S. persons
managing official.
Code Sub-category
(A) Controlling Person Type:
A An organization exempt from tax under section 501(a) or any individual retirement
Code Sub-category plan as defined in section 7701(a)(37)
01 CP of legal person-ownership B The United States or any of its agencies or instrumentalities
02 CP of legal person-other means C A state, the District of Columbia, a possession of the United States, or any of their
03 CP of legal person-senior managing official political subdivisions or instrumentalities
04 CP of legal arrangement-trust-settlor D A corporation the stock of which is regularly traded on one or more established
05 CP of legal arrangement--trust-trustee securities markets, as described in Reg. section 1.1472-1(c)(1)(i)
06 CP of legal arrangement--trust-protector E A corporation that is a member of the same expanded affiliated group as a
corporation described in Reg. section 1.1472-1(c)(1)(i)
07 CP of legal arrangement--trust-beneficiary
F A dealer in securities, commodities, or derivative financial instruments (including
08 CP of legal arrangement--trust-other notional principal contracts, futures, forwards, and options) that is registered as
09 CP of legal arrangement—Other-settlor equivalent such under the laws of the United States or any state
10 CP of legal arrangement—Other-trustee equivalent G A real estate investment trust
11 CP of legal arrangement—Other-protector equivalent H A regulated investment company as defined in section 851 or an entity registered at
12 CP of legal arrangement—Other-beneficiary equivalent all times during the tax year under the Investment Company Act of 1940
13 CP of legal arrangement—Other-other equivalent I A common trust fund as defined in section 584(a)
14 Unknown J A bank as defined in section 581
(v) Specified U.S. person – A U.S person other than the following: K A broker
(i) a corporation the stock of which is regularly traded on one or more established securities markets; L A trust exempt from tax under section 664 or described in section 4947(a)(1)
(ii) any corporation that is a member of the same expanded affiliated group, as defined in section 1471(e)(2) of M A tax exempt trust under a section 403(b) plan or section 457(g) plan
the U.S. Internal Revenue Code, as a corporation described in clause (i);
(iii the United States or any wholly owned agency or instrumentality thereof;
(iv) any State of the United States, any U.S. Territory, any political subdivision of any of the foregoing, or any
wholly owned agency or instrumentality of any one or more of the foregoing;

FOR MORE INFORMATION

BOI AXA Mutual Fund
Add: B/204, Tower 1, Peninsula Corporate Park, Ganpatrao Kadam Marg, Lower Parel, Mumbai 400013
Call us at (Toll Free) Alternate Number Email us at Website
1800-103-2263 & 1800-266-2676 020-4011 2300 & 020-6685 4100 [email protected] www.boiaxa-im.com