Canara Robeco Mutual Fund

Investment Manager : Canara Robeco Asset Management Co. Ltd. CIN No: U65990MH1993PLC071003
Construction House, 4th Floor, 5, Walchand Hirachand Marg, Ballard Estate, Mumbai 400 001.
Tel.: 6658 5000, Fax: 6658 5012/13, www.canararobeco.com Application No.

APPLICATION FORM (Please fill in BLOCK Letters)

Distributor/Broker ARN/RIA Code# Sub Broker Code / ARN Employee Unique Identification Number Bank Serial No. / Branch Stamp / Receipt Date

ARN-68172 E060449
#By mentioning RIA Code, I/We authorize you to share with the Investment Adviser the details of my/our transactions in the scheme(s) of Canara Robeco Mututal Fund.
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.
Declaration for “execution-only” transaction (only where EUIN box is
left blank) (Refer Instruction 28): 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 broker or notwithstanding
the advice of in-appropriateness, if any, provided by the employee/
relationship manager/sales person of the distributor/sub broker. Signature of 1st Applicant / Guardian Signature of 2nd Applicant Signature of 3rd Applicant
TRANSACTION CHARGES FOR APPLICATIONS THROUGH DISTRIBUTORS ONLY (Refer Instruction 25)
I confirm that I am a First time investor across Mutual Funds. I confirm that I am an existing investor in Mutual Funds.
(` 150 deductible as Transaction Charge and payable to the Distributor) (` 100 deductible as Transaction Charge and payable to the Distributor)
In case the purchase / subscription amount is ` 10,000 or more and your Distributor has opted to receive Transaction Charges, the same are deductible as applicable from the purchase / subscription
amount and payable to the Distributor. Units will be issued against the balance amount invested.
EXISTING UNIT HOLDER INFORMATION [Please fill in your Folio Number and proceed to Investment Details and Payment Details]

Folio No. Name of 1st Unit Holder

The details in our records under the folio number mentioned will apply for this application.
PAN / PEKRN AND CKYC COMPLIANCE STATUS DETAILS - Mandatory [Refer Instruction Nos. 12 & 26]
PAN/PEKRN # (refer instruction) CKYC Compliance Status** (if yes, attach proof) KIN (CKYC Identification No.)
First / Sole Applicant@ Yes

Second Applicant Yes

Third Applicant Yes

First/Sole Applicant@ Second Applicant Third Applicant

Aadhaar Number
(Optional)
@ If the first/sole applicant is a Minor, then please provide details of Natural / Legal Guardian. **Refer instruction 12
APPLICANT(S) INFORMATION [Refer Instruction 1]
DATE OF BIRTH
NAME OF FIRST / SOLE APPLICANT / MINOR (incase of minor their shall be no joint holder) (Mandatory in case of Minor) D D / M M / Y Y Y Y
Mr. | Ms. | M/s.

Father / Husband's Name

Occupation Please () Private Sector Service Government Service Professional Retired Student Others
Public Sector Agriculturist Business Forex Dealer Housewife Please specify
Status Please() Resident Individual NRI - NRO Trust HUF Bank / Fls NRI-NRE
Minor thru Guardian Company/Body Corporate Flls/FIPs Partnership Firm Society
OTHER DETAILS Please tick () Individual Non-Individual (Mandatory)
1. Gross Annual Income Details Please tick () Below 1 Lac 1 - 5 Lacs 5 - 10 Lacs 10 - 25 Lacs 25 Lacs - 1 Crore 1 Crore & above
[OR]
Net-worth in ` ________________________________________________________________________ as on (date) D D / M M / Y Y Y Y

2. Please tick if applicable: Politically Exposed Person (PEP) Related to a Politically Exposed Person (PEP) Not Applicable
3. Is the entity involved in / providing any or the following services
– Foreign Exchange / Money Changer Services YES NO
– Gaming / Gambling / Lottery Services (e.g. casinos, betting syndicates) YES NO
– Money Lending / Pawning YES NO
4. Any other information ____________________________________________________________________________________________________________________________________
I declare that the information is to the best of my knowledge and belief, accurate and complete. I agree to notify Canara Robeco Mutual Fund / Canara Robeco Asset Management company limited
immediately in case there is any change in the above information.

ACKNOWLEDGMENT SLIP (TO BE FILLED IN BY THE SOLE/FIRST APPLICANT)

Canara Robeco Mutual Fund

Investment Manager : Canara Robeco Asset Management Co. Ltd. Application No.
Construction House, 4th Floor, 5, Walchand Hirachand Marg, Ballard Estate, Mumbai 400 001.

Received from Mr./Ms./M/s.______________________________________________________________ Date _____/_____/___________

___________________________________________________________________________________ Stamp, Signature & Date

An application for purchase of______________ units of_________________________________________
along with cheque/DD as detailed overleaf. Cheques/Drafts are subject to realisation.
NAME OF SECOND APPLICANT
Mr. | Ms. | M/s.

Occupation Please () Private Sector Service Government Service Professional Retired Student Others
Public Sector Agriculturist Business Forex Dealer Housewife Please specify
Status Please() Resident Individual NRI - NRO Trust HUF Bank / Fls NRI-NRE
Minor thru Guardian Company/Body Corporate Flls/FIPs Partnership Firm Society
OTHER DETAILS Please tick () Individual Non-Individual (Mandatory)
1. Gross Annual Income Details Please tick () Below 1 Lac 1 - 5 Lacs 5 - 10 Lacs 10 - 25 Lacs 25 Lacs - 1 Crore 1 Crore & above
[OR]
Net-worth in ` ________________________________________________________________________ as on (date) D D / M M / Y Y Y Y
2. Please tick if applicable: Politically Exposed Person (PEP) Related to a Politically Exposed Person (PEP) Not Applicable
3. Is the entity involved in / providing any or the following services
– Foreign Exchange / Money Changer Services YES NO
– Gaming / Gambling / Lottery Services (e.g. casinos, betting syndicates) YES NO
– Money Lending / Pawning YES NO
4. Any other information ____________________________________________________________________________________________________________________________________
I declare that the information is to the best of my knowledge and belief, accurate and complete. I agree to notify Canara Robeco Mutual Fund / Canara Robeco Asset Management company limited
immediately in case there is any change in the above information.
NAME OF THIRD APPLICANT
Mr. | Ms. | M/s.

Occupation Please () Private Sector Service Government Service Professional Retired Student Others
Public Sector Agriculturist Business Forex Dealer Housewife Please specify

Status Please() Resident Individual NRI - NRO Trust HUF Bank / Fls NRI-NRE
Minor thru Guardian Company/Body Corporate Flls/FIPs Partnership Firm Society
OTHER DETAILS Please tick () Individual Non-Individual (Mandatory)
1. Gross Annual Income Details Please tick () Below 1 Lac 1 - 5 Lacs 5 - 10 Lacs 10 - 25 Lacs 25 Lacs - 1 Crore 1 Crore & above
[OR]
Net-worth in ` ________________________________________________________________________ as on (date) D D / M M / Y Y Y Y
2. Please tick if applicable: Politically Exposed Person (PEP) Related to a Politically Exposed Person (PEP) Not Applicable
3. Is the entity involved in / providing any or the following services
– Foreign Exchange / Money Changer Services YES NO
– Gaming / Gambling / Lottery Services (e.g. casinos, betting syndicates) YES NO
– Money Lending / Pawning YES NO
4. Any other information ____________________________________________________________________________________________________________________________________
I declare that the information is to the best of my knowledge and belief, accurate and complete. I agree to notify Canara Robeco Mutual Fund / Canara Robeco Asset Management company limited
immediately in case there is any change in the above information.
NAME OF THE GUARDIAN (In case of first Applicant is a Minor) Relation with Minor Please ()
Mr. | Ms. | M/s. Mother Father Legal Guardian

Proof of DOB ( Any one Mandatory) Birth Certificates School Certificates / Mark Sheet Pass Port Others _____________________________
Occupation Please () Private Sector Service Government Service Professional Retired Student Others
Public Sector Agriculturist Business Forex Dealer Housewife Please specify

Status Please() Resident Individual NRI - NRO Trust HUF Bank / Fls NRI-NRE
Minor thru Guardian Company/Body Corporate Flls/FIPs Partnership Firm Society
OTHER DETAILS Please tick () Individual Non-Individual (Mandatory)
1. Gross Annual Income Details Please tick () Below 1 Lac 1 - 5 Lacs 5 - 10 Lacs 10 - 25 Lacs 25 Lacs - 1 Crore 1 Crore & above
[OR]
Net-worth in ` ________________________________________________________________________ as on (date) D D / M M / Y Y Y Y
2. Please tick if applicable: Politically Exposed Person (PEP) Related to a Politically Exposed Person (PEP) Not Applicable
3. Is the entity involved in / providing any or the following services
– Foreign Exchange / Money Changer Services YES NO
– Gaming / Gambling / Lottery Services (e.g. casinos, betting syndicates) YES NO
– Money Lending / Pawning YES NO
4. Any other information ____________________________________________________________________________________________________________________________________
I declare that the information is to the best of my knowledge and belief, accurate and complete. I agree to notify Canara Robeco Mutual Fund / Canara Robeco Asset Management company limited
immediately in case there is any change in the above information.

Mode of Holding Please () Anyone or Survivor Joint (Default option is Anyone or Survivor)

Payment Details
Sr. Amount
Scheme Name Plan Option Cheque/DD No./UTR No.
No. Invested (`) Bank and Branch
(incase of NEFT/RTGS)
1.

2.

M/s. Karvy Fintech Private Limited “Karvy Plaza”

Karvy Selenium, Tower B, Plot No 31 & 32, Gachibowli, Financial District, Nanakramguda, Serilingampally, Hyderabad 500 032
Tel No. : 040 33215262/ 5269 E-mail : [email protected]
POWER OF ATTORNEY (PoA) HOLDER DETAILS
Name of POA Mr. | Ms. | M/s.

PAN KYC [Please () (Mandatory)] Proof Attached

Occupation Please () Private Sector Service Government Service Professional Retired Student Others
Public Sector Agriculturist Business Forex Dealer Housewife Please specify
Status Please() Resident Individual NRI - NRO Trust HUF Bank / Fls NRI-NRE
Minor thru Guardian Company/Body Corporate Flls/FIPs Partnership Firm Society
OTHER DETAILS Please tick () Individual Non-Individual (Mandatory)
1. Gross Annual Income Details Please tick () Below 1 Lac 1 - 5 Lacs 5 - 10 Lacs 10 - 25 Lacs 25 Lacs - 1 Crore 1 Crore & above
[OR]
Net-worth in ` ________________________________________________________________________ as on (date) D D / M M / Y Y Y Y
2. Please tick if applicable: Politically Exposed Person (PEP) Related to a Politically Exposed Person (PEP) Not Applicable
3. Is the entity involved in / providing any or the following services
– Foreign Exchange / Money Changer Services YES NO
– Gaming / Gambling / Lottery Services (e.g. casinos, betting syndicates) YES NO
– Money Lending / Pawning YES NO
4. Any other information ___________________________________________________________________________________________________________________________________
I declare that the information is to the best of my knowledge and belief, accurate and complete. I agree to notify Canara Robeco Mutual Fund / Canara Robeco Asset Management company limited
immediately in case there is any change in the above information.
DEMAT ACCOUNT DETAILS (This section to be filled only if investor wish to hold units in demat form) (Client Master List (CML) to be enclosed) (Refer instructions No. 24)
National Securities Depository Limited (NSDL) Central Depository Services (India) Limited (CDSL)

Depository Participant Name____________________________________________________

Depository Participant Name
DP ID No. I N
Target ID No.

FATCA/CRS DETAILS For individuals & HUF (Mandatory) (Refer instruction no. 30)
The below information is required for all applicant(s) / guardian
Address Type: Residential Business Registered Office (for address mentioned in form / existing address appearing in Folio)
Do you have non-Indian Country[ies] of Birth / Citizenship / Nationality and Tax Residency? Yes No Please tick as applicable and if yes, provide the below mentioned information (mandatory)

Sole / First Applicant / Guardian Yes No Second Applicant Yes No Third Applicant Yes No or POA Yes No
Date of Birth Date of Birth Date of Birth
Place of Birth Place of Birth Place of Birth
Country of Birth Country of Birth Country of Birth
Country of Citizenship/ Country of Citizenship/ Country of Citizenship/
Nationality Nationality Nationality
Are you a US Specified Person? Yes No Are you a US Specified Person? Yes No Are you a US Specified Person? Yes No
please provide Tax Payer Id please provide Tax Payer Id please provide Tax Payer Id
Country of Tax Residency# Country of Tax Residency# Country of Tax Residency#
Taxpayer Identification No Taxpayer Identification No Taxpayer Identification No
[other than India] [other than India] [other than India]
1 1 1

2 2 2
# Please indicate all countries in which you are a resident for tax purpose and associated Taxpayer Identification number.
In case of applications with PoA, the PoA holder should fill separate form to provide the above details mandatorily.
MAILING ADDRESS [Please provide Full Address. P.O. Box No. may not be sufficient. Overseas Investors will have to provide Indian Address]
Local Address of 1st Applicant

City State Pin Code

Tel Office Residence Mobile

E-mail* P L E A S E U S E B L O C K L E T T E R S
* The primary holder's own email address and mobile number should be provided for speed and ease of communication in a convenient and cost-effective manner, and to help prevent fraudulent transactions.
Overseas Correspondence address (Mandatory for NRI/FII Applicant)

City State Pin Code

COMMUNICATION (Please )
I/We wish to receive Account Statements/Annual Reports/Quarterly Statements/Newsletter/Updates or any other Statutory/Regulatory Information via Physical Mode.
BANK ACCOUNT DETAILS - Mandatory
Name of the Bank

Account No. A/c Type (please )  SAVINGS  NRE  CURRENT  NRO  FCNR

Branch Address

Bank Branch City State Pin Code MICR Code

(Please enter the 9 digit number that appears after your cheque number)
IFSC CODE (RTGS/NEFT) (Mandatory for Credit via NEFT/RTGS) Please attach a cancelled cheque OR a clear photo copy of a cheque
(11 Character code appearing on your cheque leaf. If you do not find this on your cheque leaf, please check for the same with your Bank)
REDEMPTION / DIVIDEND REMITTANCE [Refer Instruction 20]
It is the responsibility of the Investor to ensure the correctness of the IFSC code/ MICR code for Electronic Payout at recipient/
Electronic Payment Cheque Payment
destination branch corresponding to the Bank details.
If MICR and IFSC code for Redemption/Dividend Payout is available all payouts will be automatically processed as Electronic Payout-RTGS/NEFT/Direct Credit/NECS.

SIP ENROLLMENT DETAILS

SIP Amount Enrollment Period
(Rs.) REGULAR SIP : Start Month M M - Y Y Y Y End Month M M - Y Y Y Y Frequency Please ( ) Any Date Monthly Quarterly

PERPETUAL SIP : Start Month Year until further instruction (or) End on Month 1 2 Year 2 0 9 9

SIP Top Up : Rs. (in multiplies of Rs. 500/-) ________________________________________________________ Frequency Please ( ) Half Yearly Yearly
PAYMENT MECHANISM : Debit through ECS / Auto Debit facility (Fill up SIP Registration cum mandate form for NACH/ECS/Direct Debit)
INVESTMENT DETAILS AND PAYMENT DETAILS (Payment through Cash/Outstation Cheques not accepted)
Separate cheque / demand draft must be issued for each investment, drawn in favour of respective scheme name. Please write appropriate scheme name as well as the Plan/Option/Sub Option.
Sr. Amount Cheque/DD No./UTR No.
Scheme Name Plan Option Bank and Branch and Account Number
No. Invested (`) (incase of NEFT/RTGS)

1.

2.

# (Type of Account / Saving / Current / NRE / NRO / FCNR / NRSR) * All purchases are subject to realization of cheque/DD.

(Mandatory for Non-Individual)

Category Unlisted company Partnership Firm Unincorporated Association/Body of Individuals Trust Foreign Investor $$$
Ownership per cent @@@ >25% >15% >15% >=15%

intimate CRAMC / its Registrar / KRA as may be applicable immediately about such change.

Sr. Name Address Details of Identity such as % of ownership

PAN/Passport

[Please attach self attested copy of PAN/Passport (proof of photo identity) along with application form]
NOMINATION DETAILS for Individuals [Minor / HUF / POA Holder / Non Individuals cannot Nominate – Refer Instruction No. 13]
I/We ___________________________________________________________________ do here by nominate the undermentioned Nominee(s) to receive the units to my / our credit in this folio no. in
the event of my / our death. I/We also understand that all payments and settlements made to such Nominee(s) and Signature of the Nominee(s) acknowledging receipt thereof, shall be a valid discharge by the
AMC / Mutual Fund / Trustees. I/We_____________________________________________________ do not wish to nominate
No. Nominee(s) Name Date of Birth (in case of Minor) Name of the Guardian Relationship with @ % of Share

(in case of Minor) Unit Holder

1 D D - M M - Y Y Y Y
2 D D - M M - Y Y Y Y
3 D D - M M - Y Y Y Y

 First/Sole Applicant/Guardian  Second Applicant  Third Applicant

@ If the percentage of share is not mentioned then the claim will be settled equally amongst all the indicated nominee(s)
DECLARATION
To the trustees Canara Robeco Mutual Fund. I / We have read and understood the contents of the SAI, SID and Key Information Memorandum of the Scheme. I/We hereby apply to the Trustees of Canara Robeco Mutual Fund
for allotment of units of the Scheme, as indicated above and agree to abide by the terms, conditions, rules and regulations of the Scheme. I/We hereby declare that I/ We are authorised to make this investment in the above
mentioned Scheme (s) and that the amount invested in the scheme (s) is through legitimate sources only and does not involve and is not designed for the purpose of any contravention or evasion of any Act, Rules, Regulations,

necessary proof / documentation, if any, required to substantiate the facts of this undertaking. I have not received nor been induced by any rebate or gifts, directly or indirectly in making this investment. I / We authorize the Fund
to disclose details of my/our account and all my/our transactions to the intermediately whose stamp appears on the application form. I also authorize the Fund to disclose details as necessary, to the Registrar & Transfer agent(s),

I/We hereby declare that currently there is no subsisting order/ruling/judgment etc., in force which has been passed by of any court, tribunal, statutory authority or regulator, including SEBI prohibiting or restraining me/us
from dealing in securities.
That in the event, the above information and/or any part of it is/are found to be false/untrue/misleading. I/We will be liable for the consequences arising therefrom. I/We will indemnify the fund, AMC, Trustee, RTA and other
intermediaries in case of any dispute regarding the eligibility, validity, and authorization of my/our transaction.
I / We hereby provide my / our consent in accordance with Aadhaar Act, 2016 and regulations made there under, for (i) collecting, storing and usage (ii) validating / authenticating and (ii) updating my/our Aadhaar number(s)
in accordance with the Aadhaar Act, 2016 (and regulations made there under) and PMLA. I / We hereby provide my / our consent for sharing / disclose of the Aadhaar number(s) including demographic information with the
asset management companies of SEBI registered mutual fund and their Registrar and Transfer Agent (RTA) for the purpose of updating the same in my / our folios with my / our PAN.
Applicable to NRIs only
or from funds in my/our Non Resident External / Ordinary Account / FCNR / NRSR Account. Investment in the scheme is made by me / us on: Repatriation basis Non Repatriation basis.

 First/Sole Applicant/Guardian  Second Applicant  Third Applicant

To, The Trustees of Canara Robeco Mutual Fund, Sub : Our Subscription to the Schemes of

severally authorise Mr. ____________________________________________________ to subscribe an amount of `_____________ for allotment of units of ____________________ Scheme on

application for subscription.

Name of the partners Signatures
________________________________________________________________ ________________________________________________________________

For Scheme related information kindly refer Key Information Memorandum ( KIM)