Statement Date : 20-Jul-2025
Statement Period : From 19-May-2025 To 18-Jul-2025 Page 1 of 4
Folio No. : 16977817 / 85
Gunavathi R Bank Account Number : SB / XXXXXXXXXXX3092
Bank Details : Union Bank of India / CHANDRA LAYOUT /
IFSC Code/MICR No : BANGALORE URBAN
UBIN0556343/560026028
1788 1St Block Sir M V Layout
Nagadevanahalli Jnanabharathi Tax Status : Individual
Post Bengaluru South Mode of Payout : CHEQUE PAYMENT
Bangalore - 560056
Karnataka, India Distributor : ARN-96030 / Tegginmath Manjeshwar
Nirmala
Mobile No. : XXXXXXXXX1686 (Self)
E-mail ID :
[email protected] Insurance Nominee : Balaraju M B
Mode of Holding : Single
Nominee Details
Sr.No. Nominee Name Date of Birth Guardian Name (in case of minor) Share (%)
1 XXXXXXXXXX B N/A N/A 100%
PAN AADHAR Supplementary
PAN/PEKRN KYC FATCA CKYC No. UBO
LINKING KYC
1st Holder XXXXXX553E Successful OK Registered Done XXXXXXXXXX8024 Not applicable
2nd Holder
3rd Holder
Guardian,
if any
ACCOUNT SUMMARY AS ON 18-JUL-2025
Cost of Investment * IDCW IDCW Current
Scheme Code / Name NAV NAV Date Unit Balance
(INR) Reinvested (INR) Paid ** (INR) Value (INR)
1451 Focused Equity Fund - Growth 91.43 18-Jul-2025 613.266 47,256.80 0.00 0.00 56,070.91
3131 P.H.D Fund Growth 40.50 18-Jul-2025 1,313.546 43,472.30 0.00 0.00 53,198.61
Total : 1,926.812 90,729.10 0.00 0.00 109,269.52
* Cost of investment is inclusive of IDCW amount transferred from other schemes.
** IDCW Paid is inclusive of IDCW amount transferred to other schemes.
Nomination in an individual folio helps in seamless transfer of units in case of an unforeseen event. This facility is available free of cost.
~ Effective from July 01, 2020, stamp duty @ 0.005% will be deducted from the Net investment amount. Units will be allotted for the balance amount i.e. net investment amount - stamp duty.
Stamp duty will be computed using the formula ((Investment amount-transaction charges, if any)/100.005)*0.005.
Systematic Registrations
Registration Package From Date Target Cycle Installment Broker Top up Top up % / Policy
Scheme Frequency
Type Name To Date Amount Day Amount (INR) Code Frequency Amount (INR) Number
SIP ICICI Prudential 26-Feb-2021 NA Once A 18 2,000.00 ARN-96030 NA NA NA
Focused Equity Fund - 18-Jan-2036 Month
Growth
SIP ICICI Prudential Pharma 12-May-2021 NA Once A 12 2,000.00 ARN-96030 NA NA NA
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Healthcare and 12-Dec-2030 Month
Diagnostics (P.H.D)
Fund Growth
1451 / INF109K01BZ4 / ICICI Prudential Focused Equity Fund - Growth
Date Transaction Type Amount (INR) NAV(INR) Price (INR) No. of Units Balance Units
Opening Balance as on 19/05/2025 546.950
Purchase - Instalment 51/179 - ARN-96030/E105727 1,999.90 89.77 89.77 22.278
19/05/2025 569.228
Gross Amount: Rs.2000/-; Stamp Duty charges Levied ~ 0.10
Purchase - Instalment 52/179 - ARN-96030/E105727 1,999.90 90.23 90.23 22.164
18/06/2025 591.392
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Statement Date : 20-Jul-2025 Statement Period : From 19-May-2025 To 18-Jul-2025
Folio No. : 16977817 / 85 Page 2 of 4
1451 / INF109K01BZ4 / ICICI Prudential Focused Equity Fund - Growth
Date Transaction Type Amount (INR) NAV(INR) Price (INR) No. of Units Balance Units
Gross Amount: Rs.2000/-; Stamp Duty charges Levied ~ 0.10
Purchase - Instalment 53/179 - ARN-96030/E105727 1,999.90 91.43 91.43 21.874
18/07/2025 613.266
Gross Amount: Rs.2000/-; Stamp Duty charges Levied ~ 0.10
Units Under Lien : 0.000 Name Of Financier : Not Applicable
Free units available TO REDEEM/SWITCH : 613.266
Current Value(INR) of Units: 56,070.91
NAV as of 31st Jan 2018 :
Current : Entry Load - Nil. Exit Load w.e.f 06-Apr-2015 [including SIP,STP,SWP(SIP) wherever available] if redeemed or switched out within 1 year - 1.00%, > 1 year - Nil.
For lumpsum investment/switch in, the applicable load will be based on the load structure as on the date of investment/applicable NAV date. For SIP/STP transactions, load
for each transaction is based on the applicable load structure as on the registration date. For details, please refer to SID and Addenda available on www.icicipruamc.com.
Scheme Name of ICICI Prudential Select Large Cap Fund has been changed to ICICI Prudential Focused Equity Fund with effect from May 28, 2018. "Please ensure that your
account information is up to date. If there are any changes to your KYC details like address, contact details, occupation, income, PEP status, FATCA/CRS information etc.
kindly update them immediately."
3131 / INF109KC1GE9 / ICICI Prudential Pharma Healthcare and Diagnostics (P.H.D) Fund Growth
Date Transaction Type Amount (INR) NAV(INR) Price (INR) No. of Units Balance Units
Opening Balance as on 12/06/2025 1,213.002
SIP Purchase - Instalment 50/116 - via Internet - ARN- 1,999.90 39.42 39.42 50.733
12/06/2025 1,263.735
96030/E105727
Gross Amount: Rs.2000/-; Stamp Duty charges Levied ~ 0.10
SIP Purchase - Instalment 51/116 - via Internet - ARN- 1,999.90 40.15 40.15 49.811
14/07/2025 1,313.546
96030/E105727
Gross Amount: Rs.2000/-; Stamp Duty charges Levied ~ 0.10
Units Under Lien : 0.000 Name Of Financier : Not Applicable
Free units available TO REDEEM/SWITCH : 1,313.546
Current Value(INR) of Units: 53,198.61
NAV as of 31st Jan 2018 :
Current : Entry Load - Nil. Exit Load w.e.f 01-Jan-2019 [including SIP,STP,SWP&Micro(SIP) wherever available] - If redeemed or switched out within 15 days - 1 %, after
15 days - Nil. For lumpsum investment/switch in, the applicable load will be based on the load structure as on the date of investment/applicable NAV date. For SIP/STP
transactions, load for each transaction is based on the applicable load structure as on the registration date. For details, please refer to SID and Addenda available on
www.icicipruamc.com. "Please ensure that your account information is up to date. If there are any changes to your KYC details like address, contact details, occupation,
income, PEP status, FATCA/CRS information etc. kindly update them immediately."
OTM Registration Details Summary
Sl. Bank OTM OTM From Expiry OTM
Bank Name UMRN
No. Account Number Status Frequency Date Date Amount
As and When
1 Union Bank of India XXXXXXXXXXX3092 UBIN0000000008235092 Active 26-Feb-2021 31-Dec-2099 50,000.00
presented
In case of any further assistance or clarification, (1) you can get in touch with your financial distributor/advisor OR (2) write to us at
[email protected] OR (3) contact on our customer
care helplines 1800 222 999/1800 200 6666(Monday to Saturday- 8 am to 8 pm / Sundays- 9 am to 7 pm)
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Statement Date : 20-Jul-2025 Statement Period : From 19-May-2025 To 18-Jul-2025
Folio No. : 16977817 / 85 Page 3 of 4
COMMON TRANSACTION SLIP (For existing Unitholders only)
ADVISER CODE (ARN CODE) SUB BROKER ARN CODE Employee Unique SUB-BROKER CODE Agent/Advisor Name and Mobile No
Identification No.(EUIN) (As allotted by ARN holder)
Tegginmath Manjeshwar Nirmala /
ARN-96030 +919901676895
Upfront commission shall be paid directly by the investor to the AMFI registered Distributors based on the investor's assessment of various factors including the service rendered by the distributor.
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) :16977817 / 85 TAX STATUS : Individual MODE OF HOLDING : Single
1st Holder
Gunavathi R ) XXXXXX553E OK
(Mandatory)
t hol der(s s*
2nd Holder NA e Uni NA * tatu
SNA
ft h PAN KYC
3rd Holder NA N ame o NA NA
* PAN & KYC are mandatory for all applicants including NRIs. In case there is any changes in your KYC information please update the same by using the prescribed 'KYC change request form' available on our
website www.iciciprumf.com under downloads section, and submit the same at the point of service of any KYC registration Agency.
Contact Mobile Number and/or Land Line Number
details of
First/Sole
applicant E-mail address
Additional Purchase Request (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 default option as per respective
scheme information documents.
Scheme Name PLAN: OPTION:
Drawn on Bank
Cheque / DD No.
Name & Branch
Amount of cheque/ DD charges, if any.
Cheque / DD Date D D M M Y Y Y Y DD in figures (Rs.) Rs. (in figures)
Bank Current Savings NRO NRE FCNR
Account Type
A/c No. Others (Please specify)
Documents attached to avoid Third Party Payment Rejection where applicable: In case, the additional purchase amount 10,000 or above and distributor has opted
Bank Certificate - for DD Third Party Declaration to receive transaction charges, 100/- will be deducted from the Purchase amount
For third party investment/pre-funded instrument, please fill in a separate declaration form as available with AMC. and paid to the distributor. Units shall be allotted for the balance amount only.
Redemption Request (For details, please refer to the SID of the Scheme) I wish to redeem : Rs. or Units
From(Scheme, Plan & Option)
Switch Request (Please refer to the SID of the scheme) I wish to switch : Rs. or Units
From(Scheme, Plan & Option) To(Scheme, Plan & Option)
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.
YOUR CONFIRMATION/DECLARATION: I/We have read and understood the contents of the Scheme Information Document(s)/Key Information 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.
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Signature(s) (To be signed as per Mode of Holding)
First Holder Second Holder Third Holder
ICICI Prudential Asset Management Company Limited
Corporate Office : One BKC, A - Wing 13th Floor, Bandra Kurla Complex,Bandra (East),Mumbai - 400051.Tel: +91 22 2652 5000 Fax: +91 22 2652 8100.www.icicipruamc.com
Central Service Office : 2nd Floor,Block B-2,Nirlon Knowledge Park,Western Express Highway,Goregon(E),Mumbai - 63,Tel: 91-22-2685 2000 Fax: 91-22-2686 8313.www.icicipruamc.com
Contact us : Customer care helpline at 1800222999/18002006666 (Monday to Saturday- 8 am to 8 pm and on Sundays- 9 am to 7 pm)
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Statement Date : 20-Jul-2025 Statement Period : From 19-May-2025 To 18-Jul-2025
Folio No. : 16977817 / 85 Page 4 of 4
Nomination Details
Folio No : 16977817
Investor Name : Gunavathi R
Name Share (%) Relationship Identity Number
Nominee 1 Balaraju M B 100 Spouse
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