TEARHERE
Date______ / ______ / __________
ACKNOWLEDGEMENT SLIP (To be filled in by the Sole/First Applicant)
CANBANK MUTUAL FUND
Construction House, 4th floor, 5, Walchand Hirachand Marg, Ballard Estate, Mumbai 400 001.
Application No.
FOR OFFICE USE ONLY
CURRENT LOAD STRUCTURE
Entry Load
Exit Load
Stamp,
Signature & Date
Received from Mr. / Ms. /M/s.____________________________
An application for purchase of units of ____________________
Scheme along with cheque / DD as detailed overleaf.
Please note : Cheques / Drafts are subject to realisation.
Please read the Instructions before filling in the Application Form.
Application No.
Growth
Growth with Automatic Repurchase
Option Selected : (Please 4 )
Particulars of Applicant
Status (Please 4 )
Individual
On behalf of Minor
HUF Body Corporate
Partnership Firm Trust
NRI
Regd.Co-op Soc.
Others:Specify_______
# Karta in case of HUF / Principal Partner in case of Partnership Firm.
(Cheques/Drafts should be drawn in favour of “CANBANK MUTUAL FUND”)
Gross Investment Amount
(1)
* DD Charges
(2)
In Figures (Rs.)
In Words (Rupees)
Amount Remitted
(1+2)
* Only for payments made through DD.
Cheque/DD No. _______________________ Date _______________________ Bank & Branch _________________________________________________
NRI’s Address in India
Growth
Dividend
Total
Age
Date of Birth
(If the applicant is minor)
DD
MM
YY
Name of the Guardian
(If the applicant is minor)
Occupation (Please 4 )
Service
Business
Professional
Retired
Housewife
Agriculture
Student
Others
Bonus
Dividend Reinvestment
Income/Dividend Payout
Full Name of First / Sole Applicant / Corporate
Salutation Mr. Ms. M/s. Dr. Prof
PAN /GIR No. (Refer Instruction No. 12 )
Circle/Ward/District
Unique Identification Number (UIN) under MAPIN Database (Refer Instruction No.13 )
Full Name of Second Applicant
Salutation Mr. Ms. M/s. Dr. Prof
PAN /GIR No.
Circle/Ward/District
Unique Identification Number (UIN) under MA