Application No.
SIP PAUSE FORM
[For investment through ECS (Debit Clearing)/Direct Debit Facility
/Standing Instruction/NACH]
is a facility that allows you to “Pause” your SIP for a specified period of time and restart Date: D D M M Y Y
your SIP without going through the paper work of starting a fresh SIP.
Please read INSTRUCTIONS overleaf carefully. All sections to be completed in ENGLISH in BLACK / DARK COLOURED INK and in BLOCK LETTERS.
ARN- BROKER CODE SUB-BROKER CODE FOR OFFICIAL USE ONLY
Upfront commission shall be paid directly by the investor to the AMFI registered Distributors based on the investors’ SERIAL NUMBER, DATE & TIME OF RECEIPT
assessment of various factors including the service rendered by the distributor.
SIP Pause Start Date M M Y Y Y Y SIP Pause End Date M M Y Y Y Y
[Please refer Instruction No. C . Please note the SIP shall restart from the immediate month after the completion of Pause period.]
Sole/First Applicant’s Name Existing Folio No.
Mr. Ms. M/s FIRST MIDDLE LAST
Scheme Name: ICICI PRUDENTIAL __________________________________________________________________________________________________________________
Plan/Option: ______________________________________________________ Sub-Option: ____________________________________________________________________
Each SIP Amount: Rs. Rupees in words: _______________________________________________________________________
SIP Frequency Monthly SIP Date __________________________________________________________________________________
Signature(s) as per ICICI Prudential Mutual Fund Records (Mandatory)
2nd Holder
3rd Holder
1st Holder
I/We, Mr. / Ms. / M/s. (NAME AS PER THE BANK RECORD) (NAME AS PER THE BANK RECORD)
I hereby authorise ICICI Prudential Mutual Fund and their authorised service providers to Pause/Cancel my/our SIP and then debit from my/our Bank Account No. mentioned below (hereinafter referred as “funding account”) as per
the restart date by ECS (Debit Clearing)/Direct Debit for collection of SIP payments/authorise the bank to record a Standing Instruction for debit to my bank account as mentioned below, as instructed by ICICI Prudential Mutual Fund.
PARTICULARS OF BANK ACCOUNT
Account Type Savings Current NRE NRO FCNR Account Number
BANK MANDATE SECTION (Mandatory)
Name of Bank
Branch Name Branch City
9 Digit MICR code
(Please enter the 9 digit number that appears next to the cheque number). In case of At Par accounts, kindly provide the correct
MICR number of the bank branch. MICR code starting and/or ending with 000 are not valid for ECS.
Authorisation of the Bank Account Holder for Auto Debit (ECS)/Standing Instruction/Direct Debit
I/We have read and understood the contents of the Scheme Information Document(s) and Statement of Additional Information and the terms & conditions of SIP Pause/Cancellation and ECS (Debit Clearing)
/ Direct Debit / Standing Instruction and agree to abide by the same. I /We hereby apply to the Trustee of ICICI Prudential Mutual Fund for Pause/Cancellation under the SIP of the following Scheme(s)/
Plan(s) / Option(s) and agree to abide by the terms and conditions of the same. I/We hereby declare that the particulars given above are correct and express my willingness to make payments referred
above through participation in ECS. This is to inform I/we have registered for the RBI’s Electronic Clearing Service (Debit Clearing) and that my payment towards my investment in ICICI Prudential Mutual
Fund shall be made from my/our below mentioned bank account with your bank. I/We authorise the representative carrying this ECS mandate Form to get it verified & executed. I/We authorise the bank to
honour the instructions as mentioned in the application form. I/We also hereby authorise bank to debit charges towards verification of this mandate, if any. I/We agree that AMC/Mutual Fund (including its
affiliates), and any of its officers directors, personnel and employees, shall not be held responsible for any delay/wrong debits on the part of the bank for executing the direct debit instructions of additional
sum on a specified date from my account. If the transaction is delayed or not effected at all for reasons of incomplete or incorrect information, I/We would not hold the user institution responsible. I/We
confirm to have understood that the introduction of this facility may also give rise to operational risks and hereby take full responsibility. I/We undertake to keep sufficient funds in the funding account on
the date of execution of standing instruction. I/We have not received nor been induced by any rebate or gifts, directly or indirectly, in making this investment. The ARN holder has disclosed to me/us all the
commissions (in the form of trail commission or any other mode), payable to him/them for the different competing Schemes of various Mutual Funds from amongst which the Scheme is being recommended
to me/us. I/We agree that AMC/Mutual Fund (including its affiliates), and any of its officers directors, personnel and employees, shall not be held responsible for any delay / wrong debits on the part of the
bank for executing the standing instructions of additional sum on a specified date from my account.
SIGNATURE(S) OF BANK ACCOUNT HOLDER(S) AS IN BANK RECORDS (Mandatory)
2nd Holder
3rd Holder
1st Holder
Scheme Name:______________________ Folio No./
ACKNOWLEDGEMENT SLIP Please Pause Application No.
(To be filled in by the investor) tick ()
Cancellation Option:____________________________ Acknowledgement Stamp
SIP Amount Rs. ________________________________SIP Frequency: Monthly Quarterly Sub-Option:_________________________
1
Introducing for the first time in the Mutual Fund Industry.... SIP Pause
• SIP Pause is a facility that allows you to pause your existing SIP for a temporary period*.
• You can pause your existing SIP without discontinuing it.
• Your SIP restarts automatically after the pause period is over.
• This facility can be availed only once during the tenure of the existing SIP.
*SIP can be paused for a minimum period of 1 month to a maximum period of 3 months.
SIP PAUSE - TERMS & CONDITIONS
1. SIP Pause form incomplete in any respect are liable to be rejected. period.
2. The Bank shall not be liable for, nor be in default by reason of, any failure 6. SIP Pause facility will allow existing investor to ‘Pause’ their SIP for a specified
or delay in completion of its obligations under this Agreement, where such period of time. i.e Minimum 1 month and Maximum 3 months. The SIP Pause
failure or delay in completion of its obligations under this Agreement, where tenure shall not exceed more than 3 months.
such failure or delay is caused, in whole or in part, by any acts of God,
7. Investors can avail this facility only once in the tenure of the existing SIP.
civil war, civil commotion, riot, strike, mutiny, revolution, fire, flood, fog,
war, lightening, earthquake, change of Government policies, unavailability 8. Investors need to provide their folio number in this SIP Pause form.
of Bank’s computer system, force majeure events, or any other cause of
peril which is beyond the Bank’s reasonable control and which has effect of 9. ICICI Prudential Mutual Fund, its registrars and other service providers
preventing the performance of the contract by the Bank. shall not be responsible and liable for any damages/compensation for
any loss, damage etc. incurred by the investor. The investor assumes
3. The applicant will have the right to Pause SIP at any time he or she so desires the entire risk of using this facility and takes full responsibility.
by filling in the SIP Pause form and submitting the same at the office of the 10. The investor hereby agrees to indemnify and not hold responsible, the
ICICI Prudential Mutual Fund Customer Service Centres. Notice of Pause AMC and its employees, the R&T agent and the service providers incase
should be received 30 days prior to the subsequent SIP date. his/her bank is not able to effect any of the payment instructions for
4. The SIP Pause facility is only available for SIP registration with monthly whatsoever reason.
frequency.
5. The SIP shall restart from the immediate month after the completion of Pause
Mutual Fund investments are subject to market risks, read all Scheme related documents carefully.
