JM FINANCIAL SERVICES LIMITED

CIN : U67120MH1998PLC115415
Registered Office: 7th Floor, Cnergy , Appasaheb Marathe Marg, Prabhadevi, Mumbai-400025 Tel: No : (91 22) 66303030
UCC FOR OFFICE USE ONLY
Form No. 96231

Account Opening Form- Mutual Fund (MFD)-Individual

BROKER ARN ARN-0 0 0 2 SUB BROKER CODE 1025067 EUIN E558387

SB ARN A R N - ARN-296232 SB NAME Sneha Trivedi

Unit Holder Information:
First Holder Tax Status (refer Note5 on page 5): Individual Gender: M / F
1st Applicant Name as per PAN
(IN BLOCK LETTERS) DEEPAK KAPUR

Date of Birth
PAN Number: AIAPK7900R KYC: YES/NO dd/mm/yyyy 27/05/1957

AADHAAR No:

Father’s Name :
HIRALAL KAPUR

Mother’s Name :

Name of Guardian: PAN :

Correspondence Address Permanent Address

R 2 GOYAL NAGAR KANADIA ROAD NEAR R 2 GOYAL NAGAR KANADIA ROAD NEAR CHAMELI
CHAMELI PARK INDORE PARK INDORE

PIN 452018 PIN 452018

City : INDORE City: INDORE

State MADHYA PRADESH State: MADHYA PRADESH

Country INDIA Country: INDIA

Mobile : 8821845160 Email : [email protected]

Tel (Res) : 9191 Tel (Off) : 9191 Fax (Off): Fax (Resi): 9191

Place of Birth : indore Country of Tax Residence : Tax Id No:

Mode of Holding : Single Joint Anyone or Survivor

2nd Applicant Name as per PAN

(IN BLOCK LETTERS)

PAN Number : KYC: YES / NO Date of Birth

dd/mm/yyyy

AADHAAR No :

Place Of Birth Country Of Tax Residence Tax Id No

Signatures ST ND RD Page 1/9

Holder Signature 1.1 2. 2 3.3
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 3rd Applicant Name as per PAN

(IN BLOCKLETTERS)
Date of Birth
PAN Number : KYC: YES / NO dd/mm/yyy
y
AADHAAR No:

Place of Birth : Country of Tax Residence : Tax Id No:

Other Details of Sole/ 1st Applicant

Overseas Address : (In case of NRI investor)

ZIP CODE

City : State: Country :

Bank Details

Name of Bank : ICICI BANK LIMITED Branch : BENGALI SQUARE, INDORE

A/C No. : 657301417211

Account Type: Saving Bank IFSC Code: ICIC0002370

Bank Address : ICICI BANK LTD., O FRIENDS COLONY, BENGALI SQUARE, INDORE - 452016,
MADHYA PRADESH

PIN 123123
City : State : Country :
OTHERS OTHER INDIA
Nomination Details

Nominee Name : UDIT KAPUR

IN CAPITAL LETTERS

Relation Ship: Son

Date Of Birth : 30/04/1996

Guardian Name (If Nominee is Minor):

Nominee Address : R 2 GOYAL NAGAR KANADIA ROAD NEAR CHAMELI PARK INDORE

PIN 452018

City: INDORE State: MADHYA PRADESH Country: INDIA

Page 2/9
Signatures
Holder Signature 1ST 2ND 3RD
1. 2. 3.

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 Annexure I

Additional Bank Details UCC Code

Bank Details (Second Bank) – PLEASE ATTACH CHEQUE LEAF

Name of Bank: Branch:

A/C No:

Account Type: IFSC Code:

Bank Address PIN

City: State: Country:

Bank Details (Third Bank) – PLEASE ATTACH CHEQUE LEAF

Name of Bank: Branch:

A/C No:

Account Type: IFSC Code:

Bank Address PIN

City: State: Country:

Bank Details (Fourth Bank) - PLEASE ATTACH CHEQUE LEAF

Name of Bank: Branch:

A/C No:

Account Type: IFSC Code:

Bank Address PIN

City: State: Country:

Bank Details (Fifth Bank) – PLEASE ATTACH CHEQUE LEAF

Name of Bank: Branch:

A/C No:

Account Type: IFSC Code:

Bank Address PIN

City: State: Country:

1. 2. 3.

Page 3/9
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 Occupation/ Income/ Source of wealth/PEP details

First/Sole Applicant/Guardian Second Applicant Third Applicant

Name: DEEPAK KAPUR

Occupation Details (Please  the relevant) :

Private Sector Service □ □ □
Public Sector Service □ □ □
Government Service □ □ □
Professional □ □ □
Retired □ □ □
Housewife □ □ □
Student □ □ □
Business [Nature of Business] □ □ □
Agriculturist □ □ □
Forex Dealer □ □ □
Casino/Gambling Services □ □ □
Arms Manufacturer □ □ □
Money lender/Pawn Broker □ □ □
Gems & Jewelry □ □ □
Real Estate □ □ □
Export-Import □ □ □
Others [Please specify] □ □ □
_________________________ _________________________ _________________________ _________________________
Gross Annual Income (Please  the relevant) :
Below INR 1 Lac □ □ □
INR 1-5 Lacs □ □ □
INR 5-10 Lacs □ □ □
INR 10-25 Lacs □ □ □
> INR 25 Lacs □ □ □
Net-worth as on date (should
not be older than 1 year): 600000
Rs.______________________ Rs.______________________ Rs.______________________
Source of Wealth (Please  the relevant):
Salary □ □ □
Business Income □ □ □
Gift □ □ □
Ancestral Property □ □ □
Rental Income □ □ □
Others [Please Specify]: □ □ □
_________________________ _________________________ _________________________ _________________________
Are you: (Please  the relevant)
Politically Exposed Person □ □ □
(PEP)
Related to a PEP (RPEP) □ □ □
Not PEP/RPEP □ □ □

Signatures
Holder Signature 1. 1ST 2. 2ND RD
3. 3
Page 4/9

Declaration and Signature:

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I/We am/are in the process of registering as a client with JM Financial Services Ltd. (“JMFS”) for availing a Mutual Fund transaction
initiation facility through BSE StAR Mutual Fund Distributors platform provided by BSE Ltd (“BSE”) and NMF II provided by National
Stock Exchange of India Ltd (“NSE”) (hereinafter the said exchange platforms are referred as “MFD platform”). In this regards, I/we
hereby agree and undertake as follows:

a. I/We am/are aware that MFD platform is a transaction initiation platform provided by BSE and NSE (“the Stock Exchanges”)
for undertaking online MF transaction and I/we shall be able to place the subscriptions/redemptions request only in those
Mutual Funds schemes which are made available by the Stock Exchanges on its MFD platform.
b. I/We understand that once JMFS or any of the sub-distributor having ARN and registered with JMFS (“IFD”) enters the
transactions request details on MFD platform, I/we shall receive SMS/E-mail containing my/our transaction request details
from the Stock Exchanges/JMFS on my/our e-mail Id/mobile number which is registered with JMFS/Exchanges. I/We hereby
confirm that I/we shall always keep my/our mobile number/e-mail Id active, failing which if any of my/our transaction request
is rejected then I/we shall not held JMFS and/or its IFD responsible for the same and shall not claim any losses, either actual
or notional, from them.
c. In case of any change in my/our registered e-mail Id/mobile number, I/we shall immediately update the same with JMFS,
failing which if any of my/our transaction request could not be executed then I/we shall not held JMFS and/or its IFD
responsible for the same and shall not claim any losses, either actual or notional, from them. I/We understand that change
of my/our mobile number/e-mail Id would be updated in JMFS/Stock Exchange records within 7 days of submitting the
modification request to JMFS/IFD.
d. In case if I/we do not act or give confirmation for the transaction request initiated on behalf of me/us by JMFS/IFD on MFD
platform within cut off time defined by the Stock Exchanges, I/we am/are aware that the said transaction request will get
rejected and I/we hereby confirm that I/we shall not claim any consequential loss from JMFS/IFD.
e. I/We am/are aware about the cut off timelines as prescribed by the Exchanges for NAV applicability and my/our units shall
be valued accordingly.
f. I/We am/are aware that transaction confirmation and unit allotment is done by AMCs/Registrars of AMCs and JMFS/IFD does
not have any role/responsibility in this regards.
g. I/We am/are aware that transactions request placed by me/us may not get executed since it depends over many uncertain
factors which are not within the control of JMFS and involves the hardware, software, systems, communication lines,
peripherals, etc. which are susceptible to interruptions and dislocations. JMFS do not make any representation or warranty
that the MFD platform will be available at all times without any interruption.
h. I/We shall always ascertain my/our holding/balance units from the account statements provided by the respective AMCs or
their Registrars before placing redemption/switch out requests.
i. I/We agree that JMFS can show the full unit holding of all my/our folios to the IFD under whom I/we am/are getting registered
for the MFD platform
j. I/We agree that in case of redemption of the demated units, I/we shall provide the delivery instruction slip (DIS) to my/our
Depository Participant within the time prescribed as defined by the Depositories/Stock Exchanges.
k. While JMFS may on best effort basis provide the number of units held in my/our existing folios, the said units cannot be
claimed by me/us to be accurate due to JMFS’s dependency of data provided by Registrars of AMCs.
l. I/We shall ensure that in case of subscriptions of units sufficient funds is available in my/our bank account. In case of non-
availability of funds in my/our bank account the transaction will get rejected. I/We am/are also aware that the units shall be
allotted to me/us only when funds have been received by the Stock Exchanges within the cut-off time of pay-in as defined by
SEBI/ Stock Exchanges in this regard.
m. I/We may use National Automated Clearing House (“NACH”) facility by duly signing the NACH mandate authorizing “BSE
Limited” and its authorised service providers to debit my/our bank account for the purpose of collecting funds for transactions
on MFD platform.
n. I/We am/are aware that in case of SIP transactions registered through MFD platform, I/we may not receive any intimation
on or before Due Date of the said SIP from the Stock Exchanges/JMFS/IFD. I/We shall ensure that there will be sufficient fund
available in my/our bank account on the due date of the said SIP.
o. I/We shall ensure compliance with the requirements as may be specified from time to time by Securities and Exchange Board
of India (SEBI), Association of Mutual Funds of India (AMFI), Stock Exchanges and Government authorities with regards
my/our transactions through MFD platform and investments in units of Mutual Fund. I/We shall also abide by the terms and
conditions as may be specified by the Stock Exchanges/ JMFS from time to time in this regard.

ST
Signature
Holder Signature 1. 1 2. 2ND 3. 3RD Page 5/9

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 p. My/Our transactions on MFD platform shall not be construed as a recommendation or solicitation of any
scheme/product/business by JMFS.
q. I/We shall notify JMFS in writing if there is any change in the information in the 'Client Registration Form' and FATCA
declaration provided by me/us to JMFS at the time of registering me/us as a client for MFD platform or at any time thereafter.
r. I/We shall read and understand the contents of the Scheme Information Document and Key Information Memorandum,
addenda issued regarding each Mutual Fund Schemes which I/we choose to subscribe.
s. I/We have read and understood the risks involved in investing in Mutual Fund Schemes.
t. I/We shall be wholly responsible for all my/our investment decisions and instruction.
u. I/we hereby give my/our consent to receive product information, scheme details, marketing materials, transaction details
etc. from JMFS on my/our registered email id and mobile number.
v. I/We shall pay to JMFS fees as mutually agreed by and between me/us and JMFS and statutory levies as are prevailing from
time to time and applicable to my/our transactions and to the services that JMFS renders to me/us.
w. I/We confirm that I/we am/are not a resident of the United States of America/Canada or a resident of any jurisdiction, the
laws of which imposes prohibition on soliciting the securities business in that jurisdiction without going through the
registration requirements and/or prohibit the use of any information contained in MFD platform.
x. I/We am/are not disqualified/debarred under any Rules, Regulations, Bye-Laws of the Stock Exchange/SEBI and all such Acts
and Laws for the time being in force in India to deal in Securities.
y. I/We am/are aware about the risk involved in the investment in capital market and I/We shall take an informed decision in
accordance with my/our risk appetite, investment objectives etc.
z. The ARN holder (IFD) has disclosed to me/us all the commission (In the form of trail commission or any other mode), payable
to him for the different competing Schemes of various Mutual Fund from amongst which the scheme is being recommended
to me/us.
aa. I/We hereby give my/our consent to update my/our Gross Annual Income/Net worth as disclosed herein above in my/our
account maintained with you.
bb. I/We confirm that details provided by me/us are true and correct

Signatures
Holder Signature 1. 1ST ND
2.2 3RD3.

Date: Place:
Note
1) PEP are 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.

2) Please note this is not a KRA Form. If the address mentioned here is different from your KRA details then the same will be
captured and will be used for all future correspondence for the transactions processed on this platform. If you wish to modify
the same in your KRA details please provide us the duly filled KRA Modification form along with all the necessary documents
to modify the KRA details
3) Communication mode: Mobile and email
4) Div Payout Mode- Direct Credit Only
5) Tax Status: Individual, On behalf of minor, Company, AOP, Partnership firm, Trust, DFI, NRI(NRE), NRI(NRO), LLP
6) For BSE Cheque should be drawn in favor of “Indian Clearing Corporation Ltd”
7) Document check list : List of documents to be attached with the Account Opening Form.
For Individuals

1. Pan Card Copy

2. KYC/KRA Acknowledgement Copy
3. Cancelled Cheque copy
4. AADHAAR copy and FATCA (for INDVIDUAL)
5. Annexure of Folio Declaration for existing investors

Page 6/9

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 FATCA & CRS INFORMATION (for Individual including Sole Proprietor) (Self Certification)

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.

First/Sole Holder /Guardian Second Holder Third Holder

DEEPAK KAPUR
Name:

Place of Birth:
indore

Country of Birth:
INDIA

Nationality:
indian

Do you satisfy any of the criteria mentioned below:

a. Citizen of any country other
than India (including □ Yes □ No □ Yes □ No □ Yes □ No
Dual/Multiple/ Holding
Green Card)?
b. Tax Resident of ANY
country/ies other than □ Yes □ No □ Yes □ No □ Yes □ No
India?
c. POA or mandate holder
who has an address outside □ Yes □ No □ Yes □ No □ Yes □ No
IsPOAOutsideIndia3No
India
If answer to the question “b” above is “Yes”, please provide the following information [mandatory], else
directly go to declaration & acknowledgement.
Please indicate all countries in which you are resident for tax purposes and the associated Tax Reference
Numbers below:
Country of Tax Residency 1

Tax Payer Ref. ID No. 1

Identification Type 1
(TIN or other, please specify)
Country of Tax Residency 2

Tax Payer Ref. ID No. 2

Identification Type 2
(TIN or other, please specify)

Signatures 1st 1.
Holder : _________________ 2nd2.
Holder :____________________3rd3.
Holder :___________________

Page 7/9
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 Folio Declaration for MFD

To

JM Financial Services Ltd.

Mumbai

I request you to map the below mentioned Folios to my/our UCC (Unique Client Code) for transacting in MFD platform
of BSE.

Care : Holding pattern: The holding pattern of the below folios must be the same as in the Account Opening Form. For
every different holding pattern, there must be separate Account Opening Form and Folio declaration.
DEEPAK KAPUR AIAPK7900R
1st holder Name : _____________________________________________ PAN ___________________

2nd Holder Name: _____________________________________________ PAN ___________________

3rd Holder Name: _____________________________________________ PAN ___________________

Sr no AMC Scheme Name with plan and option Folio no

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
(Add extra sheet if required)

Holder Signature 1ST 2ND 3RD Page 8/9

Signatures 1. 2. 3.

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NACH/ECS/AUTO DEBIT UMRN Date 17
D D 7M M 2024
Y Y Y Y
MANDATE INSTRUCTION FORM
Tick ( ) Sponsor Bank Code Utility Code
CREATE
I/We hereby authorize BSE Limited to debit (tick ) SB/CA/CC/SB-NRE/SB-NRO/Other
MODIFY
CANCEL Bank a/c number 657301417211
with Bank ICICI BANK LIMITED IFSC ICIC0002370 or MICR 452229019
an amount of Rupees One Lac R 100000
FREQUENCY x Mthly x Qtly x H-Yrly x Yrly As & when presented DEBIT TYPE x Fixed Amount Maximum Amount

Reference 1 (Mandate Reference No.) Phone No. 8821845160

Reference 2 (Unique Client Code-UCC) Email ID [email protected]
I agree for the debit of mandate processing charges by the bank whom I am authorizing to debit my account as per latest schedule of charges of the bank.
PERIOD
From 17/07/2024
D D M M Y Y Y Y
To D D M M Y Y Y Y x x x
Or Until Cancelled DEEPAK KAPUR
1. 2. 3.
- This is to confirm that the declaration has been carefully read, understood & made by me/us. I am authorizing the user entity/ Corporate to debit my account, based on the instructions as agreed and signed by me.
- I have understood that I am authorised to cancel/amend this mandate by appropriately communicating the cancellation / amendment request to the User entity / Corporate or the bank where I have authorized the debit.

NOTE : Name and Signature should be as per Bank Records

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