Distributor / RIA / PMRN Name and ARN / Code

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.

(As per PAN) (Refer Instructions)

(As per PAN) (Refer Instructions)

NRI Investors should mention their Overseas address (Refer instructions).

2nd Applicant Name

(As per PAN) (Refer Instructions)

3rd Applicant Name

(As per PAN) (Refer Instructions)
 Relationship If Nominee is a Minor*
Nominee Name/s & PAN with Allocation Nominee
Date of (%) Signature
applicant Guardian Name & PAN Birth
1
2
3
Address *In case of each Minor as Nominee, please mention Total 100%
Guardian’s relationship with Minor as Mother / Father /
Legal Guardian & Attach proof like Birth Certificate / School Leaving Certificate
/ Passport / Others.
*Please attach proof of date of birth of minor like Birth Certificate, School Leaving Certificate, Passport etc.

Contact Center: 1800-208-4499 / 1800-200-4499

Name/s mentioned are as per PAN only
Address, Email ID/Mobile are correctly mentioned.
Debit Mandate Checklist: SIP Registration Checklist:
● Distributor code & details, if any, ● Distributor code & details, if any,
● Bank Account Number, Bank Name, IFSC or MICR Code ● Name, Folio No. / Application No.
● Amount in words AND in Figures, as you would in a cheque ● Scheme/s details
(your maximum limit) ● Date, Other details
● Your NAME and SIGNATURE as in your bank account ● Signature/s

Distributor / RIA / PMRN Name and ARN / Code Sub Broker ARN & Name Sub Broker/Branch/ EUIN (Refer note below) For Office use only
RM Internal Code

The following Mandate needs to be submitted only once for registration with or without SIP form. Once the mandate is registered, investor need not submit mandate again and can do lump sum investments,
start new SIP registrations, using Physical Forms, Call, SMS or Online.

OTM Debit Mandate Form NACH/DIRECT DEBIT Date D D M M Y Y Y Y

[Applicable for Lumpsum Additional Purchases as well as SIP Registrations]

UMRN Office use only

Tick()
CREATE Sponsor Bank Code Office use only Utility Code Office use only

MODIFY I/We hereby authorize: DSP MUTUAL FUND Schemes to debit (tick) SB / CA / CC / SB-NRE / SB-NRO / Other
CANCEL
Bank A/c No.:
With
Bank Name & Branch IFSC OR MICR
Bank:
an amount of Rupees In Words ` In Figures
FREQUENCY  Mthly  Qtly  H. Yrly  Yrly  As & when presented DEBIT TYPE  Fixed Amount  Maximum Amount
Reference 1 Folio No: Mobile

Reference 2 Appln No: Email id

I agree for the debit of mandate processing charges by the bank whom I am authorising to debit my account as per latest schedule of charges of the bank.
PERIOD
From D D M M Y Y Y Y
1. 2. 3.
to D D M M Y Y Y Y Signature of Account Holder Signature of Account Holder Signature of Account Holder
or  Until Cancelled 1. 2. 3.
Name of Account Holder Name of Account Holder Name of Account Holder
Declaration: This is to confirm that the declaration has been carefully read, understood and made by me/us. I/We have understood that I/we are authorised to cancel/amend this mandate by appropriately communicating the
cancellation/amendment request to the User entity or the bank where I have authorised the debit and express my willingness and authorize to make payments through participation in NACH/Direct Debit/Standing Instructions. I/We
hereby confirm adherence to the terms of OTM Facility and as amended from time to time and of NACH/(Debits)/Direct Debits /Standing Instructions. Authorisation to Bank: This is to inform that I/We have registered for NACH (Debit
Clearing) / Direct Debit / Standing instructions facility and that my/our payment towards my/our investment in DSP Mutual Fund shall be made from my/our above mentioned bank account with your Bank. I/We authorize the represent-
atives of DSP Mutual Fund carrying this mandate form to get it verified and executed. Please attach a cancelled cheque/cheque copy

SIP Registration/Renewal Form (for OTM registered investors only)

Please tick  as applicable:
Attention: No need to attach OTM Debit Mandate again, if already registered earlier.
 OTM Debit Mandate is already registered in the folio. [No need to submit again].  OTM Debit Mandate is attached and to be registered in the folio.
Distributor / RIA / PMRN Name and ARN / Code Sub Broker ARN & Name Sub Broker/Branch/RM Internal Code EUIN (Refer note below) For Office use only

I/We confirm that the EUIN box is intentionally left blank by me/us as this is an “execution-only”transaction without any interaction or advice by the distributor personnel concerned. Upfront Sole / FirstApplicant's
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. Signature Mandatory

Investor Name: Existing Investor

Folio No./Application No.

Sr. Scheme/Plan/Option/Sub-option SIP Installment SIP Date Start Month/Year Top-Up (Minimum ` 500 or in Percentage %)
Frequency
No. (Mention Cheque details, if attached) Amount (`) (1st* to 31st) End Month/Year# Amount (`) or Percentage %) Frequency
From M M Y Y Y Y
1. DSP - Monthly* ` OR % Yearly*
D D Quarterly For Perpetual 10 yrs 7 yrs 5 yrs Half-yearly

Or till M M Y Y Y Y Top-Up CAP*:

2. DSP - Monthly* From M M Y Y Y Y

` OR % Yearly*
D D Quarterly For Perpetual 10 yrs 7 yrs 5 yrs
Half-yearly

Or till M M Y Y Y Y Top-Up CAP*:

3. DSP - Monthly* From M M Y Y Y Y ` % Yearly*

D D Quarterly For Perpetual 10 yrs 7 yrs 5 yrs
OR
Half-yearly

Or till M Top-Up CAP*:

M Y Y Y Y

(*Default option/Date)
(#Default/Perpetual: 12/2099) Total
First SIP transactions via single cheque no. favouring ‘DSP Mutual Fund’ Dated D D M M Y Y Y Y

Debit Bank Details: Bank Name: A/C. No.:

Declaration: Having read, understood and agreed to the contents of OTM Facility, the Scheme Information Document, Statement of Additional Information, Key Information Memorandum, Instructions
and Addenda issued from time to time of the respective Scheme(s) of DSP Mutual Fund mentioned within, I hereby declare that the particulars given above are correct and express my willingness to
make payments towards SIP instalments referred above through participation in NACH/Direct Debit/Standing Instructions. The ARN holder, where applicable, has disclosed to me/us all the commissions
(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.
Signatures [as per Mutual Fund Records/Application]
x First
Unit
Holder’s
Second
Unit
Holder’s
Third
Unit
Holder’s
Signature Signature Signature
V6 01/OCT/2019

Acknowledgement DSP Mutual Fund ISC Stamp

Investor Name: Folio No/Application No.
DEBIT MANADATE FORM SIP FORM
Website : www.dspim.com | E-mail : service@dspim.com | Contact Centre : 1800-208-4499 / 1800-200-4499