ASSOCIATION OF MUTUAL FUNDS IN INDIA

FORM - A

APPLICATION FORM FOR RENEWAL OF ARN

(FOR INDIVIDUAL / CORPORATE EMPLOYEE ARN HOLDERS ONLY)
(NOTE: Please read the instructions given at the end of application form carefully before filling the form.)

PART A
1.6x1.8cm WXH Two color photograph

ARN NO

DATE OF VALIDITY OF ARN CARD

: D D M M Y Y Y Y

NAME

: FIRST NAME MIDDLE NAME LAST NAME

DATE OF BIRTH

: D D M M Y Y Y Y

SEX

F M
ADDRESS :

CITY

PIN CODE

TELEPHONE NUMBER (Residence)

TELEPHONE NUMBER (Office)

E-MAIL ID

PAN NO BANK DETAILS NAME OF THE BANK BRANCH AND ADDRESS

: : : :

A/C TYPE AND NUMBER CC/SB NO

: :

PART B
(To be filled in by corporate employee/Partner/Director holding ARN or behalf of company) NAME OF THE COPORATION: CATEGORY OF CORPORATION: PLEASE TICK WHICHEVER APPLICABLE
PUBLIC LTD TRUST PRIVATE LTD ANY OTHER BANK PARTNERSHIP FIRM PROPRITORSHIP FIRM

Please Specify:

PERIOD OF SERVICE / ASSOCIATION WITH THE CORPORATION:

PART C
(To be filled in by Individual Distributors) NAME/S OF MUTUAL FUNDS WITH WHOM EMPANELLED: 1) 2) I I I I I NO.OF INVESTORS SERVICED:

PART D
2

PAYMENT DETAILS DD NO DATE AMOUNT DRAWN ON : : : :

UNDERTAKING
I, hereby apply for renewal of ARN with Association of Mutual Funds in India (AMFI), which has been allotted to me by AMFI solely for the purpose to enable me to canvass sale of products of Mutual Funds. I hereby undertake to attend Refresher Course offered by AMFI or reappear and pass the AMFI Certification Test within a period of six months from the date of renewal of ARN and produce to AMFI a copy of certificate duly attested by AMC/ Mutual Fund to that effect within a month of attending such a course or passing the test. I hereby confirm that I am canvassing business for selling products of Mutual Funds in accordance with the Code of Conduct and Guidelines prescribed by SEBI and AMFI respectively and shall continue to follow the same including any Rules and Regulations that may be framed or amended by SEBI and AMFI from time to time. I undertake that any breach of Guidelines and Code of Conduct or any Rules and Regulations framed by SEBI and AMFI will render my registration liable to be cancelled.

DATE: PLACE: *ATTESTED BY NAME OF THE AUTHORISED SIGNATORY: DESIGNATION:

(SIGNATURE OF THE APPLICANT)

SIGNATURE WITH COMPANY SEAL * NOTE: Signature of the applicant who is corporate employee to be attested by authorized signatory of the corporate and corporate seal to be affixed against the same.

INSTRUCTIONS
Form should be completed in all respects. None of the column should be left blank. Incomplete form shall be liable for rejection.

The prescribed fees of Rs. 2500/- be paid only by a Demand Draft (DD) in favor of ASSOCIATION OF
MUTUAL FUNDS IN INDIA payable at the place of CAMS center at which form is submitted. List of CAMS centers is attached. You may submit the form at center convenient to you.

Application form can also be submitted to AMFI at Mumbai at the following address alongwith Demand Draft
of Rs. 2500/- favoring ASSOCIATION OF MUTUAL FUNDS IN INDIA PAYABLE AT Mumbai. ASSOCIATION OF MUTUAL FUNDS IN INDIA ONE INDIABULLS CENTER, TOWER 2, WING B, 701, 7TH FLOOR, 841 SENAPATI BAPAT MARG, ELPHINSTONE ROAD, MUMBAI - 400 013 Two-stamp size colored photographs should be send alongwith the form. Please send your application well in advance before due date for renewal.

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ACKNOWLEDGEMENT
Received Registration form from (Mr./Ms. ) ____________________________________ along with a Demand Draft No. _______________ for Rs. ___________________ (Rs. __________________________________________) Drawn on (Bank & Branch) ______________________________________________dated ___________________ being Fees for Registration with AMFI.

(SIGNATURE OF THE RECEIVER)