scripbox Investor Application Formscripbox.com ARN-84967

Investor NameTanu Dubey

Date of birthMar 30, 1990

PANAXKPD5559L

NationalityIndia

Resident StatusResident Indian(Individual)

MinorNO

Guardian Name Relationship Guardian PAN

Correspondence Address91 Dalchand, Pilibhit, 262001, Uttar Pradesh

Overseas Address Telephone+91 8056004101

Gross Annual Income5-10 Lac

OccupationPrivate Sector Service

Politically Exposed PersonNo

Related to a Politically Exposed PersonNo

Bank NameHDFC Bank Ltd

Branch NameAsansol

Account No.03241140010571

Account TypeSavings Account

IFSC CodeHDFC0000324

Nominee NameAnunay Dubey

RelationshipBrother

Date of birthJul 10, 1981

Address91 Dalchand , Pilibhit, Uttar Pradesh, 262001

Date of online applicationSep 1, 2015

PlacePilibhit

Sign here

........................................... Tanu Dubey

Documents for Tanu Dubey

Application Form (Signed on both pages) Bank Mandate (Signed) Cheque Leaf (Cancelled Original) PAN Card Copy (Signed Photocopy)

PLEASE PRINT, SIGN AND SEND THIS FORM TO THE ADDRESS AT THE BOTTOM OF THE PAGE

INVESTOR ID 145636 Email tanudubey20@gmail.com Application No. 145636A02

INVESTOR DETAILS

BANK DETAILS

NOMINEE DETAILS Nomination not required

DECLARATIONS

I confirm that the above details are true and correct. I am responsible for keeping the above information current and accurate. I confirmthat I am 18 years of age or older and, where I am acting as a Guardian, I have the necessary authority to execute this document andoperate the investment account on behalf of the minor.

I have understood, and agree to abide by the terms of the Investment Services Agreement appended to this Application Form. (Page 2)

I authorise Scripbox.com India Private Limited ("Scripbox") and/or its authorised service provider(s) to - execute the ECS/NACH/Direct Debit mandate enclosed with this application form (Page 3), subsequent ECS/Direct debit instructionsrelated to my investments and electronic money transfer instructions through online payment gateway(s).- carry out all mutual fund subscription/ redemption/ non-financial instructions ("Instructions") which I provide through the websitehttps://scripbox.com ("Website") using the Email and Password then associated with my Investment Account ("Login Credentials").- communicate with the AMC on my behalf for financial and non-financial transactions and to receive details of my investment from theAMC.

Documents Checklist

scripbox.com India Private Limited#128/8, #32, Golden Tower, 7th Floor, Kodihalli, Old Airport Road, Bangalore-560017, India.

To have your form collected, please call 1800-200-1265

scripbox.com India Private Limited#128/8, #32, Golden Tower, 7th Floor, Kodihalli, Old Airport Road, Bangalore-560017,India.

To have your form collected, please call 1800-200-1265

Sign here

................................................... Tanu Dubey

INVESTMENT SERVICES AGREEMENT

A. I acknowledge that:1. I have applied for an Investment Account after understanding the nature and scope of services ("Services") provided by Scripbox.2. This document is a legal contract between Scripbox and me ("Agreement").3. The operation of my investment account and the execution of Instructions are subject to this Agreement, and the Offer Documents* of the respective

Asset Management Company ("AMC").4. My identity on the Website is authenticated by the use of my Login Credentials. Scripbox will consider Instructions authenticated by my Login

Credentials to have originated from me.5. I have the right to transact directly with the AMC even in respect of the investments made through Scripbox.

B. Under this Agreement, Scripbox's obligations are to provide Services as below:1. Offer scientifically selected mutual fund schemes.2. Facilitate subscription and redemption of mutual fund units by transmitting my money and Instructions to the appropriate AMC, as per my Instructions.3. Securely and confidentially maintain a record of my personal information and my financial transactions.4. Promptly & efficiently respond to my queries relating to my online investment account.

C. Under this Agreement, my obligations are to:1. Ensure that the money I invest is from my bank account (primary holder's bank account in case of Investment Account held jointly), is from legitimate

sources and is remitted through approved banking channels.2. Keep my Login Credentials safe and secret. Promptly change my Login Credentials and inform Scripbox of any actual or suspected unauthorised use of

my Login Credentials.3. Make an informed investment decision by reading the Offer Documents* of the mutual fund schemes that I am investing in.4. Seek independent financial planning, legal, accounting, tax or other professional advice before investing or withdrawing.

D. I further acknowledge and agree to the following:1. I am aware that Scripbox is an AMFI registered distributor of mutual funds and receives commissions from AMCs, details of which are available on the

Website.2. My Investment Account will be activated after Scripbox verifies my personal information in accordance with the Know Your Client ("KYC") guidelines

issued by the Securities and Exchange Board of India ("SEBI").3. Scripbox does not, and is not obliged to, offer all mutual fund schemes for investment. By limiting the number of schemes on the Website, Scripbox does

not make any representation as to the quality, bona fides or nature of any AMC or mutual fund scheme, or any other representation, warranty orguaranty, express or implied.

4. For investments using ECS/NACH/ Direct Debit, Scripbox will first submit the fund transfer instruction(s) to my bank. My request for subscription will besent to the AMC only after receiving confirmation of successful money transfer to the AMC's account. Consequently, there may be a lag between thedate of debit to my account and date Scripbox submits my request to the AMC.

5. Subject to point no. D.4, my Instructions will be processed the same day if received before the cut-off time(s) specified by Scripbox. Else, my Instructionswill be processed on the next business day. Scripbox may specify cut-off time(s) earlier than the time(s) specified by the AMC/ SEBI.

6. Scripbox will forward my Instructions to the AMC electronically and the AMC will process the transactions on the basis of such electronic instructions.AMCs are not obliged to accept my application for subscription to units of their mutual fund schemes in part or in full.

7. For Investment Accounts held jointly, the mutual fund folios maintained by the concerned AMC will also be held jointly and all the individuals will havethe same authority to operate those folios (Any or Survivor).

8. The data and information provided on the Website does not constitute advice and shall not be relied upon by me while making investment decisions.9. In case I violate this agreement, or any local or international laws, Scripbox may, at any time and at its sole discretion, terminate my Investment Account

and/or prevent me from accessing the Website and/or Services at any time and at its sole discretion.10. Scripbox may modify these terms at any time by informing me. My continued use of the Services will imply my acceptance of the changes.

E. I will not dispute and/or hold Scripbox responsible for:1. Any act that is not an obligation of Scripbox in this Agreement.2. Any disclosures made by Scripbox to any statutory body under any law.3. Any loss, notional or otherwise, incurred because of

a. delays either at the Bank, Registrar and Transfer Agency or AMC.b. rejection of my instructions by the Bank, Registrar and Transfer Agency or AMC.c. processing of Instructions authenticated by my Login Credentialsd. non-availability or non-accessibility of the Website, telephone(s), or office(s) of Scripbox in case of circumstances beyond Scripbox's control.

F. Governing lawsThe laws of India govern this Agreement. All disputes are subject, firstly, to mediation, and then by Arbitration by a sole arbitrator appointed by Scripbox.The venue of arbitration will be Bangalore.G. SEBI CautionMutual Fund investments are subject to market risks, read all scheme-related documents carefully.* Offer Documents: Collective term for Offer Document, Scheme Information Document, Statement of Additional Information, Key Information Memorandum,issued by the Asset Management Company that manages the mutual fund.

ONE TIME BANK MANDATE(NACH / ECS / Direct Debit Mandate Form)

(Applicable for Lumpsum Additional Purchases as well as SIP Registration)

scripbox.com India Private Limited

Tick ( )

createModifyCancel

Date 0 1 0 9 2 0 1 5UMRN

Sponsor Bank Code Utility Code

I/We hereby authorize scripbox.com India Pvt ltd to debit (tick ) SB CA CC SB-NRE SB-NRO Other

Bank A/c no: 0 3 2 4 1 1 4 0 0 1 0 5 7 1

PERIODFrom : 0 1 0 9 2 0 1 5

To :OR : Until Cancelled

1 2 3Signature of Account Holder Signature of Account Holder Signature of Account Holder

1 Tanu Dubey 2 3Name as in bank records Name as in bank records Name as in bank records

BANK MANDATE

This Mandate is required to automate the process of investing for you.It is an authorisation from you to your bank to transfer funds from your bank account to the bank account of the appropriate Mutual FundCompany.

With Bank HDFC Bank Ltd IFSC H D F C 0 0 0 0 3 2 4 or MICR 7 1 3 2 4 0 0 0 3

an amount of Rupees FIFTY THOUSAND ONLY 50000

FREQUENCY: Mtly Qtly H-Yrly Yrly As & when presented DEBIT TYPE Fixed Amount Maximum Amount

Reference 1: 145636 Email ID: tanudubey20@gmail.com

Reference 2: Phone No: 918056004101

FEW COMMON QUESTIONS RELATING TO THE BANK MANDATE:

I only want to invest Rs 20,000. Why is the amount 50000 in the mandate above?This is the maximum amount and not the specific investment you are planning at this time. This mechanism allows you to make multipleinvestments (either lump sum or SIP) without registering a separate bank mandate for each investment.

For example: You may want to make a Rs 50,000/- investment when you get your bonus or increase the amount of SIP as your salary increases.If we have a fixed amount mandate, you will need to print, sign and send another mandate to us with every new investment. The upper limit of50000 has been decided based on the investing behaviour of a typical investor.

The amount transferred from your bank account is based on the amount you choose to invest.

When will money be transferred?Money will be transferred as and when you place an investment instruction online by logging into Scripbox.com. This completely depends on you.Sending your mandate now will only set up the account and make it ready for when you want to invest.

Does the money go to the bank account of Scripbox?No. The money does not go to the bank account of Scripbox. It goes from your bank account to the mutual fund company via an RBI approvedpayment service provider.This is also as per SEBI regulations.

Can I revoke this mandate when I want?Yes. You can do so at any time by contacting your bank directly.

If you have any other questions, please call us on 1800-200-1265

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Know Your Client (KYC)Application Form (For Individuals Only)

Please fill in E NG L I S H and in BLOCK L E TTE RS with black ink

Application No :

C. Date of Birth 3 0 / 0 3 / 1 9 9 0

d d / m m / y y y y

d d / m m / y y y y

DECLARATIONI hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief and I undertake toinform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading ormisrepresenting, I am/we are aware that I/we may be held liable for it.

Place: Pilibhit Date: Sep 1, 2015

SIGNATURE OF APPLICANT

d d / m m / y y y yFOR OFFICE USE ONLY IPV Done on

A MC/Intermediary name OR code

(Originals Verified) Self Certified Document copies received

(Attested) True copies of documents received Main Intermediary

Seal/Stamp of the intermediary should contain Staff NameDesignation

Name of the OrganizationSignature

Date

Seal/Stamp of the intermediary should contain Staff NameDesignation

Name of the OrganizationSignature

Date

A. Identity Details (please see guidelines overleaf)

1. Name of Applicant (As appearing in supporting identification document).Name T A N U D U B E Y

Father's/Spouse Name R A M R A S I K D U B E Y

2. G ender Male Female B.Marital status Single Married

3. Nationality Indian Other Please Specify

4. Status Please tick ( √ ) Resident Individual Non Resident Foriegn National (Passport Copy Mandatory for NR Is & Foriegn Nationals)

5. PAN A X K P D 5 5 5 9 L Please enclose a duly attested copy of your PA N Card

Unique Identification Number (U I D)/Aadhaar, if any: Paste photo and sign across6. P roof of Identity submitted for PAN exempt cases Please tick ( √ )

UID (Aadhaar) Passport Voter ID Driving Licence Others (Please see guidelines overleaf

B. Address Details (please see guidelines overleaf)

1. Address for Correspondence

9 1 D A L C H A N D

C ity/Town/Village P I L I B H I T P in C ode 2 6 2 0 0 1State U T T A R P R A D E S H C ountry I N D I A

2. Contact Details

Tel.(Off.) (ISD) (STD) Tel.(Res.) (ISD) (STD)

Mobile (ISD) (STD) 8 0 5 6 0 0 4 1 0 1 Fax (ISD) (STD)

E-MailId. T A N U D U B E Y 2 0 @ G M A I L . C O M

3. Proof of address to be provided by Applicant. Please submit A NY ONE of the following valid documents & tick(√) against the document attached.

Passport Ration Card Registered Lease/Sale Agreement of Residence Driving License Voter Identity Card *Latest Bank A/c Statement/Passbook

*Latest Telephone Bill (only Land Line) *Latest Electricity Bill *Latest Gas Bill Others (Please Specify)

* Not more than 3 Months old. Validity/Expiry date of proof of address submitted

4. Permanent Address of Resident Applicant if different from above B1 OR Overseas Address (Mandatory) for Non-Resident Applicant

C ity/Town/Village P in C ode

State C ountry

5. Proof of address to be provided by Applicant. Please submit A NY ONE of the following valid documents & tick(√) against the document attached.

Passport Ration Card Registered Lease/Sale Agreement of Residence Driving License Voter Identity Card *Latest Bank A/c Statement/Passbook

*Latest Telephone Bill (only Land Line) *Latest Electricity Bill *Latest Gas Bill Others (Please Specify)

* Not more than 3 Months old. Validity/Expiry date of proof of address submitted

6. Any other information:

1. Self attested copy of PAN card is mandatory for all clients.

2. Copies of all the documents submitted by the applicant should be self-attested and accompanied by originals for verification. In case theoriginal of any document is not produced for verification, then thecopies should be properly attested by entities authorized for attestingthe documents, as per the below mentioned list.

3. If any proof of identity or address is in a foreign language, thentranslation into English is required.

4. Name & address of the applicant mentioned on the KYC form, shouldmatch with the documentary proof submitted.

5. If correspondence & permanent address are different, then proofs forboth have to be submitted.

6. Sole proprietor must make the application in his individual name &capacity.

7. For non-residents and foreign nationals, (allowed to trade subject toRBI and FE MA guidelines), copy of passport/PIOCard/OCICard andoverseas address proof is mandatory.

8. For foreign entities, CIN is optional; and in the absence of D IN no. forthe directors, their passport copy should be given.

9. In case of Merchant Navy NRI's, Mariner's declaration or certified copyof CDC (Continuous Discharge Certificate) is to be submitted.

10. For opening an account with Depository participant or Mutual Fund,for a minor, photocopy of the School Leaving Certificate/Mark sheetissued by Higher Secondary Board/Passport of Minor/Birth Certificatemust be provided.

11. Politically Exposed Persons (PE P) are defined as individuals who are orhave been entrusted with prominent public functions in a foreigncountry, e.g., Heads of States or of Governments, senior politicians,senior Government/judicial/military officers, senior executives of stateowned corporations, important political party officials, etc.

1. PAN card with photograph. This is a mandatory requirement for allapplicants except those who are specifically exempt from obtainingPAN (listed in Section D).

2. Unique Identification Number (U ID) (Aadhaar) / Passport / Voter IDcard / Driving license.

3. Identity card/ document with applicant's Photo, issued by any of thefollowing: Central/State Government and its Departments,Statutory/Regulatory Authorities, Public Sector Undertakings,Scheduled Commercial Banks, Public Financial Institutions, Collegesaffiliated to Universities, Professional Bodies such as ICAI, ICWAI, ICS I,Bar Council etc., to their Members; and Credit cards/Debit cards issuedby Banks.

1. Passport/Voters Identity Card/Ration Card/Registered Lease or Sale

Agreement of Residence/Driving License/Flat Maintenancebill/Insurance Copy.

2. Utility bills like Telephone Bill (only land line), Electricity bill or Gasbill Not more than 3 months old.

3. Bank Account Statement/Passbook - Not more than 3 months old.

4. Self-declaration by High Court and Supreme Court judges, giving thenew address in respect of their own accounts.

5. Proof of address issued by any of the following: Bank Managers ofScheduled Commercial Banks/Scheduled Co-OperativeBank/Multinational Foreign Banks/Gazetted Officer/Notarypublic/Elected representatives to the LegislativeAssembly/Parliament/Documents issued by any Govt. or StatutoryAuthority.

6. Identity card/document with address, issued by any of the following:Central/State Government and its Departments, Statutory/RegulatoryAuthorities, Public Sector Undertakings, Scheduled Commercial Banks,Public Financial Institutions, Colleges affiliated to Universities andProfessional Bodies such as ICAI, ICWAI, ICS I, Bar Council etc.,to theirMembers.

7. For FII/sub account, Power of Attorney given by FII/sub-account tothe Custodians (which are duly notarized and/or apostiled orconsularised) that gives the registered address should be taken.

8. The proof of address in the name of the spouse may be accepted.

1. In case of transactions under taken on behalf of Central Governmentand/or State Government and by officials appointed by Courts e.g.Official liquidator, Court receiver etc.

2. Investors residing in the state of Sikkim.

3. UN entities/multilateral agencies exempt from paying taxes/filing taxreturns in India.

4. S IP of Mutual Funds upto Rs50,000/-p.a.

5. In case of institutional clients, namely, FI Is, Mfs, VCFs, FVCIs,Scheduled Commercial Banks, Multilateral and Bilateral DevelopmentFinancial Institutions, State Industrial Development Corporations,Insurance Companies registered with IRDA and Public FinancialInstitution as defined under section 4A of the Companies Act, 1956,Custodians shall verify the PAN card details with the original PAN cardand provide duly certified copies of such verified PAN details to theintermediary.

1. Notary Public, Gazetted Officer, Manager of a ScheduledCommercial/Co-operative Bank or Multinational Foreign Banks (Name,Designation & Seal should be affixed on the copy).

2. In case of NRIs, authorized officials of overseas branches of ScheduledCommercial Banks registered in India, Notary Public, Court Magistrate,Judge, Indian Embassy/Consulate General in the country where theclient resides are permitted to attest the documents.

INSTRUCTIONS / CHECK LIST FOR FILLING KYC FORM

Please Submit the KY C Documents on A4 Size Paper Only.

IMPORTAN T POIN TS:A.

Proof of Identity( POI): List of documents admissible as Proof ofIdentity:

B.

Proof of Address (POA): List of documents admissible as Proof ofAddress: (*Documents having an expiry date should be valid on thedate of submission.)

C.

Exemptions/clarifications to PAN (*Sufficient documentary evidence in support of such claims to becollected.)

D.

List of people authorized to attest the documents:E.