We thank you for investing in RELIANCE REGULAR SAVINGS FUND - EQUITY PLAN - GROWTH OPTION of Reliance Mutual Fund Please note that the units will be allotted based on the applicable NAV as per Offered Document / SEBI guidelines Allocation of units will be based on the Transaction Time captured during Online Transaction If the Online Transaction is done by Cheque mode - Allocation of units is done based on DateStamp time at the ISC you submit the application If Online transaction is done by Cheque Mode,You have to write the Inhouse number that is generated on the pdf file behind the Cheque that you submit along with the application form You have to submit your PAN proof for each and every mutual fund purchase In case Mode of holding is 'Joint' or 'Either or Survivor' please submit the PAN proof for the other unit holders also You also have to submit the PIN agreement, duly signed by all the unit holders along with your Application Form [the pdf file] to continue to do Online Transactions further You have to submit all these below mentioned documents [duly signed] to the nearest Investor Service Center for further processing with in 7 days from Online Submission Date Application Form [pdf format] Cheque with Inhouse Number written behind it PIN Agreement form PAN proof compulsory for every purchase transaction Please find the details of your Nearest IRC centers at the end of this document
Transacted directly through wwwreliancemutualcom Sale of Units at applicable NAV based price Inhouse No For Office Use 395345371 Market Status Mode of Payment : Online Payment Trade World, B Wing, 7th floor, Kamala Mills Compound, S B Marg, Lower Parel (W), Mumbai - 400 013 Broker / Agent Code Sub Broker / Sub Agent Code Online Submission Date Registrar Serial No 000000-0 09-Oct-2007, 16:11:37 APPLICANT DETAILS MODE OF HOLDING OCCUPATION STATUS (INDIVIDUAL) (Tick Whichever is applicable) Joint Single Any One Or Survivor Business Service Student Others Professional Retired House Wife 1st Applicant 2nd Applicant 3rd Applicant Minor Name of Sole / 1st Applicant/Minor/Karta of HUF/Non-individual Zinith Patel Name of Parent/ Guardian In case of Minor 24-Sep-1983 Name of 2nd Applicant Name of 3rd Applicant PAN (Mandatory for Investment of Rs50,000 & Above) 1st Applicant 2nd Applicant 3rd Applicant AQGPP8555P PAN Proof Attached OR PAN Proof Attached OR PAN Proof Attached OR Form 60 / 61 attached Form 60 / 61 attached Form 60 / 61 attached Unique Identification No CONTACT DETAILS Address 39, PARSHWANATH NAGAR,, NR MINI VIRPUR, PALAN PUR GAM ROAD, City SURAT State GUJARAT PIN 395009 Foreign Address of Applicants Address for Correspondence (for Applicants only) Indian Foreign City Country ZIP Telephone Number : Office 2772041 Residence 9825920380 Fax Mobile No 9833292737 E-mail Id patel_zinith@rediffmailcom (PTO) Acknolwdegement Slip Transacted directly through Inhouse No wwwreliancemutualcom 395345371 Sales of Units at applicable NAV based price Trade World, B Wing, 7th floor, Kamala Mills Compound, S B Marg, Lower Parel (W), Mumbai - 400 013 RELIANCE REGULAR SAVINGS FUND - EQUITY PLAN - GROWTH OPTION Received From: Zinith Patel Scheme Name Growth Plan Dividend Plan Growth Option Bonus Option Dividend Reinvestment Dividend Payout Rs Rs Rs Rs Amt In Rs Cheque / DD No Date Bank & Branch 200000 Amt In WordsRupees Two Thousand only, Signature & Stamp
Bank Name UNION BANK OF INDIA Branch Account No 369102010803003 Branch Address JUHU TARA ROAD, JUHU SANTACRUZ (W), MUMBAI PIN 400049 9 Digit MICR Code Scheme Name RELIANCE REGULAR SAVINGS FUND - EQUITY PLAN - GROWTH OPTION Growth Plan Dividend Plan Growth Option Bonus Option Dividend Reinvestment Dividend Payout Direct credit facility for payment of dividend / redemption presently available with HDFC Bank & ICICI Bank Amount Invested Rs DD Charges Rs Net Cheque / DD Amount Rs Cheque No Cheque Date 200000-2,00000 Drawn On Account Type Bank BANK ACCOUNT DETAILS Rs Rs Rs Rs Branch Resident : Non Repatriation basis : Repatriation basis SB CURRENT NRO FCNR NRE Foreign Inward remittance NRE FCNR Foreign Inward remittance E-MAIL OPTION I / We wish to receive the following through e-mail instead of physical document : Account Statement Quarterly Newsletter / Fact-sheets Annual Report Nominee's Name : MR BHARTIBEN R PATEL Guardian (In case of Minor Nominee) NOMINATION 12-Mar-62 Address of Nominee /Guardian 39, PARSHWANATH NAGAR,, NR MINI VIRPUR, PALAN PUR GAM ROAD City SURAT PIN 395009 DECLARATION & SIGNATURE/S I/We would like to invest in RELIANCE REGULAR SAVINGS FUND - EQUITY PLAN - GROWTH OPTION subject to terms of the Offer Document and subsequent amendments thereto I/We have read the instructions and the Offer Document before filling the Application Form I/We have understood the details of the scheme and I/We have not received nor been induced by any rebate or gifts, directly or indirectly, in making this investment APPLICABLE TO s ONLY: I/We confirm that I am/we are Non-Resident of Indian Nationality/Origin and I/We hereby confirm that the funds for subscription have been remitted from abroad through approved banking channels or from funds in my/our Non-Resident External / Ordinary Account/FCNR Account Place : Please ensure that: Date: Your Application Form is complete in all respect, Name, Address & contact details are mentioned in full, signed by all applicants Bank Account Details are entered completely and correctly Permanent Account Number (PAN) of all Applicants is mentioned if the investment amount is Rs50,000/- or more If PAN is not available, please attach Form 60 / 61 in duplicate, with requisite address proof The Cheque / DD is drawn in favour of RELIANCE REGULAR SAVINGS FUND - EQUITY PLAN - GROWTH OPTION dated and duly signed Appropriate Scheme Name, Plan & Option is mentioned clearly Application Number is mentioned on the reverse of the Cheque / DD Documents as listed alongside are submitted along with the Application (as applicable to your specific case) Sole/ 1st Applicant/ Guardian Authorised Signatory 2nd Applicant Authorised Signatory 3rd Applicant Authorised Signatory CHECKLIST SIGNATURE/S Documents Required 1 Resolution / Authorisation to invest 2 List of Authorised Signatories with Specimen Signatures(s) 3For applications for Rs 50,000 & above : - Proof of PAN or Form 60 / 61 alogwith Proof of Address Specimen Signature of Nominee/Minor Nominee's Gaurdian (OPTIONAL) INDIVIDUAL
Adyar Anu Arcade, No 1, 15th Cross Street, Shastri Nagar, Adyar, Chennai - 600020 Phone: 044-30983065 Email: varunnallur@reliancemutualcom Allahabad Rsa Towers, 2nd Floor, Above Sony Tv Showroom,, 57, S P Marg, Civil Lines,, Allahabad - 211001 Phone: 0532-3294281/80 Email: allahabadmfd@karvycom Annanagar Nr Dave Complex, 201, Old No C 34, 2nd Avenue, 11th Road, Annanagar, Chennai - 600040 Phone: 044-30982602 Email: AnantharamanSethu@reliancemutualcom Bankura Ambika Market Natunganj, Bankura - 722101 Phone: 3242255964 Fax: 0 Email: mfsbankura@karvycom Berhampur Ramlingam Tank Road,, Berhampur,, Berhampur - 760002 Phone: 09337798898 Bhilwara 215, 2nd Floor, Om Textile Tower, Pur Road, Bhilwara - 311001 Phone: 9352966007 Email: AASHISHTIWARI@RELIANCEMUTUALC OM Burdwan 63 G T Road, Halder Complex 1st Floor, Burdwan Distt, Burdwan - 713101 Phone: 0342 2550801,0840/0219 Email: mfsburdwan@karvycom Chennai Flat No F11, First Floor,, Akshya Plaza (erstwhile Harris Road),, Opp Chief City Metropolitan Court,#108, Adhithanar Salai, Eg, Chennai - 600002 Phone: 044-42028512 / 13 Fax: 044-42028514 Email: chennaimfd@karvycom Cuttack At Dargha Bazar, Po Buxibazar,, Opp Dargha Bazar Police Station,, Cuttack - 753001 Phone: 0671-2332680/81/3110827, 0671- Email: mfscuttack@karvycom Dharwad G7 & 8, Sri Banashankari Avenue, Ramnagara, Dharwad - 580001 Phone: 0836-2744207 - 8 Email: mfsdharwad@karvycom Faridabad A-2b, 1st Floor, nehru Ground,, Neelam Bata Road, Nit,, Faridabad - 121001 Phone: 0129-4024441, 42, 43 Fax: 0 Email: mfsfaridabad@karvycom Ghaziabad Rdc 16 Advocate Chambers, Rdc Raj Nagar, Ghaziabad - 201002 Email: ArunJain@reliancemutualcom INVESTOR SERVICE CENTERS Ahmedabad 201, Shail Buildings,opp: Madhusudhan Ho, Near Navrangpura Telephone Exchange, Off Cg Road, Ahmedabad - 380006 Phone: 079-26400527, 26400528 Fax: 079-269565551 Email: edward@karvycom Ambala 6349 Nicholson Road,, Adjecent Kos Hospital,, Ambala Cantt,, Ambala - 133001 Phone: 0171-2631324 /9315115772 Email: varun@karvycom Aurangabad Shop No : 214 / 215, Tapadiya City Centre, Nirala Bazar, Aurangabad - 431001 Phone: 0240-2363517 / 23/24 Baroda Piccadilly, Office # 5,, First Floor, Opp Adani Super Market,, Jetalpur Road,, Baroda - 390007 Phone: 0265-2225210 Email: rajanpatel@karvycom Bharuch F/135, Rangoli Complex, Station Road, Bharuch - 392001 Phone: 02642-242082 / 242394 / 2415 Email: mfsbharuch@karvycom Bhubhaneswar 624, Sahid Nagar, Bhubaneswar - 751007 Phone: 0674-547531 - 33 Fax: 0674-547532 / 33 Email: bhubaneswarmfd@karvycom Calicut First Floor, Savithri Building, Bank Road, Calicut - 673001 Phone: 0495-2760882 / 2760883 / 27608 Fax: 3520370 Cochin G 39, Panampally Nagar,, Kochi - 682036 Phone: (0484) 310884 / 322152 Fax: 0484 323104 Dehradun Shop No 16, First Floor, Swaraj Complex, 72 Rajpur Road, Dehradun - 248001 Phone: 0135-3259939 Fax: 0 Email: PriyankaBhasin@relianceadacom Dsfaasdfsdf Sdfsdfsdf, Sdfsdfs, Dfsdfsdf, Sdfsdf - 324324 Phone: 23423423432 Fax: 0 Gandhidham 14, 1st Floor, Komal Complex,, Plot No305, Sector 12b,near Shivaji Park,, Opp: Sbi Main Branch Atm, Gandhidham - 370201 Phone: 02836-228630 / 228640 Fax: 0 Email: mfsgandhidham@karvycom Guntur 6-10 - 18, 2nd Floor, 10/1, Arundelpet, Guntur - 522002 Phone: 0863-2326684 / 86 Email: mfsguntur@karvycom Aligarh Na, Na, Na, Aligarh - 0 Phone: 0 Fax: 0 Anand Opp: Union Bank Of India, My Fair Road, Anand - 388001 Phone: 02692-266220 / 266230 Bangalore No 51/25, 1 st Floor, Ratna Avenue, Richmond Road, Bangalore - 560025 Phone: 080-25320085 / 86 Fax: 080-25320086 Email: bangaloremfd@karvycom Begusarai Hotel Diamond Surbhi Complex, Near Ioc Township Gate, Kapasiya Chowk, Begusarai - 851117 Phone: 06243-243696, 06243-243551 Fax: 0 Email: mfsbegusarai@karvycom Bhavnagar 126 / 127 ;madhavdarshan, Waghwadi Road, Bhavnagar - 364001 Phone: 0278-2525005 / 06 /07 /08 /09 Email: mfsbhavnagar@karvycom Bokaro Karvy Computershare Private Limited, Kc-7, Secondfloor, Sector-4, City Centre, Bokaro Steel City - 827004 Phone: 06542-233330/ 31/ 32,98351004 Email: mfsbokaro@karvycom Chandigarh Sco - 127/ 128, First Floor, Sector 9/c, Chandigarh - 160009 Phone: 0172-3265582 Email: gauravvatsyayan@reliancemutualcom Coimbatore 575 C, Shyalaja Complex, D B Road, R S Puram, Coimbatore - 641002 Phone: 0422-3090029 - 30 Email: kiruthika@reliancemutualcom Delhi 212, Arunachal Building, 19, Barakhamba Road, Connaught Place, New Delhi - 110001 Phone: 011-23324401 / 23737194 / 51 Fax: 011-23730743 Email: delhimfd@karvycom Durgapur Dutta Automobile Building, 1st Floor, Benachity, Burdwan Dist, Durgapur - 700013 Phone: 0343-2586375 - 77 Email: mfsdurgapur@karvycom Ghatkopar Shop No12 A & B, Ground Floor, Kailas Plaza, Vallabh Baug Lane, Ghatkopar (east), Ghatkopar - 400075 Phone: 022-39434886 Email: varundsilva@reliancemutualcom
Gurgaon Karvy Computershare Private Limited, Sco- 18, 19 First Floor, Above Nirulas, Sector- 15, Old Delhi Road, Gurgaon - 122001 Phone: 0124-5083854 Email: mfsguragon@karvycom Hissar Sco 71,, Ist Floor,, Red Square Market, Hissar - 125001 Phone: 01662-225845/68/36/9315391419/ Email: ashwinigupta@karvycom Indore Karvy Computershare Private Limited, Dm Tower 105,106 & 107, Above Standered Chartered Bnk, Nr Jangeerwala Chowrah, Indore - 452001 Phone: 0731-3014204,3014205 Email: mfsindore@karvycom Jammu 20-c Ext, Gandhi Nagar, Jammu - 180004 Phone: 09323128413,09419669579 Jodhpur Reliance Web World, 26 Nai Sadak, Next Hotel Bruinternational, Jodhpur - 342001 Phone: 9314480215 Email: anuragshangari@reliancemutualcom Karaikudi Gopi Arcade, 100 Feet Road,, Karaikudi - 630001 Phone: 04565-237192 / 93, 98432 935 Email: mfskaraikudi@karvycom Kottayam 1st Floor, Csi Ascension Church Complex, Kottayam - 686001 Phone: 0481-2302420 / 21 Malda No 1, Govt Colony, Opp Ggb Head Office, Near Niit Center, Malda - 732101 Phone: 03512-223190, 193, 221342, 223 Fax: 0 Email: mfsmalda@karvycom Mumbai Express Building, 4th & 6th Floor, 14 - "e" - Road,, Above Satkar Hotel, Churchgate, Mumbai - 400020 Phone: 022-56386700 & 022-22854880 Fax: 022-22853702 Email: mumbai_service@reliancemutualcom Nagpur 5,galaxy Appt, Museum Road, Civil Lines, Nagpur - 440001 Phone: (0712) - 5656101-5656102-56561 Email: nagpurmfd@karvycom New Delhi Office No 405, Ashoka Estate, 4th Floor, 24 Barakhamba Road, New Delhi - 110001 Phone: 011-30915445, 30934114 Email: kavitaneogi@rilcom Patna Anand Towers, 2nd Floor, Exhibition Road, Near Republic Hotel, Opp: Mithila Motors, Patna - 800001 Phone: 0612-2321354 - 56 Fax: 0612-2222470 Email: mfspatna@karvycom Gwalior 37/38 Near Nadi Gate Pul, M L B Road Shinde Ki Chhawani, Lashkar, Gwalior - 474001 Email: gwaliormfd@karvycom Hubli Giriraja House, No 451/b, Ward No1, Club Road, Hubli - 580029 Phone: 0836-2353962, 2353974, 23539 Fax: 0836-2353961 Email: mfshubli@karvycom Jalgaon 1, Shresta Apartments, Balirampeth, Jalgaon - 425001 Phone: 0257-2226761 / 2227432/ 3090 Email: mfsjalgaon@karvycom Jamnagar Shop No 4-5, Shilp Building, Indira Gandhi Marg, Jamnagar - 361001 Phone: 0288-3090481, 2671234 Fax: 0288-2671234 Email: jamnagar@reliancemutualcom Jorhat New Medical Store Complex, 3rd Floor, A T Road, Opp Chowk Bazar, Jorhat - 785001 Phone: 0376-2301923, 09954076776 Kharagpur Malancha Road, Beside Uti Bank, Kharagpur - 721304 Phone: 03222-242512 Fax: 0 Email: mfskharagpur@karvycom Lucknow 94, Mahatma Gandhi Marg, Opp Governor House, Lucknow - 226001 Phone: 0522-236819 - 21, 236823-2 Fax: 0522-2236826 Email: rashi@karvycom Mathura 3538-3540,, Infront Of Bsa College, Gaushala Road, Mathura - 281004 Phone: 0565-2463172-74 Fax: 0 Email: mfsmathura@karvycom Mumbai 26/30,fort Foundation Bldg, Near Msc Bank, Maharashtra Chamber Of Comm Lane, Fort, Mumbai - 400023 Phone: 022-56341967 Fax: 022-56341966 Email: sandeep@karvycom Nasik G - 18, Ground Floor, Suyojit Sankul, Sharanpur Road, Nasik - 422002 Phone: 0253-3120474 Fax: 0731 2577811 Email: sapna_nasik@rediffmailcom Panipat Karvy Computershare Private Limited, 1st Floor, Krishna Tower, Above Amertex,gt Road, Panipat - 132103 Phone: 0180-3096760 / 3095517 Email: mfspanipat@karvycom Pondicherry First Floor, No7, Thiayagaraja Street, Pondicherry - 605001 Phone: 0413-2220636 / 33 / 40 / 44 Fax: 043-2220659 Email: mfspondy@karvycom Haldwani 4 - Durga City Center, 1st Floor,, Near Mb College, Nainital Road,, Haldwani - 263139 Phone: 05946-282635, 05946-284523 Fax: 0 Email: mfshaldwani@karvycom Hyderabad Lower Ground Floor, Unit No Lg3, Olbee Centre, 6-3-1090/a/24, Rajbhavan Road, Hyderabad - 500082 Phone: 040-3062001 - 3 Fax: 040-30331436 Email: chandrakiran@reliancemutualcom Jalpaiguri Karvy Computershare Pvt Ltd, Dbc Road, Near Rupasree Cinema Hall, Beside Kalamandir, Po & Dist Jalpaiguri, Jalpaiguri - 735101 Phone: 03561-224207 / 225351 Fax: 0 Email: mfsjalpaiguri@karvycom Janak Puri Shop No 14 B Block, Community Center, Janak Puri - 0 Email: LalitSuri@reliancemutualcom Kanpur 15 / 46, First Floor, Opp: Muir Mills, Civil Lines, Kanpur - 208001 Phone: 0512-3246390,0512-3292333 Fax: 0512-2330127 Email: kanpurmfd@karvycom Kolkata Reliance House, 34 J L Nehru Road, 3 rd Floor, Kolkata - 700071 Phone: 033-22176931 / 32 Fax: 033-22176933 Email: devendradaga@rilcom Ludhiana Sco 3, Ground Floor, Aptech Building, Feroze Gandhi Market, Ludhiana - 141001 Phone: 0161-3018445,3018460 Email: mfsludhiana@karvycom Mehsana 14-15 Prabhu Complex, Near Hdfc Bank, Mehsana Highway, Mehsana - 384002 Phone: 02762-242949/50 Fax: 0 Email: mfsmehsana Mysore No9/2 ( Newnol-350), First Floor, Oppclock Tower,ashoka Road, Mysore - 570001 Phone: 0821-2524292/94,2441520/24,24 Email: mfsmysore@karvycom Navsari House No 1, Upper Ground,, Sule Complex,, Opp Sayaji Library, Navsari - 396445 Phone: 09375972948/02637-233548/2335 Email: deepakjani@karvycom Panjim No7 & 8 El Dorado Plaza, Heliodoro Salgado Road, Panjim - 403001 Phone: 0832-2426870 - 74 Email: panjimmfd@karvycom Pune 105 & 106, First Floor, Winners-window, Behind Vaishali Restaurant, F C Road, 1218 / 2a, Shivaji Nagar, Pune - 411004 Phone: 020-4015745 / 46 Fax: 020-4015746 Email: sapna@reliancemutualcom
Rajahmundry D No 7-27-8, First Floor, Vygram Road, T Nagar, Rajahmundry - 0 Phone: 0883-2434468 / 69, 2434471 Email: mfsrajahmundry@karvycom Saharanpur 18 Mission Market, Court Road, Saharanpur - 247001 Phone: 0132-2725106, 0132-3297925 Fax: 0 Email: mfssaharanpur@karvycom Silchar 1st Floor, Chowchakra Complex,, N N Dutta Road,, Premtala, Silchar - 788001 Phone: 03842-247326 Email: mfssilchar@karvycom Tirunelveli Jeney Building, 55/18, S N Road, Near Arvind Eye Hospital, Tirunelveli - 627001 Phone: 0462-2335135 / 36 / 37,9843 Email: mfstirunelveli@karvycom Valsad Shop No 2, Phiroza Corner, Icici Bank Char Rasta,, Tithal Road, Valsad - 396001 Phone: 9824513532/02632-396901/ 02 Email: mfsvalsad@karvycom,amishgandhi@karvy com Visakhapatnam 47-14-5/1 Eswar Paradise, Dwaraka Nagar, Main Road, Visakhapatnam - 530016 Phone: 0891-2752915 Email: vizagmfd@karvycom Rajkot 204, Star Chambers, Dr Rajendra Prasad Road, Harihar Chowk, Rajkot - 360001 Phone: 0281-2239404 / 2239338 / 229 Email: rajkotmfd@karvycom Sambalpur Karvy Computershare Pvt Ltd, Quality Mansion, 1st Floor, Above Bata Shoe Shop/ Preeti Auto Combine, Nayapara, Sambalpur - 768001 Phone: 0663-2522105 / 106 / 2230195 / Fax: 0 Email: mfssambalpur@karvycom Standard Chartered Bank Flat 2 - B First Floor, Wellington Estate No:24,, Ehtiraj Sali, Commander-in-chief-road, Chennai - 600105 Phone: 044-5341301 Fax: 044-52028514 Trichur 2nd Floor, Brother's Complex,, Near Dhana Laxmi Bank Head Office,, Naikkanal Junction, Shornoor Road,, Trichur - 680001 Phone: 0487-2322483 Fax: 0 Email: mfstrichur@karvycom Varanasi D-64 / 132, 1 st Floor, Anant Complex, Sigra, Varanasi - 221010 Phone: 0542-2225365 / 2223814 Email: varanasimfd@karvycom Rohtak 1st Floor,, Ashoka Plaza,, Delhi Road, Rohtak - 124001 Phone: 01262-241597/9355615554/935562 Email: rakeshnegi@karvycom Shimla Triveni Building, By Pas Chowk, Khallini, Shimla - 171002 Phone: 0177-2624453, 0177-3102055 Fax: 0 Email: mfsshimla@karvycom Thane Unit No3, Ground Floor, Saptashri Chs Ltd, Near Hdfc Bank, Talopali, Thane (west), Thane - 400062 Phone: 022-39434887 Email: vipinpoliyamkottu@reliancemutualcom Udaipur Reliance Web World, Opposite Meera Girls College, Meera Marg, Udaipur - 313001 Phone: 9829409794(M) Email: hitesh_dhankani@reliancemutualcom Vellore Karvy Computershare Pvt Ltd, No1, M N R Arcade,, Officer's Line, Krishna Nagar,, Vellore - 632001 Phone: 0416 2215007 / 08 / 09 Fax: 0 Email: mfsvellore@karvycom