Icici Prudential Smart Fund

ICICI Prudential S.M.A.R.T. (Structured Methodology Aiming at Returns over Tenure) Fund Application Form for Resident Indians and NRIs/ PIOs/FIIs

NJ India Broker Invest / Code ARN-0155

New Fund Offer Opens on : August 18, 2008

Date & Time of Receipt

54934 Sub-Broker Code

New Fund Offer Closes on : September 19, 2008

(Application to be filled in BLOCK LETTERS in ENGLISH only) 1

Application No.

FOR EXISTING UNITHOLDERS

If you have an existing folio with PAN validation & KYC validation (if applicable), please mention the folio number in the space provided and proceed to Step 5. Please note that the applicable details and mode of holding will be as per the existing folio.

2

Serial Number

Folio No.

Date:

ABOUT YOU

Name of First Applicant

Date of Birth (Mandatory) D

Mr. Ms. M/s.

D M M

Y

Y

Y

Y

Status [Please tick ()]

Name of Guardian (in case of minor) / Contact Person (In case of non-individual investors) Mr. Ms. Designation of the Contact Person (In case of non-individual investors)

Mailing Address (Please provide full address)

Minor

Trust

NRI/PIO

Bank/FI

Resident Individual

AOP/BoI

HUF

Club/Society

Sole Proprietorship

Company

Partnership Firm FII Others (Please specify) _______

_______________________ City

_______________________

PIN (Mandatory)

(Mandatory)

State

_______________________

Country

(Mandatory)

Communication Tel. (Res.)

Tel. (Off.)

Mob

E-Mail Overseas Address (in case of NRIs/FIIs)

ZIP/P I N

City

(Mandatory)

Country

State

(Mandatory)

Mode of holding [Please tick ()]

Name of Second Applicant Mr. Ms.

Single

Mr. Ms. Permanent Account Number (PAN) - Mandatory {Please submit a copy of PAN card. In case the 1st applicant is minor, please provide Guardian’s PAN. Refer to Instruction No. II-b(4) }

Know Your Customer (KYC) (Please refer to instruction no. IX) Please tick () (Mandatory for investment of Rs.50,000 & above)

1st Applicant

Copy of KYC acknowledgement enclosed

Guardian (in case 1st applicant is minor)

Copy of KYC acknowledgement enclosed

2nd Applicant

Copy of KYC acknowledgement enclosed

3rd Applicant

Copy of KYC acknowledgement enclosed

3

Joint

Anyone or Survivor (Default option: Anyone or Survivor)

Name of Third Applicant

Occupation [Please tick ()] Professional Housewife Business Service Retired Student Others (Please specify) _____________________ _____________________ _____________________

E-MAIL COMMUNICATION – I/We wish to receive the following via e-mail instead of physical document: Account Statement

Quarterly Review & Annual Report



Other statutory information





ICICI PRUDENTIAL S.M.A.R.T. (STRUCTURED METHODOLOGY AIMING AT RETURNS OVER TENURE) FUND ACKNOWLEDGEMENT SLIP (To be filled in by the Investor)

Application No.

Received from:

ess Addr Options (Tick  any of the boxes below) Series C - 24 months

Series F - 36 months

Options (Tick  any of the boxes below) Retail

Institutional

Sub-Options (Please Tick  ) Cumulative

Dividend Payout

Signature, Stamp & Date

4

BANK ACCOUNT DETAILS OF FIRST APPLICANT

(Refer instruction No.III)

Branch Address City Account Number

Account Type Current

9 Digit MICR code

Savings

If “Mandatory Details” are not provided, your application is liable to be rejected.

NRE

NRO

IFSC Code (11 digit)

Please quote 9 Digit Code No. of your Bank and Branch corresponding to Bank Account details. (This number appears on every leaf of your cheque book after your cheque number). Please attach a blank “cancelled” Cheque or a clear photocopy of a cheque issued by your bank verifying of the Code No. The AMC reserves the right to make dividend payments through ECS where MICR code is available.

5

YOUR INVESTMENT DETAILS UNDER ICICI PRUDENTIAL S.M.A.R.T. (STRUCTURED METHODOLOGY AIMING AT RETURNS OVER TENURE) FUND Plans (Tick  below)

Options (Tick  below)

Series C - 24 months Series F - 36 months

Retail Option Institutional Option

Amount Invested

Default Option & Sub-option: Retail with Cumulative will be the default option & sub-option. Hence, If an investor fails to specify the option/sub-option or has selected multiple options/sub-options, he will be allotted units under the default option/sub-option.

Sub-Options (Tick  any of the boxes below) Cumulative Dividend Payout Cheque/DD No.

Account Type (For NRI Investors)

Cheque/DD Date

Rs.

D

D

M

M

Y

Y

NRO

NRE

FCNR

Bank Name & Branch

City

6

The cheque/demand draft should be drawn in favour of “ICICI Prudential SMART Fund - Series C - 24 months” or “ICICI Prudential SMART Fund - Series F - 36 months” and crossed “Account Payee Only”. The cheque/demand draft should be payable at the centre where the application is lodged.

NOMINATION DETAILS (Optional) (For single nomination)

I/We hereby nominate the undermentioned Nominee to receive the amounts to my/our credit in event of my/our death. I/We also understand that all payments and settlements made to such Nominee and signature of the Nominee acknowledging receipt thereof, shall be a valid discharge by the AMC/Mutual Fund/Trustees. Date of Birth (If nominee is minor) - Mandatory Name of the Nominee D D M M Y

Mr. Ms. M/s. Address of Nominee (Please provide full address) PIN Code Relationship with minor

Name of the Guardian (If nominee is minor) - Mandatory

Signature of Guardian / Nominee

Address of Guardian PIN Code

7

YOUR CONFIRMATION

The Trustee, ICICI Prudential Mutual Fund I/We have read and understood the SID/Key Information Memorandum of ICICI Prudential S.M.A.R.T. (Structured Methodology Aiming at Returns DD MM YYYY over Tenure) Fund. I/We apply for the units of the ICICI Prudential S.M.A.R.T. (Structured Methodology Aiming at Returns over Tenure) Fund and I/we agree to abide by the terms, conditions, rules and regulations of the scheme. I/We confirm to have understood the terms & conditions. Its investment objectives, investment pattern, fundamental objectives and risk factors applicable to the Plans under the Scheme. I/We agree to abide by the terms, conditions, rules and regulations of the Scheme. 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. I/We agree to abide by the terms, conditions, rules, regulations and other statutory requirements of SEBI, AMFI, Prevention of Money Laundering Act, 2002 and such other regulations as may be applicable from time to time. I/We declare that the amount invested in the Scheme is through legitimate sources only and is not designed for the purpose of contravention or evasion of any Act, Regulation, Rule, Notification, Directions or any other applicable laws enacted by the Government of India or any Statutory Authority.

First Applicant

SIGNATURE(S)

MANDATORY

Bank Particulars (Name of the Bank)

Second Applicant

Third Applicant

REGISTRAR Computer Age Management Services Pvt. Ltd. Floor III, Tower 1, Rayala Towers, 158, Anna Salai, Chennai 600 002, Ph: (044) 30212631/673





ICICI Prudential S.M.A.R.T. (Structured Methodology Aiming at Returns over Tenure) Fund – ACKNOWLEDGEMENT SLIP (To be filled in by the Investor) Investment Plan

Cheque/DD No.

Dated

Amount (Rs.)

Drawn on (Name of Bank & Branch)

Y

Y

Y