Application For Mutual Fund Nomination / Cancellation of

Nomination

Date : ________________
To,
Mutual Funds Operations Team
ICICI Securities Ltd
Shree Sawan Knowledge Park,
Ground Floor, Plot No. D-507, T.T.C Ind Area,
M.I.D.C, Turbhe, Opp. Juinagar Railway Station,
Navi Mumbai - 400705

Dear Sir/ Madam,

I, the undersigned Mr. / Mrs. / Ms._________________________, holding ICICIdirect trading ac-

count no. __________________,

(* strike out whichever is not applicable )

# wish to make the undermentioned nomination for the attached list of folios. I do hereby nomin-
ate the following person in whom all rights and/or amount payable in respect of the following Mu-
tual Fund Holdings held in the said account by me shall vest in the event of my death.

# wish to cancel existing nomination made by me for the attached list of folios. I understand and
agree that consequent to the cancellation,all rights and liabilities in respect of the holdings held by
me in the said account shall vest in me.

Nominee Details: (kindly read the instructions before filling up the details)

Name: …………………………………………………………………….

Date of Birth of Nominee : …………………………………………………………….

Nominee Address:.......................... Relationship:..............

.......................................................

Guardian Details (If nominee is a minor):

( to be deleted if not applicable):

Name of the Guardian: ……………………………................... Relationship...............................

Address of the Guardian……………..... ......................................................

Signature of the guardian : ……………………………………………………........

Regards,

Name of ICICIdirect A/c holder : ______________________

Signature of the A/c holder : _________________________

 AMC Name Scheme Name Folio Number

Regards,

Name of ICICIdirect A/c holder : ______________________

Signature of the A/c holder : _________________________

Instructions :

(1) The nomination can be made only by individuals holding units on their own name .
(2) Only one person can be nominated for each folio. In case you wish to make more than one
nomination for different folios held by you,kindly fill separate nomination forms.
(3) A minor can be nominated and in that event, the name and address of the guardian of the
minor nominee shall be provided by the unit holder.
(4) Non-individuals including society, trust, body corporate, partnership firm, Karta of Hindu
Undivided Family, holder of Power of Attorney cannot nominate.
(5) The Nominee shall not be a trust, society, body corporate, partnership firm, Karta of Hindu
Undivided Family or a Power of Attorney holder. A non-resident Indian can be a Nominee
subject to the exchange controls in force, from time to time.
(6) Nomination in respect of the units stands rescinded upon the transfer of units.
(7) Transfer of units in favour of a Nominee shall be valid discharge by the asset management
company against the legal heir.
(8) The cancellation of nomination can be made only by those individuals who hold units in
their own name singly and who had earlier registered their nomination with us.
(9) On cancellation of the nomination, the existing nomination shall stand rescinded and the
asset management company shall not be under any obligation to transfer the units in
favour of the cancelled Nominee.