Common Application Form

Sr. No.

Please read product labeling details available on cover page and the instructions before filling

up the Application Form. Tick (P) whichever is applicable, strike out whichever is not required.

(For Lumpsum / Systematic Investments)

DISTRIBUTOR INFORMATION

(Only empanelled Distributors / Brokers will be permitted to distribute Units of Baroda Pioneer Mutual Fund)

Upfront commission shall be paid directly by the investor to the AMFI registered distributor, based on the investor's assessment of various factors, including the service rendered by the

distributor.

I/We hereby confirm that the EUIN box has been intentionally left blank by me/us as this transaction is executed without any interaction or advice by the employee/relationship

manager/sales person of the above distributor/sub broker or notwithstanding the advice of in-appropriateness, if any, provided by the employee/relationship manager/sales person of the

distributor/sub broker.

1st Applicant Signature / Guardian Signature / POA Signature / Thumb Impression

3rd Applicant Signature / POA Signature / Thumb Impression

2nd Applicant Signature / POA Signature / Thumb Impression

Occupation of the Applicant (Mandatory, please P)

MODE OF HOLDING

Default Option: Joint

Joint

Single

Anyone or Survivor

SOLE / FIRST APPLICANT'S PERSONAL DETAILS (Please fill in ALPHABETS and use one box for one alphabet, leaving one box blank between two words, as it appears in your Bank Account)

Student Business Professional Housewife

Retired

Gross Annual Income OR

Net-worth* in ` (Lacs)

Any other information

*Should not be older than

one year

<5 L 5-25 L

25L-1Cr

1Cr-5 Cr >5 Cr

as on Date

D D M M Y Y

Politically Exposed Person (PEP) Related to a PEP

INDIVIDUALS

NON-INDIVIDUALS

Is the entity involved in any of the following services:

• Foreign Exchange/ Money Changer

• Gaming/ Gambling/ Lottery (casinos, betting syndicates)

• Money Lending/ Pawning

Yes

<50 L 50 L - 2.5 Cr

2.5 - 10 Cr

10 Cr - 50 Cr

Yes

as on Date

D D M M Y Y

TRANSACTION CHARGES FOR APPLICATIONS THROUGH DISTRIBUTORS ONLY (Please refer Instructions for filling up the Application Form - VIII)

Existing Folio Number

In case the subscription amount is `10,000/- or more and your distributor has opted to receive Transaction Charges, they are deductible, as applicable, from the purchase / subscription

amount and payable to the distributor. Units will be issued against the balance amount.

I confirm that I am an existing investor across Mutual Funds.

( ` 100 deductible as Transaction Charge and payable to the Distributor)

I confirm that I am a first time investor across Mutual Funds.

( ` 150 deductible as Transaction Charge and payable to the Distributor)

FOREIGN ACCOUNT TAX COMPLIANCE ACT (FATCA) / COMMON REPORTING STANDARD (CRS) RELATED INFORMATION OF THE APPLICANT(S)

(Please refer instruction XI for details)

It is mandatory to fill and sign the annexure relating to FATCA & CRS, which forms part of this Application Form.

Public Co. - Listed Public Co. - UnlistedBuilder

ACKNOWLEDGMENT SLIP (To be filled in by the investor)

Signature, Stamp & Date

Received from Mr. / Ms. / M/s.

Option (please P)

Growth

Dividend

along with Cheque / DD No. / UTR No.

D D M M Y Y Y Y

Dated

Amount `

Drawn on (Bank)

an Application for scheme

Sub-option (please P)

Payout

Reinvestment

Sr. No.

Natural Guardian (Father / Mother)

Legal Guardian (Court appointed Guardian)

Proof of DOB of Minor enclosed (please P)

Passport

Birth Certificate Other

Address [P. O. Box Address is not sufficient] (Indian address, in case of NRIs/ FIIs)

City

Pincode

State

Country

(Mandatory)

Phone (Res)

Email ID*

Phone (Off.)

Fax No. Mobile No.

*If the First Applicant is a Minor, please state the details of Guardian. # Please attach PAN proof.

Name of the contact person in case of Non-Individual

Date of Birth (DOB)

D D M M Y Y Y Y

Nationality (For Individuals)

Name

M/s

Guardian Name (if Sole/ First applicant is a Minor)

M/s

PAN (Refer Instruction IV)#

PAN

PAN (Refer Instruction IV)*#

Minor through guardian

Other

Resident IndividualForeign National Resident in IndiaNRI - Non Repatriation

Body Corporate

NGO Sole Proprietorship

NRI-Repatriation

Society / Club

Partnership

AOPOCIPIOQFICompany

FIIsTrustHUFLLP

BOI

Status of the First Applicant (Mandatory, please P)

Distributor / Broker ARN Sub-Broker Code LG Code

EUIN

Sub-Broker ARN

Date & Time Stamp

I H No. (K Bolt)

For Office use only For Office use only

Defence

Agriculture

Forex Dealer

Gov. Service

Public Sector Pvt. Sector Service OtherSports Entertainment

Not Applicable

*Wherever email ID is registered, an electronic Statement of Account (e-SOA) will be shared with the investor. In case you want to receive a physical statement, please request for the same separately.

>50 Cr

(refer instructions bank account details)

KYC Identification No (KIN)

Investors who have completed their Centralised KYC (CKYC) and have obtained KYC Identification Number (KIN) from the Central KYC

Records Registry (CKYCR), may quote their KIN while investing. In case of minor, please provide KIN of guardian.

DECLARATION AND SIGNATURES

I/We have read and understood the contents of the scheme related documents and hereby apply for allotment of units in the Scheme. I/We agree to abide by the terms, conditions, rules & regulations governing the

Scheme. I/We hereby declare that I/We am/are authorized to make this investment and that the amount invested in the Scheme is through legitimate sources only and does not involve and is not designed for the

purpose of any contravention or evasion of any act, rule, regulation, notification or direction or any other applicable laws issued by the Government of India or any regulatory or statutory authority. I/We have

understood the details of the Scheme and in the event “Know Your Customer” process is not completed by me/us to the satisfaction of the AMC, I/We hereby authorize the AMC to redeem the funds invested in the

Scheme, in favour of the first applicant at the applicable NAV prevailing on the date of such redemption and to undertake such other action with such funds as may be required by law. I/We hereby authorise Baroda

Pioneer Mutual Fund, its Investment Manager and its agents to disclose details of my investment to my bank(s)/Baroda Pioneer Mutual Fund’ bank(s) and/or Distributor/Broker/Investment Adviser.

The ARN holder has disclosed to me/us all the commission (in the form of trail commission or any other mode), payable to him/it for the different competing schemes of various mutual funds from amongst which

the Scheme is being recommended to me/us. I/We have neither received nor been induced by any rebate or gifts, directly or indirectly, in making this investment. I/We declare that the information given in this

application form is correct, complete and truly stated. If I/We have not ticked for not appointing a nominee, then the Application Form shall be processed as without nomination.

Applicable for “Execution Only” transaction : I/We, the undersigned, hereby acknowledge and confirm that the above transaction is “Execution Only” as explained vide SEBI circular no. CIR /IMD/DF/13/2011 dated

22 August 2011. This investment is being made notwithstanding the advice of the appropriateness/inappropriateness of the same and the distributor has not charged any advisory fees on this transaction.

Applicable for NRIs : I/We confirm that I am/we are Non-Residents of Indian nationality/origin but not residents of the United States and Canada and I/we hereby confirm that I/we have remitted funds from abroad

through approved banking channels or from my/our monies in my/our domestic account maintained in accordance with applicable RBI guidelines.

THIRD APPLICANT'S DETAILS

Name

Overseas Address (Mandatory in case of NRI/ FII applicant, in addition to mailing address)

State

Country Zip Code

Sub-option (please P)

Payout

Reinvestment

Option (please P)

Growth

Dividend

NOMINATION DETAILS (To be filled in by individuals singly or jointly. Mandatory only for Investors who opt to hold units in Non-Demat Form) Refer Instruction VII.

Name and Address of

the Nominess(s)

Relationship

between Nominee

& Investor

Name & Address of Guardian

(to be furnished in case the nominee is minor)

Signature of

Guardian / Nominee

Proportion (%) by which the units

will be shared by each nominee

(% to aggregate to 100%)

Date of Birth

Nominee 1

Nominee 2

Nominee 3

All communication / payments will be made to the first applicant, or to the Karta in case of HUF. Bank account details of first applicant required, without which the application is liable to be rejected.

Name of the Bank

Branch

Account No. (in figures)

Bank Address

Account Type

Savings

Current NRO NRE Others

MICR Code (9 digits)

Pincode

State

City

*IFSC Code for NEFT / RTGS

*This is an 11 Digit Number,

kindly obtain it from your Bank Branch.

Example for filling

the Account No.

Ac. No.

In words

One

Three

Five

Seven

(Please attach copy of cancelled cheque)

Scheme Name

GROSS AMOUNT (A)

MODE OF PAYMENT NEFT / RTGS

Cheque

DD [(Bank Certificate / Third Party / DD Declaration Enclosed) (for Third Party Payment Refer Instruction VI(9))]

Cheque /

DD Details

A/c No.

A/c Type

Cheque / DD No.

M M Y Y

Y Y

Date

FIRST HOLDER'S BANK ACCOUNT DETAILS (Mandatory) Refer Instruction III.

REDEMPTION / DIVIDEND / REFUND PAYOUTS (Refer Instruction X for details)

SCHEME DETAILS (Please choose the Option and Sub-option for Investment, please read product labeling details available on Cover Page and Instruction before filling this section)

INVESTMENT DETAILS (Strike off whichever is not applicable)

NET AMOUNT (CHEQUE / DD AMOUNT)

DD CHARGES (IF ANY) (B)

A minus B

Drawn on Bank

In case of NEFT / RTGS payment

UTR No.

Zero Balance folio

Account no. (in words)

Plan (please P)

Plan A Plan B (Direct)

NAME OF POWER OF ATTORNEY (POA) HOLDER (If investment is being made by a Constituted Attomey) Mr

PAN

1st Applicant Signature / Guardian Signature /

POA Signature / Thumb Impression

2nd Applicant Signature / POA Signature /

Thumb Impression

3rd Applicant Signature / POA Signature /

Thumb Impression

DEMAT ACCOUNT DETAILS

National Securities Depository Limited

Central Depository Services (India) Limited

Depository Participant Name

DP ID No.

Client ID No.

Mr / Ms / M/s

Add convenience to your life with our value added service

Simply send **SMS to 9212 132763 to avail the below facilities

Balance SMS BAL <space> last 6 digits of Folio No.

NAV SMS NAV <space> last 6 digits of Folio No.

Statement thru Email SMS ESOA <space> last 6 digits of Folio No.

Last 3 Transactions SMS Transaction <space> last 6 digits of Folio No.

**SMS charges as per service provider applicable.

Investor can avail below facilities

1. NAV

2. Account Balance

3. Account Statement

4. Last 5 Transactions

IVR

24x7

9 am to 6 pm - Monday to

Saturday on all Business Days

nd th

9 am to 2 pm on 2 & 4

Saturdays of the Month

For more details call :

1800-2670-189 (Toll Free)

www.barodapioneer.in

Date of Birth

D D M M Y Y Y Y

Status: (P)

NRIRI

Nationality

SECOND APPLICANT'S DETAILS

Name

KYC Identifica-

tion No (KIN)*

PAN

Country of

Birth

(Refer Instruction IV)

Please attach PAN proof.

Date of Birth

D D M M Y Y Y Y

Status: (P)

NRIRI

Nationality

KYC Identifica-

tion No (KIN)*

PAN

Country of

Birth

(Refer Instruction IV)

Please attach PAN proof.

KYC Identifica-

tion No (KIN)*

* Refer Instruction IV under KYC details.