To:
Birla Sun Life Mutual Fund
Consent To Provide Transaction Data Feed In Respect of Investments Under “Direct Plan”
Common Account No.Account No./Folio No.
Account No./Folio No.
Account No./Folio No.
Account No./Folio No.
Account No./Folio No.
Name Sole/1st Holder/Guardian Mr./Mrs./Ms./ M/s
/ PAN of Sole/1st Holder/Guardian
Name Second Holder Mr./Mrs./Ms. / PAN of 2nd Holder
Name Third Holder Mr./Mrs./ Ms.
/ PAN of 3rd Holder
I / We hereby represent that I / we have entered into a Financial Services Execution Agreement with below distributor.
In view of the foregoing, I / we hereby authorize and consent Asset Management Company (“AMC”) / Mutual Fund (“MF”) to share, disclose or transfer my / our personal data and information including the details of my / our investments and transactions in the Schemes of Mutual Fund. This information may be disseminated by the AMC / MF and the same shall be solely used by the distributor for the purpose of collating my / our portfolio details under the said Financial Services Execution Agreement.
I / We hereby indemnify, defend and hold harmless the AMC / MF against any regulatory action, damage or liability that they may suffer, incur or become subject to in connection therewith or arising from sharing, disclosing and transferring of the aforesaid information. This indemnification shall survive termination of this agreement / arrangement.
I / We acknowledge that the RIA has entered into an agreement with the AMC / MF for accepting transaction feeds under the code. I / We further acknowledge and agree that in the event such agreement between RIA and the AMC / MF was to be terminated due to any reasons, I / we shall submit transactions in the schemes of the MF directly to the AMC / MF through other modes of transactions permitted by the AMC / MF.”
AMFI Registration number / ARN - / SEBI Registration No.
Name:
Address:
City PIN
E-Mail Id.
Tel. No.
Signatures
Sole/First Holder/Guaridan / Second Holder / Third HolderDate:…………………………………………………….
Place:……………………………………………………