EMPANELMENT FORM - Mirae Asset

EMPANELMENT FORMARN No. PAN Application Details (Please fill in Block Letters)Recent PassportSize Photograph(Only for Individuals) Date of Birth / Incorparation DateD D M M Y Y Y YKYD Acknowledgment DateD D M M Y Y Y YCorrespondence Address:Pin:Valid D M M Y Y Y YARN Name*: (*Name to be written as mentioned on ARN Certificate)Contact Person: City:State:Tel: (with STD code)Office:Residence:Mobile 1:No. of AMFI Qualified employees eligible for distributing Mutal FundsNo. of BranchesEmail 2:Email 1: 2. Tax StatusFor IndividualResident IndividualHUFSole ProprietorshipNRIFor Non IndividualPartnership FirmTrustBankFinancial InstitutionCompanyOther(Please specify)Distributors having bank account with ABN Amro Bank, Citibank, Deutsche Bank, HDFC Bank, HSBC, ICICI Bank, IDBI Bank, Kotak Mahindra Bank, Standard Chartered Bank or AXIS Bank will receive brokerage payments directly into their bank account.

EMPANELMENT FORM ARN No. PAN No. 1. Application Details (Please fill in Block Letters) Recent Passport Size Photograph (Only for Individuals) Date of Birth / Incorparation Date D D M M Y Y Y Y KYD Acknowledgment Date D D M M Y Y Y Y

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