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quant Mutual Fund

quant Mutual fund (Formerly known as Escorts Mutual fund ). Corporate Office: 6th Floor, Sea Breeze Building, Appasaheb Marathe Marg, Prabhadevi, Mumbai - 400 025. Tel: +91 9920 21 22 23 | E-mail: | DISTRIBUTORS EMPANELMENT FORM. To be filled in capital letters and in blue / black ink only. KEY CONTACT DETAILS. NAME ( M/s). (Block Letters). Photograph ADDRESS FOR. (only for Individuals). COMMUNICATION. (Block Letters). PIN. Telephone (0) _ ( R) _. Mobile Fax _. E-Mail 1 E-Mail 2. TAX STATUS (Please tick anyone). INDIVIDUALS NON-INDIVIDUALS. Individuals Sole Proprietorship Partnership Firm Private Limited Company Public Limited Company Society / Trust Others ADDITIONAL INFORMATION. INDIVIDUALS NON-INDIVIDUALS. Date of Birth D D M M Y Y Y Y Date of Incorporation D D M M Y Y Y Y.

quant Mutual Fund (Formerly known as Escorts Mutual Fund) Corporate Office: 6th Floor, Sea Breeze Building, Appasaheb Marathe Marg, Prabhadevi, Mumbai - 400 025. Tel: +91 9920 21 22 23 | E-mail: help@quant.in | www.quant-mutual.com To be filled in capital letters and in blue / black ink only. CHECK LIST

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