20211010002-Change of broker code RIA-FORMS

Request for Change in Mutual Fund Distributor Code (MFD)

ARN / Registered Investment Advisor (RIA) Code

To,

Axis Mutual Fund

I, we hereby give my/our consent to update/change the Mutual Fund Distributor Code(MFD) /RIA code in respect of my/our investments in following

folio number/s and schemes of Axis Mutual fund mentioned below:

Broker code change to be made (Please Tick P) Folio Level Scheme Level

Folio No

Scheme Name / Plan / Option / Sub Option

Axis

Request for Change in Mutual Fund Distributor Code (MFD) ARN /

Registered Investment Advisor (RIA) Code

[Acknowledgement copy (To be filled by investor)]

Stamp & Signature

Received from Mr./Ms./Mrs.

Folio number

Date

D D M M Y Y Y Y

DECLARATION & SIGNATURES (To be signed as per the Existing Mode of Holding)

Investor Details 1st holder

2nd Holder

3rd Holder

Name

Signature

D D M M Y Y Y Y

Date Place

NOTE-ARN TO DIRECT OR VICE-VERSA IS NOT APPLICABLE

Declaration: I /We wish to change the MFD ARN code/RIA code and request Axis Mutual Fund to update the MFD ARN code/RIA code in my/our folio

number/s mentioned above. I /We understand that if any mandatory details are not mentioned the request will be liable to be rejected. I/We hereby

give my/our consent to share the transaction data feeds in respect of my/our investments to the above mentioned MFD/RIA.

Old MFD ARN / RIA Details

MFD ARN /

RIA Code

MFD ARN /

RIA Name

INSTRUCTIONS

1. All fields are mandatory.

2. ARN to RIA / ARN to Direct or vice-versa is not applicable

3. In case of corrections / overwriting on key fields (as may be determined at the sole discretion of the AMC), the AMC reserves the right to reject the

request, in case the investor(s) has/have not countersigned in every place where such corrections/overwriting has/have been made.

4. Wherever no schemes are specified, the MFD code/ RIA code change/update will be processed for all schemes in the given folio.

New MFD ARN / RIA Details New Sub - MFD ARN

NEW Employee Unique

Identification No. (EUIN)

Sub - MFD ARN

Sub - MFD

ARN Name

MFD ARN /

RIA Code

MFD ARN /

RIA Name

EUIN