Annexure UOS -S3 https://cra-nsdl.com/CRA/SchReqPrintAction.do?ID=428537490&getName=Scheme Setup&dumm...

Request for Scheme Preference Change and/or Switch

(Please fill all the details in CAPITAL LETTERS & in BLACK INK only.)
For POP-SP use :

PRAN * 110002489149 Name of subscriber* VEERESH GANGAPPA KASABEGOUDAR

Scheme Preference change and/or switch: Tier I Tier II

(i).Name of the PFM (Select only one)*

PFM Name (in Alphabetic order) Please tick only one

DSP BlackRock Pension Fund Managers Private Limited
HDFC Pension Management Company Limited1
ICICI Prudential Pension Funds Management Company Limited
Kotak Mahindra Pension Fund Limited
LIC Pension Fund Limited
Reliance Pension Fund Limited
SBI Pension Fund Private Limited
UTI Retirement Solutions Limited

(Selection of PFM is mandatory both in Active and Auto Choice. In case you do not indicate a choice of PFM, your application form shall be summarily rejected)

(ii). Investment Option Active Choice Auto choice

(iii). Asset Allocation(to be filled up only in case you have selected the 'Active Choice'investment option))

Asset Class E C G A Total

% Share 20.0 15.0 65.0 100%

CRA generated Acknowledgement Number(to be filled by POP-SP) 51000000000171090

Subsriber's Signature/thumb Impression* _____________________

1 of 2 06-Dec-18, 10:12 PM
Annexure UOS -S3 https://cra-nsdl.com/CRA/SchReqPrintAction.do?ID=428537490&getName=Scheme Setup&dumm...

For POP/POP-SP use: Name & Signature _____________________

POP/POP-SP Stamp: _____________________

Acknowledgement to the subscriber

(TO be filled by POP/POP-SP)

Scheme Preference change and/or switch: Tier I Tier II
PRAN * 110002489149
Name of subscriber* VEERESH GANGAPPA KASABEGOUDAR
1. POP Transaction Charges: Rs: 2. Service Tax (as applicable): Rs:
3.Total Charges Rs:

Signature Stamp of POP/POP-SP Place :

2 of 2 06-Dec-18, 10:12 PM