Folio Consolidation Form - Prudential Mutual Fund

FOLIO CONSOLIDATION REQUISITION

(For existing Unitholders only)

Date: ____________________

I/We wish to consolidate all my/our below mentioned folio numbers into a single folio.

Source Folios for Consolidation (Folios where the following are identical can be consolidated - Unitholders’ Names & Address, Order of Unitholders, Nominee

details and Tax Status):

1

2

3

4

5

6

7

8

(Bank particulars in the target folio has been retained for your redemption/dividend proceeds.)

Target Folio Number (Mention the target folio here,

Contact Details (Mention your contact details here for easy communication):

wherein all folios to be consolidated - single folio no.):

Mobile No.

E-mail address

Declaration and Signatures:

I/We request ICICI Prudential Mutual Fund to consolidate all my/our investments in above mentioned folio nos. to the mentioned Target folio no. I understand that

consolidation can take place only if a. Names of unit holders, b. Address of unit holders, c. Mode of holding, d. Order of unit holders, e. Tax status and Nominee details are identical in all the mentioned folios.

I/We agree that the mode of holding, bank mandate, address and nomination details in the Target Folio will be applicable and will prevail after consolidation even if they were different details in source folios.

Name of the First Unitholder

First Unitholder

Name of the Second Unitholder

Second Unitholder

Name of the Third Unitholder

Third Unitholder

ACKNOWLEDGEMENT: FOLIO CONSOLIDATION FORM - ICICI PRUDENTIAL MUTUAL FUND

Receiver’s Signature & Seal

Source Folios for

Consolidation:

Target Folio

Number: