(Applicable For Individual IFAs Only)

All fields marked * are mandatory.

For Non-Individual ARN download the form and submit it in the nearest branch.

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Nominee Details

Due Diligence Questionnaire

Whether the Distributor is having presence/operating from more than 20 locations.

Whether the Distributor has raised AUM over Rs. 100 crore across the Mutual Fund industry in the non institutional category (retail) including high net worth individuals (HNIs).

Whether the Distributor has received Commission of over Rs.1 crore p.a across the Mutual Fund industry. (To check if this condition was satisfied during the last financial year).

Whether the IFA or Distributor has received over Rs. 50 lacs towards Commission from a single Mutual Fund. (To check if this condition was satisfied during the last financial year)

***If Answer to any of these questions is "YES", Please follow Physical Enrolment Process.

*Declaration:I undertake that the information provided is correct and true to my knowledge. I have read and understood the Terms & Conditions and agree to comply with and be bound by the same. My application for empanelment may accordingly be considered. My appointment shall be subject to any guidelines, notification, regulations etc. that may be framed or issued by ICICI Prudential Mutual Fund, AMFI, SEBI or regulatory authority. I agree to abide by the Terms and Conditions appended to the Empanelment Form along with the Code of Conduct that is issued by SEBI from time to time. I/we hereby declare that None of the employees of the AMC, Sponsor, Associate is related to me/us as on this date of empanelment. Further I/we agree to disclose any changes to this declared position on any subsequent date to the AMC within 30 days of such change.

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