UTT ASSET MANAGEMENT AND INVESTOR SERVICES
PLC (UTT AMIS)
MULTIPURPOSE FORM
FOMU YA KUBORESHA TAARIFA ZA MWEKEZAJI
FOR OFFICIAL USE ONLY / KWA MATUMIZI YA OFISI TU
Batch No. / Namba ya batch Date Stamp of Collecting office along with Investor Account Number / Namba ya
receiving official signature / Sahihi na Akaunti ya Mwekezaji
muhuri wa wakala anayepokea maombi
To: UTT ASSET MANAGEMENT & INVESTOR SERVICES PLC
I/We, as the registered unit holder(s), request to update the following details in my/our account(s):
Mimi / sisi / ni wamiliki wa vipande na ninaomba / tunaomba kuboresha taarifa zifuatazo:
Full names of the Applicant / Majina kamili ya mwombaji
Date of Birth / Tarehe ya kuzaliwa Date / Tarehe: Month / Mwezi: Year / Mwaka
Resident Citizen of Tanzania / Mtanzania Mkazi Non Resident Citizen of Tanzania / Mtanzania asiye mkazi Others / Nyinginezo
Gender / Jinsia Male / Mwanaume Female / Mwanamke
Identification number / Andika namba ya Kitambulisho:
National ID / Kitambulisho cha Uraia , Election Card / Namba ya mpiga kura , Passport / Namba ya pasipoti , Driving Licence / Hati ya
kuendesha gari
Applicant’s Occupation / Kazi ya mwombaji
Agriculture / Mkulima Employed / Mwajiriwa Business / Mfanyabiashara Retired / Mstaafu Others / Mengineyo
Change of Mailling address / Mabadiliko ya Anuani
P.O. Box No. / Sanduku la Posta:
District / Wilaya:
Region / Mkoa:
Town/City / State / Mji/Jiji/Jimbo:
Country of Residence / Nchi ya Makazi:
Postcode / Msimbo:
Location / Eneo:
Street / Mtaa:
Ward / Kata:
House No. / Namba ya nyumba:
Phone No. / Namba ya Simu:
Email Address / Barua pepe:
Change of Bank particulars / Mabadiliko ya taarifa za benki
Bank Name / Jina la Benki
Branch Name and Address / Tawi na Anuani
Account Number / Namba ya Akaunti
Account Type (please tick relevant box / Aina ya Akaunti Savings / Akiba Current / Hundi Others / Nyinginezo
Inclusion or change of nominee details / Kuweka au kubabili taarifa za mrithi
Details of the Nominee(s) / Taarifa za Mrithi
Sr. Full names / Majina kamili Account Number / Date of birth % of Relationship /
No. (First name / Jina la kwanza / Middle name / Kati / & Surname Akaunti Namba / Tarehe ya ownership Uhusiano
Ukoo) kuzaliwa Asilimia ya
umiliki
1.
2.
3.
4.
5.
Note: If Nominee is a Minor, please furnish the below appended details / Muhimu: Kama mrithi ni chini ya miaka 18 jaza taarifa zifuatazo
Date of Birth of parent / guardian / sponsor / Tarehe ya kuzaliwa ya Mzazi / Mlezi / Mfadhili:
Names of Parent / Guardian / Sponsor / Majina ya Mzazi / Mlezi / Mfadhili:
Minor attaining Majority (Note: The former minor and now major should append his/her signature at the place
provided for the signature of 1st applicant in this form. Also the signature of the major should be attested by the
Guardian or Bank. / Mtoto mdogo anapotimiza umri wa mtu mzima. Angalizo: Mtoto anayetimiza umri wa mtu mzima
aweke sahihi yake katika sehemu ya mwombaji wa kwanza katika fomu hii. Na sahihi yake ithibitishwe na mzazi /
mlezi au Benki.
Change in Applicant’s Category (Please tick the appropriate box) / Mabadiliko ya taarifa za mwekezaji (Tafadhali weka
✓ panapohusika.
Resident to Non-resident / Mtanzania mkazi kwenda Mtanzania asiye mkazi
Non-resident to resident / Mtanzania asiye mkazi kwenda Mtanzania mkazi
Change in name due to marriage or other reason. Submit documentary proof (please furnish below the details of new
name) / Kubadili jina kutokana na ndoa au sababu nyingine. (Ambatanisha vithibitisho na tafadhali andika majina
hayo hapo chini)
Surname / Jina la Ukoo
First Name / Jina la Kwanza
Middle Name / Jina la Kati
Death Settlement - Death of 1st and/or 2nd holder (please submit original or attested copy of death certificate of
the deceased holder along with other documents in support of your claim to units pertaining to the deceased
holder / Malipo ya mirathi - Kifo cha mwombaji wa kwanza na/au wa pili (tafadhali wasilisha cheti halisi cha kifo au
kilichothibitishwa na mwanasheria na nyaraka nyingine kuthibitisha madai ya vipande vya marehemu.
Any other service grievance redressal desired by the Unit Holder / Jambo / malalamiko mengine yoyote ya huduma
Please clearly specify the details of your service requested / grievance at the space provided below.
Tafadhali eleza hapa huduma unayohitaji
Signature of applicant(s) / Sahihi ya mwombaji / waombaji
Name of the 1st Auth. Signatory / Jina la Mwombaji wa Kwanza Signature / Thumb impressions of 1st Applicant or of 1st
Authosided / Sahihi / alama ya dole gumba ya mwombaji wa
______________________________________________________
kwanza
Designation / Wadhifa: ___________________________________
___________________________________________________
Name of the 2nd Auth. Signatory / Jina la Mwombaji wa Pili Sig. in r/o of Corporate applicant _________________________
___________________________________________________
Signature / Thumb impressions of 2nd Applicant or of 2nd
Designation / Wadhifa: ________________________________ Authosided / Sahihi / alama ya dole gumba ya mwombaji wa Pili
Date (DD-MM-YYY) / Tarehe: ___________________________ ___________________________________________________
Sig. in r/o of Corporate applicant _________________________
To be filled if application is signed by Thumb Impression / Ijazwe kama maombi yamesainiwa kwa dole gumba
Name of the Witness / Jina la Shahidi: _____________________________________ Signature of Witness / Sahihi ya shahidi:
Address of Witness / Anuani ya Shahidi: ____________________________________ ________________________________
UTT AMIS
Acknowledgement Slip
(Collecting office should detach this portion and handover the same to the Unit Holder for their records) /
Wakala atoe kipande hiki na kumkabidhi mwekezaji kwa ajili ya kumbukumbu
UTT AMIS Investor Account No. / Akaunti ya Mwekezaji Scheme Name / Jina la Mfuko:
Received from / Nimepokea kutoka kwa: .................................................................................................................................................
(Unit Holder name, an application for / Maombi ya ...................................................................................................................... service
(Date Stamp of collecting office along with receiving official signature /
Muhuri wa mtoa huduma na sahihi:
.................................................................................................................................
Notes:
If the application for service is incomplete and any other requirement is not fulfiled, the application is liable to be rejected. All
communications relating to sale, re-purchase, issue of unit Certificate/SOA, change in nomination; name, address, bank details
and death claims etc., may please be addressed to the Register at the following address:
Zingatia:
Ikiwa maombi ya huduma hayajakamilika na vigezo vinavyohitajika, maombi hayatafanyiwa kazi.
Mawasiliano yote kuhusiana na kununua na kuuza vipande, kupata taarifa ya uwekezaji, kubadilisha mrithi, jina, anuani, taarifa
za benki, mirathi na kadhalika, tafadhali yaelekezwe kwenye anuani ifuatayo:
UTT AMIS
2nd Floor, Sukari House, Sokoine Drive/ Ohio Street,
Jengo la Sukari, Ghorofa ya Pili, Mtaa wa Sokoine na Ohio
P.O. Box / S.L.P. 14825, Dar es Salaam – Tanzania
Tel / Simu: +255 22 2128460 | Toll Free No’s / Namba ya Bure: 0800112020
Fax / Faksi: +255 22 2137593
Email Address / Barua pepe: uwekezaji@[Link] | Website / Tovuti: [Link]