ES_TDR_IC_081901 1119 — Page 5 of 5
DO NOT STAPLE
Signature — YOU MUST SIGN BELOW
• I certify that I have read, understand, consent, and agree to all the terms and conditions of the Program Disclosure Statement
and understand the rules and regulations governing the TD Ameritrade 529 College Savings Plan as they relate to this information
• By signing below, I authorize the Program Manager or its designee to change my Account information according to the
• If I am changing the Account Owner, by signing this form as the current Account Owner, I acknowledge that the transfer is subject
to the Program Manager’s verication of the new Account Owner. I have consulted with a tax advisor concerning the potential
income gift and estate tax consequences of my transfer of ownership before signing and submitting this form.
• If the Account is owned by an entity or trust, I certify that I am authorized to act on its behalf in making this request. If the Account
is a minor-owned Account or is funded with UGMA/UTMA assets, I further certify that I am the parent/guardian/custodian of
• If I have changed the Account Owner or address, I understand that a withdrawal request made within ten (10) business days
of this change must be Medallion Signature Guaranteed below.
Signature of Account Owner Date (mm/dd/yyyy)
Medallion Signature Guarantee — REQUIRED FOR CHANGES TO THE ACCOUNT OWNER OF AN
EXISTING ACCOUNT, REPLACING CUSTODIAN, AND/OR REPLACING A PARENT/GUARDIAN
• You must provide the following information as underwritten certication that your signature is genuine.
• You can obtain a Medallion Signature Guarantee from an authorized ofcer of a bank, broker, or other qualied nancial institution. A
notary public cannot provide a Medallion Signature Guarantee, nor can you guarantee your own signature.
• Do not sign below until you are in the presence of the authorized officer providing the Medallion Signature Guarantee.
I certify that the information provided herein is true and complete in all respects, and that I have read and understand, consent,
and agree to all the terms and conditions of the Program Disclosure Statement.
Signature of Account Owner (In the presence of the authorized ofcer.)
Signature of Guarantor
Name of Institution
Authorized Ofcer to place stamp here
Securities Products: Not FDIC Insured - No Bank Guarantee - May Lose Value
Nebraska Educational Savings Plan Trust, Issuer. First National Capital Markets, Inc.,
Distributor, Member FINRA, SIPC. TD Ameritrade, Inc., sub-administrator. TD Ameritrade
Investment Management, LLC, portfolio consultant. First National Capital Markets and
First National Bank of Omaha are afliates.
TD Ameritrade, Inc. renders certain marketing and administrative services to the TD
Ameritrade 529 College Savings Plan. TD Ameritrade Investment Management, LLC
renders portfolio consulting services to First National Bank of Omaha and the Nebraska
Investment Council. TD Ameritrade is a trademark jointly owned by TD Ameritrade IP
Company, Inc. and the Toronto-Dominion Bank. All rights reserved. Used with Permission.