Fillable Account Information Change Form (TD Ameritrade)

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Account Information Change Form (TD Ameritrade)

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ES_TDR_IC_081901 1119 — Page 1 of 5
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1
TD Ameritrade 529 College Savings Plan
Account Information Change Form
• Use this form to change: your name, mailing address, phone number,
email address, Successor Account Owner, or interested party information. You may
also use this form to transfer assets to a new account owner.
• If you are changing your name, you must also provide a copy of an official document
that changes your name certified within 60 days of this request (i.e. Marriage
Certificate, Divorce Decree, etc.).
• If you are changing the Account Owner of an existing Account, your signature must
be Medallion Signature Guaranteed in Section 9 by an authorized officer of a bank,
broker, or other qualified financial institution, and the new Account Owner must
include an Enrollment Form if an Account is not already established.
• Type in your information and print out the completed form, or print clearly, preferably
in capital letters and black ink. Mail the form to the address listed. Do not staple.
Forms can be downloaded from our website at
www.tdameritrade.com/collegesavings
,
or you can call us to order any form — or request assistance in completing this form — at
1.877.408.4644 any business day from 8 a.m. to 8 p.m. Central time.
1.
Current Account Owner information
Account Number(s) (To list more than three Accounts, use a separate sheet.)
Name of Account Owner (rst, middle initial, last)
Telephone Number (In case we have a question about your Account.)
2.
Information to update or change
Account Owner — Section 3 or Section 4
Successor Account Owner — Section 5
Individual Authorized to Act — Section 6
Interested Party — Section 7
TDA52903
1.877.408.4644
8 a.m. to 8 p.m. Central time M-F
www.tdameritrade.com/collegesavings
tdameritrade@NEST529.com
Regular mailing address:
TD Ameritrade 529 College Savings Plan
P.O. Box 30278
Omaha, NE 68103-1378
Overnight mailing address:
TD Ameritrade 529 College Savings Plan
920 Main Street, Suite 900
Kansas City, MO 64105
ES_TDR_IC_081901 1119 — Page 2 of 5
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3.
Updated Account Owner information
• If you are changing your name and/or contact information, provide the new information exactly as you would like it to appear on your
TD Ameritrade 529 College Savings Plan Account. You do not need to enter information that will not be changed.
• If you are changing your name, you must also provide a copy of an official document that changes your name certified within 60 days
of this request. (i.e. Marriage Certificate, Divorce Decree, etc.)
Name of Account Owner (rst, middle initial, last)
Permanent Street Address (P.O. boxes are not acceptable.)
City State Zip Code
Account Mailing Address if different from above (This address will be used as the Account’s address of record for all Account mailings.)
City State Zip Code
Telephone Number (In case we have a question about your Account.)
Email Address
4.
Transfer assets to new Account Owner
• This will transfer ownership and all obligations and rights of all of the assets in the referenced Account to the new Account Owner
listed below.
• If you transfer ownership, you must also provide a Medallion Signature Guarantee in Section 9.
• The new Account Owner will control the Account and the disposition of all assets held in the Account.
• The new Account Owner must also complete an Enrollment Form.
• A new Account Owner cannot withdraw funds within 10 business days of the change.
• You cannot change the Account Owner for a Minor-Owned or UGMA/UTMA Account.
Account Number (If applicable)
Name of New Account Owner (rst, middle initial, last)
Social Security Number or Taxpayer Identication Number (Required) Birth Date/Trust Date (mm/dd/yyyy)
ES_TDR_IC_081901 1119 — Page 3 of 5
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5.
Successor Account Owner information
• Complete this section only if you are adding, changing, or deleting Successor Account Owner information on your Account.
• As the Account Owner, you may designate a Successor Account owner to take control of the Account in the event of your death
or legal incapacity. You may revoke or change your designation later by completing the appropriate form. See the TD Ameritrade
529 College Savings Plan Program Disclosure Statement and Participation Agreement (Program Disclosure Statement) for more
information.
• The person you designate as Successor Account Owner cannot be a minor.
• A Successor Account Owner is not permitted on a Minor-Owned or UGMA/UTMA Account.
Check one.
Add Change Delete
Name of Successor Account Owner (rst, middle initial, last)
Mailing Address
City State Zip Code
Birth Date (mm/dd/yyyy)
6.
Individual Authorized to Act
An Individual Authorized to Act is required when the Account Owner is a minor or when the Account is owned by an entity or Trust.
The Individual Authorized to Act is the person who can transact on the Account. The address of the Individual Authorized to Act will be
used as the Account’s address of record for all Account mailings.
A.
Custodian of UGMA/UTMA Account (If replacing, an Enrollment Form signed by the new Custodian is required.)
Replace
Change information
Parent/Guardian if a Minor-Owned Account (If replacing, an Enrollment Form signed by the new parent/guardian is required.)
Replace
Change information
Trustee of Trust (Include letter of authorization.)
Add
Replace
Delete existing and do not add
Change information
Corporate Ofcer or Governmental Agent
Add
Replace
Delete existing and do not add
Change information
Agent or Attorney-in-Fact (Include Power of Attorney form.)
Add
Delete existing and do not add
ES_TDR_IC_081901 1119 — Page 4 of 5
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Individual Authorized to Act (Continued)
B. Information to change.
Individual Authorized to Act (First name) (m.i.)
Individual Authorized to Act Legal Name (Last name)
Social Security Number or Taxpayer Identication Number (Required)
Permanent Street Address (P.O. boxes are not acceptable.)
City State Zip Code
Account Mailing Address if different from above (This address will be used as the Account’s address of record for all Account mailings.)
City State Zip Code
Telephone Number (In case we have a question about your Account.)
7.
Interested party information
Complete this section if you want to add an individual as an interested party to the account. An interested party will be able to call
the Plan, receive information verbally about the Account, and receive quarterly statements. An interested party will not be allowed
to make changes to the account or request transactions. You can also use this section to replace or change existing interested party
information on your Account. To add or change information for more than one interested party, use a separate sheet.
Check one.
Add Replace interested party Change current information Delete
Name (rst, middle initial, last)
Mailing Address
City State Zip Code
Telephone Number (In case we have a question about your Account.)
Relationship to Account Owner.
Compliance Investment Advisor Parent/Guardian Other
ES_TDR_IC_081901 1119 — Page 5 of 5
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8.
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
change request.
• By signing below, I authorize the Program Manager or its designee to change my Account information according to the
instructions above.
• 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 verication 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
the Account.
• 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
Signature of Account Owner Date (mm/dd/yyyy)
9.
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 certication that your signature is genuine.
• You can obtain a Medallion Signature Guarantee from an authorized ofcer of a bank, broker, or other qualied 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
Signature of Account Owner (In the presence of the authorized ofcer.)
Signature of Guarantor
Title
Name of Institution
Date (mm/dd/yyyy)
Authorized Ofcer 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 afliates.
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.
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Account Information Change Form (TD Ameritrade)

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Completed 20 September 2020

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