Fillable Account Information Change Form (New York's 529 Advisor-Guided College Savings Program)

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Account Information Change Form (New York's 529 Advisor-Guided College Savings Program)

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ES_NYA_AIC_030821 — Page 1 of 8
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• Complete this form to change your: mailing address, phone number, email address, your Beneciary’s name or mailing address, Successor
Account Owner, or to add or change Interested Party information. You may also be able to update some of these online by logging into your
Account at www.ny529advisor.com.
• If you are changing your name, your former signature and your new signature must be Medallian Signature Guaranteed in Section 8
by an authorized ofcer of a bank, broker, or other qualied nancial institution. If you are changing your Beneciary’s name, you must
provide supporting legal documentation for this change.
• 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 below. Do not staple.
• Forms can be downloaded from our website at www.ny529advisor.com, or you can call us to order any form — or request assistance in
completing this form — at 1.800.774.2108 any business day from 8 a.m. to 7 p.m. Eastern time.
Return this form and any other required documents to:
New York’s 529 Advisor-Guided College Savings Program
P.O. Box 55498
Boston, MA 02205-5498
For overnight delivery or registered mail, send to:
New York’s 529 Advisor-Guided College Savings Program
95 Wells Avenue, Suite 155
Newton, MA 02459
1.
Current Account Owner information
Account Number(s) (To list more than six 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
Beneciary — Section 4
Successor Account Owner — Section 5
Interested Party — Section 6
New York’s 529 Advisor-Guided College Savings Program
Account Information Change Form
ES_NYA_AIC_030821 — Page 2 of 8
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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
New York’s 529 Advisor-Guided College Savings Program (“Advisor-Guided Plan” or the “Plan”) Account.
• If you are changing your name, you must also provide a Medallion Signature Guarantee in Section 8.
Name of Account Owner (rst, middle initial, last)
Telephone Number (In case we have a question about your Account.)
Email Address
Permanent Street Address (A P.O. box is 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 and for all Account mailings.)
City State Zip Code
4.
Updated Beneciary information
• If you are changing your Beneciary’s name and/or mailing address, provide the new information exactly as you would like it
to appear on your Advisor-Guided Plan Account.
• If you are changing your Beneciary’s name you must provide supporting legal documentation of the new name with this form.
Name of Beneciary (rst, middle initial, last)
Mailing Address
City State Zip Code
ES_NYA_AIC_030821 — Page 3 of 8
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5.
Successor Account Owner information
• Complete this section only if you are adding, changing, or removing Successor Account Owner information on your Account.
• You may revoke or change the Successor Account Owner at any time. See the Advisor-Guided Plan Disclosure Booklet and Tuition
Savings Agreement (“Disclosure Booklet”) for more information. You should also consider consulting a qualied tax professional
about the potential tax consequences of a change in Account Owner at your death.
Check one.
Add Change Delete
Name of Successor Account Owner (rst, middle initial, last)
Birth Date (mm/dd/yyyy)
6.
Interested Party information
• Complete this section if you want additional persons as an Interested Party to receive quarterly statements on the Account or if you
are replacing or changing 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)
Address
City State Zip Code
Telephone Number (In case we have a question about your Account.)
Relationship to Account Owner.
Compliance Investment Professional Parent/Guardian Other
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7.
Signature — YOU MUST SIGN BELOW
IMPORTANT: If you are changing your name, do not sign in this section; see Section 8.
By signing below, I hereby certify that:
• I have received the Disclosure Booklet and Tuition Savings Agreement of New York’s 529 Advisor-Guided College Savings Program
(“Disclosure Booklet”). I understand that by signing this form, I am agreeing to be bound by the terms and conditions of the
Disclosure Booklet. I understand that the New York’s 529 Advisor-Guided College Savings Program (“Plan”) may from time to time
amend the Disclosure Booklet, and I agree I will be subject to the terms of those amendments. I understand that the Disclosure
Booklet and this form shall be construed, governed, and interpreted in accordance with the laws of the State of New York.
• I understand that the Disclosure Booklet and the Plan forms signed by me constitute the entire agreement between the Account
Owner and the Plan. No person is authorized to make an oral modication to this agreement.
• I understand that I may incur federal, state or local income and penalty taxes as a consequence of certain activities, including without
limitation non-qualied withdrawals, terminating my Account, or changing my Beneciary to an ineligible person. Account Owners
should seek advice from a qualied tax professional.
• I understand that contributions to the Plan are not insured and that the investment returns are not guaranteed by the Federal Deposit
Insurance Corporation, the State of New York, its agencies, or any other government or government agency, Ascensus Broker Dealer
Services, Inc., and its afliates, JP Morgan Distribution Services, Inc., or the investment managers for the underlying funds in the
Plan. There is no assurance that the accounts under the Plan will generate any specic rate of return; and there is no assurance that
the Account will not decrease in value. I understand that I could lose money.
• I understand that contributions that cause the total balance of this Account and any other Accounts established in the Plan and in
any other Qualied Tuition Program offered by the State of New York on behalf of the Beneciary to exceed the Maximum Account
Balance set forth in the Disclosure Booklet are not permitted. I understand that if a contribution is made to my Account that exceeds
the Maximum Account Balance, all or a portion of the contribution amount will be returned to me or the contributor.
• I understand by signing this form, I authorize Ascensus Investment Advisors, LLC or its afliates to provide my Financial Professional
or Interested Party with information regarding my Account. I agree to indemnify, defend, and hold harmless the Plan, the State
of New York, its agencies, or any other government or government agencies, Ascensus Broker Dealer Services, Inc., JP Morgan
Distributors, Inc., the investment managers for the underlying funds in the Plan, and their respective afliates, agents, and employers,
from any losses I incur as a result of the acts or omissions of my Financial Professional.
• I certify that all the information that I provided on this form is true and accurate in all material respects, that Ascensus Investment
Advisors, LLC and its afliates are entitled to rely on the information provided herein and the instructions provided on this form, and
that I am bound by any and all statutory, administrative, and operating procedures that govern the Plan.
SIGNATURE
Signature of Account Owner Date (mm/dd/yyyy)
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529-F-INFOCHANGE 3/21
8.
Medallion Signature Guarantee — REQUIRED FOR NAME CHANGES TO THE ACCOUNT OWNER
OF AN EXISTING ACCOUNT ONLY
• You must provide the following information as underwritten certication that the new signature is genuine.
• You can obtain a Medallion Signature Guarantee from an authorized ofcer 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 signature guarantee.
By signing this form I agree to all of the certications, terms and conditions set forth above in Section 7.
SIGNATURE
Authorized Ofcer to place stamp here
Former Signature of Account Owner (For name change only.)
Current Signature of Account Owner
Signature of Guarantor
Title
Name of Institution
Date (mm/dd/yyyy)
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Account Information Change Form (New York's 529 Advisor-Guided College Savings Program)

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Completed 16 May 2021

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