ES_NYA_BD 072001 0820 — Page 2 of 2
DO NOT STAPLE
2
3.
SIGNATURE — MUST SIGN BELOW
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 modication 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-qualied withdrawals, terminating my Account, or changing my Beneciary to an ineligible person. Account
Owners should seek advice from a qualied 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 afliates, 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 specic 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 Qualied Tuition Program offered by the State of New York on behalf of the Beneciary 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 afliates to provide my Financial Professional
with access to my Account and to perform transactions on my behalf. 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, LLC., JP
Morgan Distributors, Inc., the investment managers for the underlying funds in the Plan, and their respective afliates, 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 afliates 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)
SIGNATURE
Signature of New Financial Professional Date (mm/dd/yyyy)
529-F-BD-INFOCHG 0720
