TR-0453 (Rev. 8/18) - 2 - RDA-2516
2. Change Designated Beneficiary
Any new Designated Beneficiary must be a “member of the family” of your current Designated Beneficiary,
as defined in the Plan Disclosure and Participation Agreement. The Beneficiary may only be changed once.
New Designated Beneficiary:
First Name MI Last Name
Street Address Apartment / Unit
City State Zip Code
Social Security Number Date of Birth (mmddyyyy)
Male Female Relationship to Account Owner
U.S. Citizen/Resident Alien
(Non-resident aliens are not eligible to participate in the Plan.)
I certify that the information I have provided and all future information I will provide with respect to my TN Stars
College Savings 529 Program account is true, complete and correct. I have received, read and agree to the
terms set forth in the Plan Disclosure and Participation Agreement.
I will indicate the Purchaser will be required to provide the TN Stars College Savings 529 Program with a copy
of a death certificate in the case of the death of the Purchaser or an acceptable medical authorization or
court order in the case of the incapacity of the Purchaser and such other information as the TN Stars College
Savings 529 Program requires prior to taking any action regarding the account.
Account Owner’s Signature Date
4. Before You Mail, Have You ...
Entered all required information in Section 1?
Signed this form in Section 3?