Fillable Employer Group Verication Form (New York's 529 Advisor-Guided College Savings Program)

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Employer Group Verication Form (New York's 529 Advisor-Guided College Savings Program)

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ES_NYA_EGV 072001 0820 — Page 1 of 4
DO NOT STAPLE
1
1.
Employer or Existing Group information
Name of Employer
Employer Tax ID Present Number of Active
Employees or Members
Street Address
City State Zip Code
Telephone Number Fax Number
Name of Employer Group
Contact Person
E-mail Address
Contact Telephone Number
• Complete this form to establish a new or add to an existing Employer Group. Please see the Disclosure Booklet for more information.
• Investments may be made through Financial Professionals who have entered into a selling agreement with JPMorgan Distribution Services, Inc.
• 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
New York’s 529 Advisor-Guided College Savings Program
Employer Group Verication Form
ES_NYA_EGV 072001 0820 — Page 2 of 4
DO NOT STAPLE
2
2.
Financial Professional information (To be completed by the Financial Professional.)
Firm Name
Financial Professional Name (rst, middle initial, last)
Branch Number (If applicable) Financial Professional ID Number/IRD Number BIN Number (If applicable) Networking Level
(If applicable)
Mailing Address
City State Zip Code
Telephone Number
3.
New or Existing Account Owners to be Established under Employer Group
To add existing Accounts to this new group, list the existing Account Owner information below. Attach any new Enrollment
Applications you are prepared to submit now and list the new Account Owner information below as well. The Program will send
the new Group ID to the Financial Professional for use on future Enrollment Applications. The new Group ID will be applied to all
Accounts for these existing and new Account Owners.
New or Existing Account Owner Name
Social Security Number or Taxpayer Identication Number
New or Existing Account Owner Name
Social Security Number or Taxpayer Identication Number
New or Existing Account Owner Name
Social Security Number or Taxpayer Identication Number
New or Existing Account Owner Name
Social Security Number or Taxpayer Identication Number
ES_NYA_EGV 072001 0820 — Page 3 of 4
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3
4.
SIGNATURE — MUST SIGN BELOW
By signing below, I hereby certify that:
• all of the information provided on this form is complete and correct.
• this Employer Group is eligible for this program, pursuant to the eligibility requirements set out in the New York’s 529 Advisor-Guided
College Savings Program Disclosure Booklet.
SIGNATURE
Signature of Employer Group Contact Date (mm/dd/yyyy)
SIGNATURE
Signature of Financial Professional Date (mm/dd/yyyy)
529-F-EMPGRP 0720
ES_NYA_EGV 072001 0820 — Page 4 of 4
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4
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Employer Group Verication Form (New York's 529 Advisor-Guided College Savings Program)

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Completed 16 May 2021

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