Fillable Enrollment Application (New York's 529 Advisor-Guided College Savings Program)

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Enrollment Application (New York's 529 Advisor-Guided College Savings Program)

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ES_NYA_EN_120820 — Page 1 of 12
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1
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.
Account type
• Select one of the Account types below.
• If you do not select an Account type, we will open an individual Account for you.
Individual Account. I am opening a new Advisor-Guided Plan Account.
UGMA/UTMA Account. I am opening this Account with assets liquidated from an UGMA/UTMA custodial account.
I am aware that this may be a taxable event.
Indicate the state (please abbreviate) in which the UGMA/UTMA custodial account was opened.
Business Entity/Trust Account. I am opening this Account as a corporation, partnership, association, estate, or trust.
(You must include documentary evidence. Please enclose supporting documents substantiating the status of the Business Entity/
Trust Account, and the authorization of the authorized signer, including the first and last pages of the trust. We may also request
additional information from you.)
Other Entities. I am opening this Account on behalf of a scholarship program sponsored by a non-prot or state or local
governmental entity. (You must include documentary evidence. Please enclose supporting documents substantiating the status of
the Entity Account Owner and the authorization of the authorized signer. We may also request additional information from you.)
IMPORTANT INFORMATION ABOUT OPENING A NEW ACCOUNT. We are required by federal law to obtain from each person who
opens an Account in New York’s 529 Advisor-Guided College Savings Program
®
(the “Advisor-Guided Plan” or the “Plan”) certain personal
information — including name, street address, and date of birth, among other information—that will be used to verify his/her identity. If you
do not provide us with this information, we will not be able to open your Account. If we are unable to verify your identity, we reserve the right
to close your Account or take other steps we deem reasonable.
• 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.
*NY ADV ENROLL*
New York’s 529 Advisor-Guided College Savings Program
Enrollment Application
ES_NYA_EN_120820 — Page 2 of 12
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2.
Account Owner, UGMA/UTMA Custodian, Trust or Entity information (The Account Owner is the person or entity
who owns or controls the Account. If the Account Owner is a minor, provide parent/guardian’s information in Section 5.)
Legal First Name of the Account Owner, Custodian, or Trustee (Required) m.i.
Legal Last Name of the Account Owner, Custodian, or Trustee (Required)
Name of Entity/Trust (If applicable) (Required)
Social Security Number or Taxpayer Identication Number of Entity/Trust Tax Identication Number
Account Owner, Custodian, or Trustee (Required) (Required only for Entity/Trust owned accounts)
Account Owner, Custodian, or Trustee Birth Date (Required) Trust Date (Required only for Entity/Trust owned accounts)
Citizenship (Required)
U.S. OR Resident Alien
(Non-Resident Aliens are not eligible) Country of Citizenship (If not a U.S. Citizen)
Primary Phone Secondary Phone
(Providing at least one mobile phone number is preferred. We use phone numbers to contact you if we have questions about your Account and for your information security.)
Email Address
Residential/Legal Address (A P.O. box is not acceptable.) (Required)
City State Zip Code
Account Mailing Address (Required 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
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3.
Beneciary information (The Beneciary is the future student. A Beneciary is not required if the Account Owner is a non-prot
organization.)
Legal First Name (Required) m.i.
Legal Last Name (Required)
Social Security Number or Taxpayer Identication Number (Required) Birth Date (mm/dd/yyyy) (Required)
Citizenship (Required)
U.S. OR Resident Alien
(Non-Resident Aliens are not eligible) Country of Citizenship (If not a U.S. Citizen)
Check if Beneciary’s address is the same as Account Owner, otherwise complete the following:
Mailing Address (Required)
City State Zip Code
4.
Successor Account Owner information
• The Successor Account Owner is the person designated to assume Account ownership in the event of the Account Owner’s death.
• You may revoke or change the Successor Account Owner at any time. See the New York’s 529 Advisor-Guided College Savings
Program
®
Disclosure Booklet and Tuition Savings Agreement (Disclosure Booklet) for more information.
Legal First Name m.i.
Legal Last Name
Birth Date (mm/dd/yyyy)
5.
Designated Parent/Guardian information
• Complete this section only if the Account Owner listed in Section 2 is a minor.
Legal First Name of Parent or Guardian (Required) m.i.
Legal Last Name of Parent or Guardian (Required)
Social Security Number or Taxpayer Identication Number (Required) Birth Date (mm/dd/yyyy) (Required)
ES_NYA_EN_120820 — Page 4 of 12
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6.
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
By signing below, I certify that I am the Financial Professional to the Account Owner named in Section 2 above and that the information
provided in this Section 6 is true and correct and that Ascensus Investment Advisors, LLC and its afliates may rely on it in administering
this Account.
SIGNATURE
Financial Professional Signature Date (mm/dd/yyyy)
ES_NYA_EN_120820 — Page 5 of 12
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7.
Sales charge discount or waiver for Class A Units (If Applicable)
• To qualify for a sales charge reduction, you must notify the Advisor-Guided Plan.
• Check all that apply.
A. Qualied Employee. I am eligible for a sales charge waiver under the terms of the Disclosure Booklet because I am employed
by, or related to someone employed by:
Legal Name (rst, middle initial, last)
Qualifying Employer’s Name
Relationship Self Spouse Domestic Partner Child Ofcer, Director, or Trustee
Parent Grandparent Grandchild Dependent of the Person
B. Rights of Accumulation (ROA). Check this box if you or an immediate family member owns units in the Advisor-Guided Plan
or shares of J.P. Morgan Funds that are eligible to be combined for a reduced sales charge. Include the account number(s) and
market value(s) below. Please see the Disclosure Booklet for additional information. Note: To list more than two accounts, use a
separate sheet.
Legal Name of Family Member (rst, middle initial, last)
OR
529 Account Number Account Number (Where J.P. Morgan Funds are held)
$
, .
Market Value CUSIP, Fund Number, or Symbol
Legal Name of Family Member (rst, middle initial, last)
OR
529 Account Number Account Number (Where J.P. Morgan Funds are held)
$
, .
Market Value CUSIP, Fund Number, or Symbol
C. Letter of Intent. (Please see the Disclosure Booklet for additional information.) I intend to make additional purchases into Class
A Units in the Advisor-Guided Plan or shares of J.P. Morgan Funds and understand that I can reduce my sales charges through
accumulated investments. I plan to invest over a 13-month period following the date of receipt of this application an aggregate
amount of at least:
$50,000 $100,000 $250,000 $500,000 $1,000,000
I am already investing under an existing Letter of Intent:
Account Number
D. Employer Group. To qualify for a reduced Class A sales charge as an eligible member of an Employer Group, your Employer
Group must be eligible for this program pursuant to the eligibility requirements set out in the Disclosure Booklet. Please
provide your Employer Group name and number below.
Employer Group Name
Employer Group Number
ES_NYA_EN_120820 — Page 6 of 12
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8.
Investment Option selection
• Before choosing your Investment Option(s), see the Disclosure Booklet (also available at www.ny529advisor.com) for complete
information about the investments offered.
• The assets will remain in the Portfolios you select until you make a withdrawal or exchange.
• You must allocate at least 1% of your contributions to each Investment Option that you choose. Use whole percentages only.
• Your investment percentages must total 100%.
• You may leave this section blank if this form is accompanied by the Change of Ownership Form, or you may complete this section to
designate a new Account asset allocation upon your ownership change.
• These Investment Options are designed to help you save for post-secondary higher education expenses.
Age-Based Investment Option: Class A Units Class C Units
JPMorgan 529 Age-Based Portfolio
%
%
(Your investment will be allocated to the appropriate
Age-Based Portfolio for your Beneciary’s age.)
Asset Allocation Portfolio Investment Options: Class A Units Class C Units
JPMorgan 529 Aggressive Portfolio
%
%
JPMorgan 529 Moderate Growth Portfolio
%
%
JPMorgan 529 Moderate Portfolio
%
%
JPMorgan 529 Conservative Growth Portfolio
%
%
JPMorgan 529 Conservative Portfolio
%
%
JPMorgan 529 College Portfolio
%
%
Single Fund Portfolio Investment Options: Class A Units Class C Units
SSGA 529 Portfolio S&P 1500 Composite Stock Market ETF Portfolio
%
%
JPMorgan 529 Equity Income Portfolio
%
%
JPMorgan 529 Large Cap Growth Portfolio
%
%
JPMorgan 529 Mid Cap Value Portfolio
%
%
JPMorgan 529 Growth Advantage Portfolio
%
%
SSGA 529 S&P 600 Small Cap ETF Portfolio
%
%
JPMorgan 529 Small Cap Equity Portfolio
%
%
JPMorgan 529 Realty Income Portfolio
%
%
SSGA 529 Portfolio Developed World ex-US ETF Portfolio
%
%
JPMorgan 529 International Equity Portfolio
%
%
SSGA 529 MSCI ACWI ex-US ETF Portfolio
%
%
JPMorgan 529 Core Bond Portfolio
%
%
JPMorgan 529 Core Plus Bond Portfolio
%
%
SSGA 529 Portfolio Aggregate Bond ETF Portfolio
%
%
JPMorgan 529 Short Duration Bond Portfolio
%
%
JPMorgan 529 Ination Managed Bond Portfolio
%
%
JPMorgan 529 U.S. Government Money Market Portfolio
%
%
%
%
0
0
ES_NYA_EN_120820 — Page 7 of 12
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9.
Initial contribution
• Your initial contribution must be at least: $25 per month or $75 per quarter by Recurring Contribution; $25 per month by Payroll Direct
Deposit; or $1,000 by check or Electronic Bank Transfer (EBT).
• Your initial contribution can come from several sources combined. If you combine sources, check the appropriate box for
each source and write in the contribution amount for each.
• Contributions will not be available for withdrawal for seven (7) business days.
Source of funds (Check all that apply.)
A. Personal check. Important: All checks must be payable to New York’s 529 Advisor-Guided College Savings Program
®
.
Note: Third-party personal checks will only be accepted if they are payable to the Account Owner or Beneciary, are for an
amount less than $10,000, and are properly endorsed.
$
, .
Amount
B. Electronic Bank Transfer (EBT). You can make a contribution by transferring money from your bank account. To set this up,
you must provide bank information in Section 10c. The maximum contribution through a one-time EBT may be limited. See the
Disclosure Booklet for more details.
$
, .
Amount (to debit from your bank account immediately upon opening your Account)
C. Recurring Contribution. You can have a set amount automatically transferred from your bank account on a monthly or quarterly
basis. To set this up you must complete Section 10a and Section 10c.
00
$
, .
Frequency:
Amount ($25 monthly/$75 quarterly minimum) (Check one) Monthly Quarterly
D. Payroll Direct Deposit. If you want to make contributions to your Advisor-Guided Plan Account directly as a Payroll Direct Deposit, you
must contact your employer’s payroll ofce to verify that you can participate. Payroll Direct Deposit contributions will not be made to
the Plan Account until you have received a Payroll Direct Deposit Conrmation Form from the Plan and have communicated these
deposit instructions to your employer. Note: Contributions by Payroll Direct Deposit must total a minimum of $25 per month per Account.
00
$
, .
Check here if you are an employee
of the State of New York.
Amount per Pay Period State Agency/Department
E.
Direct rollover or plan transfer from a New York’s 529 College Savings Program Direct Plan Account, another 529
plan account, or an Education Savings Account (ESA). By law, rollovers between 529 plans with the same Beneciary are
permitted only once every 12 months. Complete and attach an Incoming Rollover Form. You can get this form online at
www.ny529advisor.com or by calling 1.800.774.2108.
$
, .
Amount (Estimated)
F. Indirect rollover from another 529 plan account, Education Savings Account (ESA), or qualified U.S. savings bond.
You can transfer money from one of these options to your bank account and from there, to the Advisor-Guided Plan.
Important: Indirect rollovers require the documentation described below. If you do not provide this documentation, the entire
amount will be considered earnings, which could result in adverse tax consequences, particularly if you later make a non-qualied
withdrawal from your Advisor-Guided Plan Account.
•
Indirect rollover from another 529 plan or an ESA — Enclose documentation from the distributing nancial institution
showing contributions and earnings.
• Indirect rollover from qualified U.S. savings bonds — Include a statement or IRS Form 1099-INT, issued by the distributing
nancial institution, that shows the interest paid as of the redemption date.
$
, .
$
, .
Contributions Earnings
G. Change of Ownership. Select this if the initial contribution is a transfer from an existing Advisor-Guided Plan Account currently
owned by someone else (must include a Change of Ownership Form or other documentation as instructed).
ES_NYA_EN_120820 — Page 8 of 12
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10.
Future contributions (Optional)
You may make future contributions by personal check or electronically through Recurring Contributions or by Electronic Bank Transfer (EBT).
Important: The Recurring Contribution and Electronic Bank Transfer options can be used only with accounts held by a U.S. bank, savings
and loan association, or credit union that is a member of the Automated Clearing House (ACH) network. Money market mutual funds and
cash management accounts offered by non-bank nancial companies are not members of the ACH network. For further information, please
refer to the Disclosure Booklet.
• Contributions by Recurring Contribution or Electronic Bank Transfer will not be available for withdrawal for seven (7) business days.
A. Recurring Contributions. Through Recurring Contributions, money will be transferred electronically at regular monthly or
quarterly intervals from your bank, savings and loan association, or credit union account to your Advisor-Guided Plan Account. You
may cancel or change the investment amount and frequency at any time by logging onto your Account at www.ny529advisor.com
or by calling 1.800.774.2108.
Note: A plan of regular investment cannot assure a prot or protect against a loss in a declining market.
Important: To set up this option, you must provide bank information in Section 10c.
Amount of Debit:
00
$
, .
Frequency:
($25 monthly/$75 quarterly minimum) (Check one) Monthly Quarterly
Start Date*:
Date (mm/dd/yyyy)
* Your bank account will be debited on the day you designate, provided the day is a regular business day. You will receive the trade
date of the business day on which the bank debits occurs. If no date is indicated, debits will be made on the 15th day of the month
or on the next business day thereafter. See the Disclosure Booklet for more details.
Annual Increase. You may increase your Recurring Contribution automatically on an annual basis.
Your contribution will be adjusted each year in the month that you specify by the amount indicated.
Amount of increase:
00
$
, .
Month**:
** The month in which your Recurring Contribution will be increased. The rst increase will occur at the rst instance of your
selected date of the month.
B. Electronic Bank Transfer. Through Electronic Bank Transfer, you can make a contribution of at least $25 whenever you want
by transferring money from your bank account. We will keep your bank instructions on le for future Electronic Bank Transfer
contributions.
Important: To set up this option, you must provide bank information in Section 10c.
C. Bank information. Required to establish the Recurring Contribution or Electronic Bank Transfer service. The Account Owner
listed in Section 2 must be a registered owner of the bank account listed below.
Important: I acknowledge that my bank or nancial institution is located in the U.S. and/or adheres to U.S. banking regulations.
Bank Name
Bank Registration (Name on bank account; of which 529 Account Owner must be registered.)
Account Type:
Bank Routing Number Bank Account Number (Check one) Checking Savings
Note: The routing number is usually located in the bottom left corner of your checks. You can also ask your bank for the routing number.
ES_NYA_EN_120820 — Page 9 of 12
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11.
Dollar-cost averaging (Optional)
• The minimum contribution to dollar-cost average is $5,000. By selecting this feature, you authorize the Advisor-Guided Plan to exchange money
automatically from one Portfolio to another on a monthly basis. The minimum exchange amount is $100 per Portfolio.
Note: If dollar-cost averaging is established at the time the new Account is opened or instituted for new contributions to an existing
Account, it will not count as an Investment Exchange. However, if you make any changes to your dollar-cost averaging selections,
that will count as an Investment Exchange. The allocations will be made on the day of the month you specify below, or if no day is
specied, on the 15th of the month. If such day is not a business day, the allocation will occur on the next succeeding business day and
will continue until the dollar-cost averaging has completed per the instructions below. Stopping or changing the automatic allocation
instructions with respect to prior contributions still remaining in the initial Portfolio will constitute a reallocation for purposes of
Investment Exchange limitations. See the Disclosure Booklet for additional information.
Start Date*:
Date (mm/dd/yyyy)
Frequency:
(Check one) Monthly Quarterly Semi-annually Annually
Day of Allocation Exchange:
(dd)
Stop Type:
Complete Portfolio Balance
(Check one)
Specify Total Exchange Amount
$
, .
(If less than complete Portfolio balance) ($5,000 minimum)
Stop Date
Date (mm/dd/yyyy)
I authorize the Advisor-Guided Plan to exchange from the following Investment Option (Selected in Section 8.)
$
, .
From Investment Option ($5,000 minimum initial Portfolio investment) Amount* ($100 minimum per month)
To the following Investment Options
$
, .
To Investment Option Amount* ($100 minimum per Portfolio)
$
, .
To Investment Option Amount* ($100 minimum per Portfolio)
$
, .
To Investment Option Amount* ($100 minimum per Portfolio)
* Amount per Portfolio per frequency selected above. Please specify only dollar amounts, not percentages.
ES_NYA_EN_120820 — Page 10 of 12
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12.
Trusted Contact Person (Optional)
• Completion of this section is optional and you may withdraw it at any time by notifying the Plan in writing.
• By completing this Section 12, you designate the person identied below as your Trusted Contact Person, and authorize the
Advisor-Guided Plan and its present and future direct and indirect subsidiaries, afliates, successors and assigns to contact your
Trusted Contact Person and disclose information about your Plan account:
• to address possible nancial exploitation;
• to conrm the specics of your current contact information, health status, or the identity of any legal guardian, executor, trustee,
or holder of a power of attorney; or
• as otherwise permitted by Financial Industry Regulatory Authority Rule (FINRA) 2165.
• A Trusted Contact Person must be at least eighteen (18) years of age.
• This election does not create or give your Trusted Contact Person a power of attorney. Your Trusted Contact Person
will not be able to access your Account or transfer assets to or from your Account.
Name of Trusted Contact Person (rst, middle initial, last)
Trusted Contact Person’s Telephone Number
Trusted Contact Person’s Email Address
Trusted Contact Person’s Mailing Address
City State Zip Code
Relationship to Account Owner.
(e.g., spouse, child, holder of my power of attorney, lawyer, accountant, etc.)
ES_NYA_EN_120820 — Page 11 of 12
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11
13.
Signature and Certication
Each person signing on behalf of an entity represents that his/her actions are authorized and that the information provided and all
future information provided with respect to the Account is true, complete and correct.
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 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, LLC, 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 the Investment Options offered by the Plan have been designed to save for post-secondary higher education
expenses and that for New York State tax purposes, the earnings on a withdrawal used to pay K-12 Expenses will be considered a
nonqualied withdrawal and will require the recapture of any New York State tax benets that have accrued on contributions.
• 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.
• If I have completed Section 12, I further certify that:
• I authorize the Plan to contact the person listed as my Trusted Contact Person above and disclose information about my Account
to address possible nancial exploitation, to conrm the specics of my current contact information, health status, or the identity
of any legal guardian, executor, trustee or holder of a power of attorney, or as otherwise permitted by FINRA Rule 2165. I certify
that the Trusted Contact Person is at least eighteen (18) years of age.
• I understand that by signing this form, I authorize Ascensus Broker Dealer Services, LLC or its afliates to provide my Trusted
Contact Person 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, LLC, 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 Trusted Contact Person.
• I understand that by signing this form, I authorize Ascensus Investment Advisors, LLC or its afliates 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 afliates,
agents, and employers, from any losses I incur as a result of the acts or omissions of my Financial Professional.
• 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.
ES_NYA_EN_120820 — Page 12 of 12
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12
Signature and Certication (continued)
I certify, under penalties of perjury, that:
• the Social Security Number or Taxpayer ID Number I provided is correct;
• I am a U.S. Citizen or legal U.S. Resident Alien; and
• all the information on the Enrollment Application is correct.
Please note: Federal law allows distributions of up to $10,000 per beneciary per year for tuition expenses in connection with
enrollment or attendance at an elementary or secondary public, private, or religious school. Under New York State law, however,
distributions used to pay such expenses will be considered non-qualied withdrawals and will require the recapture of any New York
State tax benets that have accrued on contributions.
Important! Please read before making a contribution by check to New York’s 529 Advisor-Guided College Savings Program
®
.
For purposes of a New York State tax deduction, the contribution check must be from the Account Owner (person listed in Section 2
of this form). All other non-owner contributions will not be eligible for a New York State tax deduction. Please see the Disclosure
Booklet for further details.
I will retain a copy of this Enrollment Application and the Disclosure Booklet for my records.
SIGNATURE
Signature of Account Owner (If the Account Owner is a minor, the designated parent or guardian must sign.) Date (mm/dd/yyyy)
529-F-ENROLL 1220
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Enrollment Application (New York's 529 Advisor-Guided College Savings Program)

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Completed 16 May 2021

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