ES_TDR_EN_081901 1119 — Page 9 of 12
DO NOT STAPLE
Signature — YOU MUST SIGN BELOW
• By signing below, I hereby acknowledge that I have received, read, and that by signing this form agree to the terms and conditions of
the Program Disclosure Statement and Participation Agreement which governs all aspects of this Account and is incorporated herein
by reference. I will retain a copy of each for my records.
• I certify that all of the information I have provided on this form is accurate and complete and that I am bound by the terms, rights,
and responsibilities stated in the Program Disclosure Statement and Participation Agreement and this form, and by any and all
statutory, administrative and operating procedures that govern the TD Ameritrade 529 College Savings Plan. Except as set forth
below, I understand that the Program Disclosure Statement and Participation Agreement, and Enrollment Form and any subsequent
forms signed by me, constitute the entire agreement between me and the Nebraska Educational Savings Plan Trust (Trust). No
person is authorized to make an oral modication to this agreement.
• I understand investments in the TD Ameritrade 529 College Savings Plan are not guaranteed or insured by the FDIC or any other
government agency, and are not deposits or other obligations of any depository institution. Investments are not guaranteed or
insured by the State of Nebraska, the Nebraska State Treasurer, the Nebraska Investment Council, First National Bank of Omaha,
TD Ameritrade, TD Ameritrade Investment Management, LLC, or their authorized agents or afliates, and are subject to investment
risks, including loss of the principal amount invested.
• I understand that participation in the TD Ameritrade 529 College Savings Plan does not guarantee that contributions and the
investment return on contributions, if any, will be adequate to cover tuition and other higher education expenses or that a
Beneciary will be admitted to or permitted to continue to attend an Eligible Educational Institution.
• I intend to use my Account solely to pay the qualied higher education expenses of the Beneciary.
• If this new account is being opened because a former account owner is deceased or legally incapacitated and I had been designated
the Successor Account Owner on that account, by signing below I certify that I am not aware of any adverse claim of ownership
or court order relating to the ownership of this Account and I agree to hold harmless the 529 Parties from any third party claims
relating to the transfer of ownership to you.
• If I am rolling over assets from another 529 Plan, by signing below I certify that there has not been a rollover for this Beneciary
during the prior 12-month period. I further understand that moving assets among the same Account Owner and Beneciary Account
that are in any 529 Plan issued by the Trust will count toward my permitted twice per calendar year Investment Option change limit
and I certify that more than one Investment Option change has not occurred during the calendar year.
• If I have chosen the AIP or EFT option, I authorize the Program Manager and its designees, upon telephone or online request, to pay
amounts representing redemptions made by me or to secure payment of amounts invested by me, by initiating credit or debit entries
to my account at the bank named in Section 8F. I authorize the bank to accept any such credits or debits to my account without
responsibility to their correctness. I acknowledge that the origination of ACH transactions involving my bank account must comply
with U.S. law. I further agree that the 529 Parties will not incur any loss, liability, cost, or expense for acting upon my telephone or
online request. I understand that this authorization may be terminated by me at any time by notifying the Program Manager and the
bank by telephone or in writing, and that the termination request will be effective as soon as the Program Manager and the bank
have had a reasonable amount of time to act upon it. I certify that I have authority to transact on the bank account identied by me
in Section 8F or that the account owners of such bank account have authorized me to institute this AIP and/or EFT service from
their account on their behalf.
• To the best of my knowledge, each contribution to my Account, when added to the value of all other accounts established for the
same Beneciary in 529 plans issued by the Trust will not cause the aggregate balances in such accounts to exceed the Maximum
Contribution Limit then in effect or the cost in current dollars of qualied higher education expenses that I reasonably anticipate the
Beneciary will incur.
• If the Account is minor-owned or is funded with UGMA/UTMA assets, I certify that I am of legal age in my state of residence, I am
the parent/guardian/custodian of the Account, and that I am authorized to open the Account, and I am not aware of any adverse
claim of ownership or court order relating to this account, and I agree to hold harmless the 529 Parties from any third party claims
relating to my actions.
• If the Account is owned by an entity or trust, I certify that I am authorized to act on its behalf in making this request and that I am
authorized to open an Account for the Beneciary named in Section 3. I agree to promptly inform the Program Manager in the event
that any of the foregoing certications becomes untrue. I understand and acknowledge that the Program Manager has the right to
terminate the entity’s participation in the Program if it has reasonable grounds to believe that any of the foregoing certications
Signature of Account Owner Date (mm/dd/yyyy)