Fillable Incoming Rollover Form (TD Ameritrade)

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Incoming Rollover Form (TD Ameritrade)

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ES_TDR_RO_081901 1119 — Page 1 of 4
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1
TD Ameritrade 529 College Savings Plan
Incoming Rollover Form
• Use this form to initiate a rollover from another 529 plan or a Coverdell Education
Savings Account (ESA) to an existing Account in the
TD Ameritrade 529 College Savings Plan. (If you have not established an Account,
you must also complete and enclose an Enrollment Form or enroll online at www.
tdameritrade.com/collegesavings.)
• Once every 12 months you may roll over assets for the same Beneciary.
You may also roll over assets at any time when you change your Beneciary.
• 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
listed. Do not staple.
Forms can be downloaded from our website at
www.tdameritrade.com/collegesavings
,
or you can call us to order any form — or request assistance in completing this form — at
1.877.408.4644 any business day from 8 a.m. to 8 p.m. Central time.
1.
Rollover type
Rollover directly from a 529 college savings plan (529 Plan).
Rollover from a Coverdell Education Savings Account (ESA).
Rollover from the redemption of a Qualied U.S. savings bond Series EE, issued January 1990 or later, or Series I savings bond
(indirect rollover). (Complete Sections 2, 4, and 5)
Re-allocation from another Nebraska state-issued 529 Plan. Note: This option is considered an Investment Option change and will
count toward your twice per calendar year Investment Option change limit.
Deposit assets from another 529 Plan that have been redeemed (indirect rollover). (Complete Sections 2, 4, and 5)
2.
TD Ameritrade 529 College Savings Plan Account information
Account Number (If you have not established an Account, also complete and enclose an Enrollment Form.)
Social Security Number or Taxpayer Identication Number (Required)
Name of Account Owner (rst, middle initial, last)
Telephone Number (In case we have a question about your Account.)
Name of Beneciary (rst, middle initial, last)
Beneciary Social Security Number or Taxpayer Identication Number (Required)
TDA52906
1.877.408.4644
8 a.m. to 8 p.m. Central time M-F
www.tdameritrade.com/collegesavings
tdameritrade@NEST529.com
Regular mailing address:
TD Ameritrade 529 College Savings Plan
P.O. Box 30278
Omaha, NE 68103-1378
Overnight mailing address:
TD Ameritrade 529 College Savings Plan
920 Main Street, Suite 900
Kansas City, MO 64105
ES_TDR_RO_081901 1119 — Page 2 of 4
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3.
Instructions for Direct Rollovers
• Please provide current 529 plan Name or ESA Custodian Financial Institution information. (Not required for savings bonds.)
• We will contact the current 529 plan or custodian to send the funds to us. Please ask the current 529 plan or custodian if this request
must be signature guaranteed and if so, complete Section 6.
• The Account from which you are moving assets must have the same Account Owner name as well as Social Security number or
Taxpayer Identication number as your TD Ameritrade 529 College Savings Plan Account. Your rollover proceeds will be invested
according to the standing allocation instructions on le at the time the assets are received. If you have not established an Account,
they will be invested according to what you choose on the Enrollment Form. Please contact the program manager or custodian of the
account from which assets are being redeemed for proper mailing address.
Account Number of 529 Plan or ESA
Name of Current 529 Plan Manager or Custodian (Usually a nancial institution)
Full Name of 529 Plan (If applicable)
Address
City State Zip Code
Contact Person Telephone Number
Check this box if the Beneciary on this account differs from the Beneciary indicated in Section 2.
Check one.
A.
Roll over all of the assets in my current 529 plan or ESA to the TD Ameritrade 529 College Savings Plan.
(To list more than two current Accounts, use a separate sheet.)
$
, .
Current Account Number Estimated Account Value
$
, .
Current Account Number Estimated Account Value
B. Roll over a portion of the assets as directed below to the TD Ameritrade 529 College Savings Plan.
(To list more than two Investment Options to roll assets out of, use a separate sheet.)
Current Account Number Name of Investment Portfolio
$
, .
Amount
Current Account Number Name of Investment Portfolio
$
, .
Amount
ES_TDR_RO_081901 1119 — Page 3 of 4
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4.
Instructions if Assets have been redeemed
Assets redeemed from another 529 plan, Qualified U.S. Savings Bond, or ESA must be deposited within 60 days of the withdrawal. You
must include a statement from the former institution certifying the breakdown of contributions and earnings of the amount transferred.
Until such statement is provided, the TD Ameritrade 529 College Savings Plan will treat the entire deposit as earnings.
Enclosed is a check made payable to TD Ameritrade 529 College Savings Plan for
$
, .
Total Amount of Redemption
$
, .
Principal Amount of Redemption
$
, .
Earnings Amount of Redemption
5.
Signature — YOU MUST SIGN BELOW
• I certify that I have read and understand, consent, and agree to all the terms and conditions of the TD Ameritrade 529 College Savings
Plan Program Disclosure Statement and Participation Agreement as they relate to this Incoming Rollover request.
• By signing below, I authorize the Program Manager or its designee to roll over assets into the TD Ameritrade 529 College Savings Plan
according to the instructions above.
• 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. If the Account
is a minor-owned Account or is funded with UGMA/UTMA assets, I further certify that I am the parent/guardian/custodian of the
Account in question, and that this request is in the best interest of the Beneficiary.
• If I am rolling over assets from another 529 plan, by signing below I certify that there has not been a rollover for this Beneficiary during
the prior 12-month period. I further understand that moving assets among the same Account Owner and Beneficiary Account that is in
any 529 plan issued by the Nebraska Educational Savings Plan Trust will count toward my 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 rolling over assets from another 529 plan to a new Beneficiary, I certify that the new Beneficiary is a “Member of the Family” of the
current Beneficiary at the distributing 529 plan.
• I further certify that if I have already redeemed the rollover amount for deposit into a TD Ameritrade 529 College Savings Plan
Account, this request is within 60 days of the withdrawal.
• If I am requesting a direct rollover, by signing below I authorize the current 529 Plan manager or custodian to liquidate my investment
identified in Section 3 and roll over the assets into the TD Ameritrade 529 College Savings Plan Account indicated in Section 2 of
this form. I understand I may need a signature guarantee in Section 6.
• I understand that I cannot make additional contributions for a Beneficiary when the fair market value of all accounts maintained for
that Beneficiary within all programs offered by the State of Nebraska exceeds $400,000.
• I understand that the program manager, custodian or financial institution of the account from which assets are being redeemed is
responsible for providing the TD Ameritrade 529 College Savings Plan with a statement certifying the breakdown of contributions and
earnings of the amount transferred. I further understand that until such statement is provided, the TD Ameritrade 529 College Savings
Plan will treat the entire deposit as earnings.
• I understand that rollovers, deposits, or Beneficiary changes not meeting these conditions may result in the earnings portion of the
deposit being considered a Non-Qualified Withdrawal subject to federal income tax and an additional 10% federal income tax,
and may be subject to state or local income tax. I acknowledge that any such tax consequences are not the responsibility of TD
Ameritrade, TD Ameritrade Investment Management, LLC, the Program Manager, or their authorized agents or any of their affiliates,
the TD Ameritrade 529 College Savings Plan, the State of Nebraska, the Nebraska State Treasurer, the Nebraska Investment Council,
or the Nebraska Educational Savings Plan Trust, or any of their authorized agents or affiliates.
SIGNATURE
Signature of Account Owner Date (mm/dd/yyyy)
ES_TDR_RO_081901 1119 — Page 4 of 4
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6.
Medallion Signature Guarantee — IF APPLICABLE
(Only applicable if the current 529 Plan manager or custodian of the account from which the assets are being redeemed
requires a Medallion Signature Guarantee - please check with your current 529 Plan manager or custodian. The lack of a
required Signature Guarantee could delay this rollover)
• You must provide the following information as underwritten certication that the new signature is genuine.
• You can obtain a Medallion Signature Guarantee from an authorized ofcer of a bank, broker, or other qualied nancial institution.
A notary public cannot provide a Medallion Signature Guarantee, nor can you guarantee your own signature.
• Do not sign below until you are in the presence of the authorized ofcer providing the Medallion Signature Guarantee.
I certify that the information provided herein is true and complete in all respects, and that I have read and understand, consent, and
agree to all the terms and conditions of the Program Disclosure Statement.
SIGNATURE
Signature of Account Owner
Signature Guarantor
Title
Name of Institution
Date (mm/dd/yyyy)
7.
Authorization and acceptance (No Account Owner action is necessary in this section.)
The TD Ameritrade 529 College Savings Plan hereby agrees to accept the rollover described herein and upon receipt will deposit the
proceeds in the Account established on behalf of the Account Owner named herein.
Authorized signature, TD Ameritrade 529 College Savings Plan
INSTRUCTIONS TO 529 PLAN OR CUSTODIAN
Send redemption proceeds by check to TD Ameritrade 529 College Savings Plan, P.O. Box 30278, Omaha, NE 68103-1378.
Make the check payable to TD Ameritrade 529 College Savings Plan. Include the Account Owner name and the TD Ameritrade
529 College Savings Plan Account number (if provided) on the check and enclose a statement that shows the principal and earnings
in the Account.
Authorized Ofcer to place stamp here
Securities Products: Not FDIC Insured - No Bank Guarantee - May Lose Value
TD Ameritrade does not provide tax advice. It is suggested that investors seek the advice
of your tax-planning professional with regard to your personal circumstances.
Nebraska Educational Savings Plan Trust, Issuer. First National Capital Markets, Inc.,
Distributor, Member FINRA, SIPC. TD Ameritrade, Inc., sub-administrator. TD Ameritrade
Investment Management, LLC, portfolio consultant. First National Capital Markets and First
National Bank of Omaha are afliates.
TD Ameritrade, Inc. renders certain marketing and administrative services to the TD
Ameritrade 529 College Savings Plan. TD Ameritrade Investment Management, LLC
renders portfolio consulting services to First National Bank of Omaha and the Nebraska
Investment Council. TD Ameritrade is a trademark jointly owned by TD Ameritrade IP
Company, Inc. and the Toronto-Dominion Bank. All rights reserved. Used with Permission.
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Incoming Rollover Form (TD Ameritrade)

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Completed 20 September 2020

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