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Complete this form to start, change, or stop a recurring investment from your bank account, or to add or change bank account information for
contributions and/or withdrawals by electronic transfer to or from a bank. Complete and submit a separate form for each Account you own in
the New York’s 529 Advisor-Guided College Savings Program (“Advisor-Guided Plan” or “the Plan”).
You can also add a bank account, start, change, or stop Recurring Contributions and Electronic Bank Transfer (EBT) by accessing your Account
online at
Type in your information and print out the completed form, or print clearly, preferably in capital letters and black ink. Mail the completed,
signed form to the address below. Do not staple.
Forms can be downloaded from our website at, 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
Account information
Account Number
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)
New York’s 529 Advisor-Guided College Savings Program
Recurring Contributions/
Electronic Bank Transfer Form
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Recurring Contributions or EBT will be unavailable for withdrawal for seven (7) business days.
Adding or changing bank information will prompt a fteen (15) calendar day holding period before proceeds of a withdrawal may be
released to the new bank account.
A. Recurring Contributions. You can transfer money from your bank account to your Advisor-Guided Plan Account on a monthly or
quarterly schedule.
Add this option to my Account. (Provide the information below and in Section 2c.)
Change my investment amount and/or debit date. (Provide the new amount and/or debit date below.)
Change my bank account information. (Provide the information in Section 2c.)
Stop this option.
Amount of Debit:
, .
($25 monthly/$75 quarterly minimum)
Start Date:* Frequency: (Check one)
Date (mm/dd/yyyy) Monthly Quarterly
* Your bank account will be debited on the day you designate, provided the day is a regular business day, or on the next business
day if the date selected is not a business day. You will receive the trade date of the business day on which the bank debit occurs.
If no date is indicated, debit will be made on the 15th day of the month or on the next business day thereafter. See the New York’s
529 Advisor-Guided College Savings Disclosure Booklet and Tuition Savings Agreement for more information.
Annual Increase. You may increase your Recurring Contributions automatically on an annual basis. Your contribution will be
adjusted each year in the month that you specify by the amount indicated.
Note: A plan of regular investment cannot assure a prot or protect against a loss in a declining market.
Amount of increase:
, .
** The month in which your Recurring Contributions will be increased. The rst increase will occur at the rst instance of your
selected date of the month selected.
B. EBT. Add or change bank information for future electronic transfers. We will keep your bank instructions on le for future EBT
contributions and/or withdrawals. You can transfer $25 or more from your bank account to your Plan Account at any time simply by
calling us or requesting a transfer online.
Add Change Delete
C. Bank information. Recurring Contributions and EBT can be made only through 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 through non-bank nancial companies cannot be used.
Important: By signing this paperwork, you agree and conrm that your ACH transactions will not involve a bank or other nancial
services company, including any branch or ofce thereof, located outside the territorial jurisdiction of the United States.
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.
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By signing below, I hereby certify that:
I have received the Disclosure Booklet and Tuition Savings Agreement of New Yorks 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 the 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, Inc., 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 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.
I certify that 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.
I understand that all changes made on this form supersede all my previous designations. I authorize the Advisor-Guided Plan and the
Program Manager (as defined in the Disclosure Booklet) and Ascensus Investment Advisors, LLC, 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 2c. I authorize the bank to accept any such credits or debits to my Account
without responsibility for their correctness. I acknowledge that the origination of ACH transactions involving my account must comply
with U.S. and New York law. I further agree that the Advisor-Guided Plan, Ascensus Investment Advisors, LLC and its afliates 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 Ascensus Investment Advisors, LLC has had a reasonable amount of time to act upon it. I certify
that I have the authority to transact on the bank account identied by me in Section 2c.
Signature of Account Owner Date (mm/dd/yyyy)
529-F-RC 0720
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