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CollegeBound 529
Account Information Change Form
Use this form to change: your name, address, phone number, email address,
Successor Account Owner, or interested party information. You may also use this
form to transfer assets to a new Account Owner.
If you are changing your name you must provide either a copy of the document that
changes your name (i.e. Marriage Certificate, Divorce Decree, etc.); or have your former
signature and your new signature must be Medallion Signature Guaranteed in Section 8
by an authorized officer of a bank, broker, or other qualified financial institution.
If you are changing the Account Owner of an existing Account, your signature must
be Medallion Signature Guaranteed in Section 8 by an authorized officer of a bank,
broker, or other qualified financial institution, and the new Account Owner must
include an Enrollment Form if an Account is not already established.
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.coll
ege
bound529.com,
or you can call us to order any form or request assistance in completing this
form — at 1.877.615.4116 any business day from 8 a.m. to 8 p.m. Eastern time.
1. Current Account Owner information
Account Number(s) (To list more than three Accounts, use a separate sheet.)
Name of Account Owner (first, middle initial, last)
Telephone Number (In case we have a question about your Account.)
2. Information to update or change
Account Owner Section 3 or Section 4
Successor Account Owner Section 5
Interested Party Section 6
1.877.615.4116
8 a.m. to 8 p.m. Eastern Time M-F
www.coll
ege
bound529.com
Regular mailing address:
CollegeBound 529
P.O. Box 55987
Boston, MA 02205-9722
Overnight mailing address:
CollegeBound 529
95 Wells Ave, Suite 155
Newton, MA 02459
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3. Updated Account Owner information
If you are changing your name and/or contact information, provide the new information exactly as you would like it to appear on your
CollegeBound 529 Account. You do not need to enter information that will not be changed.
If you are changing your name, you must either provide a copy of an official document that changes your name. (i.e. Marriage
Certificate, Divorce Decree, etc.) or have your old and new signature Medallion Signature Guaranteed in Section 8.
Note: Changing the address on your Account will place a nine business day hold on any Distribution(s) you may request. The funds will
be released once the hold time has been met.
Name of Account Owner (first, middle initial, last)
Permanent Street Address (P.O. boxes are not acceptable.)
City State Zip Code
Account Mailing Address if different from above (This address will be used as the Account’s address of record for all Account mailings.)
City State Zip Code
Telephone Number (In case we have a question about your Account.)
Email Address
4. Transfer assets to a new Account Owner
This will transfer ownership of all of the assets in the referenced Account to the new Account Owner listed below.
• If you transfer ownership, you must also provide a Medallion Signature Guarantee in Section 8.
• The new Account Owner will control the Account and the disposition of all assets held in the Account.
• The new Account Owner must also complete an Enrollment Form if the new Account Owner does not have an Account on file.
Important: You cannot change the Custodian for an UGMA/UTMA Account.
Account Number (If applicable)
Name of New Account Owner (first, middle initial, last) (Required)
Social Security Number or Taxpayer Identification Number (Required) Birth Date/Trust Date (mm/dd/yyyy) (Required)
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5. Successor Account Owner information
• Complete this section only if you are adding, changing, or deleting Successor Account Owner information on your Account.
As the Account Owner, you may designate a Successor Account Owner to take control of the Account in the event of your death. You
may revoke or change your designation later by completing the appropriate form. See the CollegeBound 529 Program Description for
more information.
• You can also name a Trust as a Successor Account Owner.
• The person you designate as Successor Account Owner must be at least 18 years old.
Check one.
Add Change Delete
Name of Successor Account Owner (first, middle initial, last)
Birth Date (mm/dd/yyyy) (Required)
6. Interested party information
Complete this section if you want to add an individual as an interested party to the Account. An interested party will be able to call
the Plan, receive information verbally about the Account and receive quarterly statements. An interested party will not be allowed
to make changes to the Account or request transactions. You can also use this section to replace or change existing interested party
information on your Account. To add or change information for more than one interested party, use a separate sheet.
Check one.
Add Replace interested party Change current information Delete
Name (first, middle initial, last)
Mailing Address
City State Zip Code
Telephone Number (In case we have a question about your Account.)
Relationship to Account Owner.
Parent/Guardian Investment Advisor Compliance Other
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7. Signature YOU MUST SIGN BELOW (However, if you are changing your name or transferring ownership of your Account(s) to
a new Account Owner, skip this section and complete Section 8 instead.)
I certify that I have read, understand, consent, and agree to all the terms and conditions of the CollegeBound 529 Program Description
and understand the rules and regulations governing CollegeBound 529 as they relate to this information change request.
By signing below, I authorize CollegeBound 529 or its designee to change my Account information according to the
instructions above.
If I am changing the Account Owner, by signing this form as the current Account Owner, I acknowledge that the transfer is subject
to CollegeBound 529s verification of the new Account Owner. I have consulted with a tax advisor concerning the potential income gift
and estate tax consequences of my transfer of ownership before signing and submitting this form.
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 funded with UGMA/UTMA assets, I further certify that I am the Parent/Guardian/Custodian of theAccount.
SIGNATURE
Signature of Account Owner Date (mm/dd/yyyy)
8. Medallion Signature Guarantee REQUIRED FOR NAME CHANGES AND CHANGES TO THE
ACCOUNT OWNER OF AN EXISTING ACCOUNT
• You must provide the following information as underwritten certification that your signature is genuine.
You can obtain a Medallion Signature Guarantee from an authorized officer of a bank, broker, or other qualified financial 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 officer 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 CollegeBound 529 Program Description.
SIGNATURE
Former Signature of Account Owner (Only used if you are changing your name) (In the presence of the authorized officer.)
SIGNATURE
Current Signature of Account Owner (In the presence of the authorized officer.)
Signature of Guarantor
Title
Name of Institution
Date (mm/dd/yyyy)
Authorized Officer to place stamp here
State of Rhode Island
Office of the General Treasurer
Seth Magaziner