Organization Resolution Form

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Pennsylvania 529 Investment Plan
Organization Resolution Form
Use this form to identify the officers or other persons who are authorized to act on Pennsylvania 529 Investment Plan account(s) on behalf of
an organization appointed as agent for an account owner pursuant to a Power of Attorney Form or a Limited Power of Attorney/Agent
Authorization Form.
Complete a separate form for each account owner for whom the organization serves as agent.
Organizations covered by this form include: corporations; partnerships; limited liability companies or partnerships; professional corporations or
associations; and other entities or organizations.
This form requires the signature of two authorized persons from your organization, one of whom must be the secretary or other authorized person
who can certify the names of those authorized to act on behalf of the organization. If your organization has only one authorized signatory, then a
bank officer, practicing attorney or member of a domestic stock exchange must countersign this form.
This resolution remains in effect until the Pennsylvania 529 Investment Plan has been notified by you that it has been revoked or a new
Organization Resolution Form has been submitted. You must file a new Organization Resolution when there is any change in the identity of the
person(s) authorized to act on behalf of your organization.
Print clearly, preferably in capital letters and black ink.
Forms can be downloaded from our website at www.PA529.com. Or you can call us toll-free to order any form at 1-800-440-4000. Return this
form and any other required documents in the enclosed postage-paid envelope, or mail to: Pennsylvania 529 Investment Plan, P.O. Box 55378,
Boston, MA 02205-5378. For overnight delivery, mail to the Pennsylvania 529 Investment Plan, 95 Wells Avenue, Suite 155, Newton, MA
02459-3204.
1. Organization Information
Name of Organization
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Address
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City
StateZip
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Firm Tax ID Number
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2. A. Agent for Account Owner
Account Owner Information—Do not include agent information here; provide as indicated in Section 2B.
Name
Address
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City
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StateZip
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Social Security Number or Individual Taxpayer Identification Number
B. Agent’s Authorized Person(s)
To be eligible to serve as agent for a Pennsylvania 529 Investment Plan Account Owner, the organization must have been appointed to serve
under a Limited Power of Attorney/Agent Authorization Form or a Power of Attorney Form that has been or is being completed and submitted to
the Pennsylvania 529 Investment Plan by the Account Owner.
In the space below, please provide information on the person(s) authorized to act on behalf of the organization as agent for the Account Owner.
If the organization has more authorized persons than can be completed in the space below, please attach a separate sheet that provides the
name and title of each authorized person.
Name(s) of Agent’s Authorized Persons
1. Name of Authorized Person (first, middle initial, last) and Title
2. Name of Authorized Person (first, middle initial, last) and Title
3. Name of Authorized Person (first, middle initial, last) and Title
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C. Certification and Indemnification—Two authorized signatories or an authorized
signatory and an eligible third party must sign
The undersigned authorized signatories of the organization identified in Section 1 hereby certify that each of the authorized signatories listed
in this section is authorized to act on behalf of the organization to the extent of the authority granted to the organization named in the Limited
Power of Attorney/Agent Authorization Form or the Power of Attorney Form previously submitted or attached hereto with this form, with
respect to the Account Owner identified in Section 2A.
The organization acknowledges that:
The authorized person(s) identified in Section 2B are authorized to act only with respect to the Pennsylvania 529 Investment Plan account(s)
designated by the Account Owner for which the organization has been authorized as an agent. The organization further acknowledges
that it must file a separate Organization Resolution for each additional Pennsylvania 529 Investment Plan Account Owner for whom the
organization serves as an agent.
The organization is solely responsible for promptly informing Pennsylvania 529 Investment Plan of any changes in the authority or identity of
the authorized person(s) listed in Section 2B.
The Pennsylvania 529 Investment Plan, the Pennsylvania Treasury Department, the Tuition Account Program Advisory Board, The Vanguard
Group, Inc., Upromise Investment Advisors LLC, their affiliates, and their respective affiliates, officials, officers, employees, representatives, agents and any third party acting hereunder (any of such persons, individually, a “third party”) in connection with the Pennsylvania
529 Investment Plan, hold harmless from and against all losses, claims, and expenses (including attorney’s fees) of any kind incurred by any
of them for relying in good faith upon information provided in this Organization Resolution Form and for acting on instructions believed by
any of them to have originated from any authorized person identified in Section 2B. This resolution remains in full force and effect until
revoked in writing by an authorized signatory of the organization. Each Organization Resolution Form submitted revokes the Organization
Resolution previously submitted to the Pennsylvania 529 Investment Plan in its entirety. Any revocation will not affect any liability
resulting from transactions initiated before Pennsylvania 529 Investment Plan or its agents have had a reasonable amount of time to act
upon the revocation.
The undersigned are authorized to certify this information on behalf of the organization and confirm that these provisions conform to the charter or
other governing document of our organization.
Signature–You Must Sign Below
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4S I G N A T U R E
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Name of Authorized Signatory (first, middle initial, last) and TitleDate (month, day, year)
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4S I G N A T U R E
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Name of Authorized Signatory (first, middle initial, last) and TitleDate (month, day, year)
Third party certification (Required if your organization has only one authorized signatory)
I certify that the person who signed above is the duly authorized signatory of the organization identified in Section 1.
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Name of Bank Officer, Practicing Attorney, or Member of a Domestic Stock Exchange (first, middle initial, last) and Title
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–
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Date (month, day, year)
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Print name of bank or firm
© 2012 Commonwealth of Pennsylvania. 3
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