Withdrawal Request Form - Ohio Tuition Trust Authority

You can request a withdrawal online at
www.CollegeAdvantage.com Questions?
Call 1‑800‑AFFORD‑IT (233‑6734) for more information.
Withdrawal Request Form
Complete this form and return to:
CollegeAdvantage Guaranteed 529 Savings Plan
P.O. Box 219305
Kansas City, MO 64121-9305
Instructions:
You can request a withdrawal online at www.CollegeAdvantage.com when you log in to your Account.
If requesting a withdrawal by mail, this original form must be used. We cannot accept faxes, copies, or email attachments.
Please print in blue or black ink.
If withdrawal amount is over $10,000, this form must be notarized (see back).
A withdrawal may have tax consequences depending on how it is used. You may wish to consult a tax advisor prior to requesting a withdrawal.
SIGNATURE REQUIRED on last page.
1
Account number
Please provide your CollegeAdvantage Guaranteed 529 Savings Plan account number.
2
Account Owner information
Account Owner’s first name
M.I.
Last name
–
–
Account Owner’s Social Security Number
(
)
–
Home phone/cell phone
3
(
Work phone
)
–
Beneficiary information
Beneficiary’s first name
M.I.
Last name
–
–
Beneficiary’s Social Security Number
4
Reason for withdrawal
Choose one option below:
Funds will be used for qualified higher education expenses. Account Owner is responsible for maintaining records substantiating use of funds for tax purposes.
Funds are not going to be used for higher education expenses.
Rollover assets from my existing CollegeAdvantage Guaranteed 529 Account to the CollegeAdvantage Direct 529 Plan or the CollegeAdvantage Advisor 529 Plan.
Rollover withdrawal to establish an account in another 529 Plan. (not a CollegeAdvantage Plan)
Documentation required for the following types of withdrawals:
Permanent disability of Beneficiary. Attach a doctor’s letter stating that the Beneficiary is unable to attend any eligible educational institution because of injury or illness expected to continue indefinitely or result in death.
Death of Beneficiary. Attach a certified copy of Beneficiary’s death certificate with name and Social Security Number.
WRF
(1-15)
1 of 4
5
Educational institution and student I.D. number
Please provide the name and address of the educational institution below. Use the address of the Bursar’s Office or the address found on the
invoice from the school.
Name of institution (plus branch, if applicable)
Institution’s mailing address
–
City
State
ZIP code
Beneficiary’s student I.D. number (the student’s unique identifier assigned by this school)
–
Academic year (e.g., 2011-2012)
6
Term
(check all that apply)
Fall
Spring
Winter
Summer
First Semester
Second Semester
Amount requested
Indicate the amount to be withdrawn or rolled over from your CollegeAdvantage Guaranteed 529 Savings Plan. Tuition units/credits will be
withdrawn on a first-in, first-out basis. Please verify your account balance before requesting a withdrawal or rollover.
If the dollar amount specified exceeds that amount available in the Account, we will disburse only the amount available at that time.
Withdrawal/Rollover Amount: $
7
,
.
OR
100%
Withdrawal recipient
Choose one option below:
Send withdrawal directly to the educational institution named in Section 5 above. The Beneficiary must be enrolled at the institution before funds can be disbursed. The end of year 1099-Q tax form will be sent to the Beneficiary. Go to Section 9.
Send withdrawal to Account Owner or Beneficiary. The end of year 1099-Q tax form will be sent to the withdrawal recipient. Complete Section 8.
Send withdrawal/rollover to my CollegeAdvantage Direct 529 Plan Account or my CollegeAdvantage Advisor 529 Plan Account (BlackRock). Complete Section 8.
Send withdrawal/rollover to another 529 Plan (not a CollegeAdvantage Plan). This withdrawal will be sent via check. The end of year 1099-Q tax form will be sent to the Account Owner. Complete Section 8.
We can only send a withdrawal to one person or entity. If you wish to have funds sent to more than one recipient, you must complete two forms.
WRF
(1-15)
2 of 4
8
Withdrawal method (Required if not being sent to educational institution)
Electronic funds transfer (EFT)
Please complete if you wish the withdrawal sent to the Account Owner or Beneficiary’s bank account via EFT.
Pay by EFT to:
Type of account:
Checking account
Savings account
Account Owner’s bank account
Routing number (first set of 9 numbers
at the bottom left corner of your check);
or call your bank to obtain.
Beneficiary’s bank account
Account number (second set of numbers at the bottom of your check)
Check
Please complete if you wish the withdrawal rollover sent to the Account Owner or Beneficiary via check. Please allow adequate time for check payment due to extended processing requirements.
Choose the payee below:
Check made payable to Account Owner.
Check made payable to Beneficiary.
*Check made payable to Ohio Tuition Trust Authority (CollegeAdvantage Direct 529 Savings Plan Account
Direct Plan Account number
*Check made payable to BlackRock CollegeAdvantage (CollegeAdvantage Advisor 529 Savings Plan offered by BlackRock)
Advisor Plan, BlackRock Account number
Check made payable to another 529 Plan (not a CollegeAdvantage Plan).
Name of new 529 Plan (not a CollegeAdvantage Plan)
Mail to the address below:
Account Owner’s address of record.
Address listed below.
If the address below is different from the Account Owner’s address of record, or if the check is payable to another 529 Plan, a notarized signature is required in Section 9 on back.
Mailing address
–
City
State
ZIP code
*Withdrawals/rollovers to CollegeAdvantage Direct or CollegeAdvantage Advisor (BlackRock) will be mailed to the Plan.
Signature required on back Æ
WRF
(1-15)
3 of 4
9
Signature
I request the withdrawal indicated herein. The Ohio Tuition Trust Authority is entitled to rely on this request and is released from any and all claims
I may have or hereafter have with respect to the withdrawal. I understand the amount withdrawn should be reported to my financial aid office.
I certify the information provided herein is true and accurate, and complies with the terms and conditions of the CollegeAdvantage Offering
Statement and Participation Agreement. I further certify that both my Social Security Number and that of the Beneficiary set forth in Sections 2
and 3 are true, correct, and complete and that the numbers are our Social Security Numbers or Taxpayer Identification Numbers (TIN).
Print name of Account Owner
–
–
Signature date (mm/dd/yyyy)
Signature of Account Owner (Required)
Additional verification requirements: NOTARY SEAL (only required in very limited circumstances, as outlined below):
1)
2)
3)
4)
Account Owner change of address was done within the last 15 days.
Withdrawal address is different from Account Owner’s address of record.
Check is payable to another 529 Plan (not a CollegeAdvantage Plan.)
Withdrawal amount is over $10,000.
Before me, a Notary Public in and for
,
County
, this document was acknowledged before me on
State
Date
who certifies the correctness of the signature above.
by
Account Owner
Notary to Place Seal Here
Notary Public name
Notary Public signature
My commission expires
Date
BENEFICIARY SIGNATURE (ONLY REQUIRED IN VERY LIMITED CIRCUMSTANCES)
Beneficiary signature is required if account includes funds invested in the suspended Guaranteed Savings Fund AND it was opened before 10/1/1996 AND Beneficiary is 18 or older AND Account Owner has not previously submitted a Pre-1996 Ownership Amendment Form to the Ohio Tuition Trust Authority. Only if ALL of these conditions apply is Beneficiary signature required.
Print name of Beneficiary
–
–
Signature date (mm/dd/yyyy)
Signature of Beneficiary
If Beneficiary’s signature is required, it must be notarized.
Before me, a Notary Public in and for
by
,
County
, this document was acknowledged before me on
State
Date
who certifies the correctness of the signature above.
Beneficiary
Notary to Place Seal Here
Notary Public name
Notary Public signature
My commission expires
Date
WRF
(1-15)
4 of 4