Financial 529 Document

Financial 529 Account Application & Agreement

Account Owner Information

Account Owner Name:

Month & Day & Year

Individual Trust Corporation Guardian Other

Beneficiary Information

Beneficiary Name:

Month & Day & Year

Initial Contribution & Funding

Initial Contribution Amount:

Contribution Date: Month Day Year

Check enclosed ACH debit (attach bank info below) Wire transfer Rollover/Transfer from another account

By selecting the ACH debit option and submitting this form, I authorize the custodian to initiate debit entries to the account described above to fund contributions in accordance with my instructions. This authorization will remain in effect until revoked in writing.
I certify authorization for ACH debit from the named account.

Investment Selection

Select one or more investment options and indicate allocation percentage. Total allocation must equal 100%.

Age-Based Portfolio — Allocation:

Static Equity Portfolio — Allocation:

Static Bond Portfolio — Allocation:

Money Market / Stable Value — Allocation:

Rollover / Transfer (if applicable)

Is this a rollover or direct transfer from another 529 plan or qualified account? Yes No

Tax Certification and Legal Notices

Under penalties of perjury, I certify that the Social Security Number or Taxpayer Identification Number provided on this form is correct and that I am not subject to backup withholding, unless I have been notified that I am subject to backup withholding. I agree to provide any additional documentation required to verify my identity or tax status.

I understand that distributions used for nonqualified expenses may be subject to federal income tax on earnings and a potential additional 10% federal penalty on earnings, as well as any state taxes or penalties. I acknowledge that I have read and accept the terms of the Plan Description, Custodial Agreement, and applicable prospectuses governing investment options selected herein.

By checking the box below and signing this application I certify that I have the authority to establish and act as account owner for the designated beneficiary, that the information provided on this application is true and accurate, and that I have read and agree to the Plan rules, fees, and restrictions contained in the governing documents.
I certify and agree to the terms above.

Privacy & Consent

I authorize the custodian and its agents to use and disclose the information provided on this application as necessary to administer this account and the selected investments, to comply with legal and regulatory requirements, and to process transactions. I consent to receiving disclosures and statements electronically unless I request paper copies in accordance with plan procedures.

Fees, Withdrawals, and Account Management

Account fees, if any, will be assessed in accordance with the Plan's fee schedule. Withdrawals are subject to the Plan's distribution procedures and may require documentation substantiating qualified education expenses. The Plan and custodian reserve the right to refuse or restrict transactions that violate Plan rules or applicable law.

Acknowledgement and Signature

The undersigned certifies under penalty of perjury that the information provided is true and correct, that the undersigned is authorized to open and manage this account, and that the undersigned accepts the terms and conditions contained herein. The undersigned further authorizes the custodian to act on instructions reasonably believed to be from the account owner.

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