Fillable C445e C445E Form (College Foundation of North Carolina)

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C445e C445E Form (College Foundation of North Carolina)

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NC 529 Plan
North Carolina’s National College Savings Program
Rollover and Transfer Form
Please print clearly in capital letters and dark ink.
Name of Participant (First, Middle, Last, Suffix)
Check type and enter the number.
Social Security or Taxpayer Identification Number
Name of Beneficiary (First, Middle, Last, Suffix)
Check type and enter the number.
Social Security or Taxpayer Identification Number
Account Number (if established)
For the transaction to be considered a qualifying Rollover, the following criteria must be met:
• The Contribution to the new Account must be made within 60 days of the date of the distribution from the former program
or Account.
and
• The Beneficiary named on the Account must qualify as a Beneficiary under the Program Rules and (1) if the Beneficiary is the
same as for the former program, the funds for this Beneficiary must not have been a part of another Rollover within the past
12 months or (2) the new Beneficiary must be a Member of the Family.
By signing and submitting this form, the Participant affirms that these two criteria are met.
Mail to:
NC 529 Plan
P.O. Box 40877
Raleigh, NC 27629-0877
Overnight or
registered
mail:
NC 529 Plan
2917 Highwoods Blvd.
Raleigh, NC 27604
Fax to:
919-835-2304
Email to:
savings@cfnc.org
For questions or forms, contact the Program
Administrator: College Foundation, Inc.
NC529.org 800-600-3453
919-828-4904 (Raleigh)
One of the College Foundation of North Carolina (CFNC) services
helping students and families plan, apply and pay for college.
Use this form to transfer assets between existing NC 529 Plan
Accounts or as documentation of the earnings portion of a
transfer of assets from a Coverdell Education Savings Account
or a Qualified U.S. Savings Bond.
Documentation from the financial institution of the earnings
portion of each Rollover or transfer must accompany the form.
Unless and until adequate documentation of the earnings
portion is provided, current federal law requires the entire
amount of the Contribution to be treated as earnings.
If you are moving assets from more than one financial
institution, fill out a separate form for each one.
Note: This form only applies to NC 529 Plan. To initiate a
Rollover from another State’s Qualified Tuition Program, you
must complete an Incoming Rollover (Form C427) and send it
to that program’s manager.
Make checks payable to: “NC 529 Plan”
❑ SSN
❑ TIN
❑ SSN
❑ TIN
1 Participant and Beneficiary Information
CFNC.org/NC529 800-600-3453 CFI Form C445 (7/20)
Note: The Participant MUST submit a statement or letter from the former qualified tuition program showing the date of
Withdrawal, the total Rollover amount, and the portions attributable to Contributions and earnings. Until the breakdown is
provided, the Program will treat the entire amount of the Rollover as earnings.
❑ Rollover from Another Qualified Tuition Program
Until the specified documentation is provided by the former program, the Program will treat the entire amount of
this Rollover as earnings.
Date Withdrawal Made (month, day, year)
Amount Considered Contribution
$ , .
Amount Considered Earnings
+ $ , .
TOTAL
= $ , .
A. ❑ Transfer Between Existing Accounts in North Carolina’s National College Savings Program
Please provide directions below.
Move funds from Account (a):
Account Number
into Account (b):
Account Number
Amount (Check one.)
❑ Full Balance.
Close Account (a) and move total amount into Account (b).
❑ Partial Balance.
Deduct the following amount from Account (a) and move it into Account (b): $ , .
Note: Withdrawal from Account (a) will be taken proportionally from each available Investment Option.
2 Rollovers
(continued)
3 Transfers
0.00
CFNC.org/NC529 800-600-3453 CFI Form C445 (7/20)
Note: Until the specified documentation requested below is provided, the Program will treat the entire amount of a transfer
designated in Sections 3B or 3C as earnings.
Check any below that apply and complete the corresponding information.
B. ❑ Transfer of Proceeds of a Coverdell Education Savings Account
Attach a statement from the financial institution that acted as trustee/custodian of the Coverdell Account showing the
basis and earnings in such account.
Date Withdrawal Made (month, day, year)
Amount Considered Contribution
$ , .
Amount Considered Earnings
+ $ , .
TOTAL
= $ , .
C. ❑ Transfer of Proceeds of a Qualified U.S. Savings Bond (Series EE or Series I, issued after 1989)
Attach an account statement or Form 1099-INT issued by the financial institution that redeemed the bonds to show
interest from the redemption.
Date Withdrawal Made (month, day, year)
Amount Considered Contribution
$ , .
Amount Considered Earnings
+ $ , .
TOTAL
= $ , .
By signing this form and submitting it to College Foundation, Inc., the Program Administrator, I hereby certify that all of the
information in this form is true, complete and correct. In addition, I certify that I understand all the criteria and documentation
required, and all the criteria are met. I authorize College Foundation, Inc. to make the Rollover or transfer as requested, and I
understand the consequences of the Rollover or transfer. If this Rollover or transfer is part of a new Account, I have also attached a
signed Enrollment and Participation Agreement.
_________________________________________________________________
Signature of Participant Date (month, day, year)
Note: If your Rollover or transfer requested on this form is intended for an existing Account, funds will be designated according to
your instructions on file. Attach instructions or a Contribution slip to this form if you wish to provide an alternate designation for this
Rollover or transfer.
4 Participant Signature – You Must Sign Below
3 Transfers
(continued)
0.00
0.00
Please print, sign, and mail to the NC 529 Plan to complete
your Rollover and Transfer form.
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C445e C445E Form (College Foundation of North Carolina)

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Completed 9 February 2021

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