Fillable C446e Request For Withdrawal (College Foundation of North Carolina)

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C446e Request For Withdrawal (College Foundation of North Carolina)

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page 1 of 6
NC 529 Plan
North Carolina’s National College Savings Program
Request for Withdrawal
Please print clearly in capital letters and dark ink.
Name of Participant (First, Middle, Last, Suffix)
Account Number
Check type and enter the number.
Social Security or Taxpayer Identification Number
Primary Telephone Number (8:00 a.m. to 5:00 p.m.) Alternate Telephone Number
Name of Beneficiary (First, Middle, Last, Suffix)
If your Beneficiary’s Social Security or Taxpayer Identification Number is not on your Account file, and you are requesting a
Qualified Withdrawal, you must enter the number below.
Check type and enter the number.
Social Security or Taxpayer Identification Number
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 for any WITHDRAWAL from your Account. A
separate form must be completed for each Withdrawal. If your
Account was established with funds from an UGMA/UTMA
custodial account, you are responsible for compliance with the
law and any relevant terms and conditions of the UGMA/UTMA
custodial account.
Capitalized terms appearing but not defined in this form have
the meanings assigned to them in the Program Description for
North Carolina’s National College Savings Program (the
“Program Description”).
Make checks payable to: ‘‘NC 529
Plan’’
1 Participant Information (The person who established, owns, and controls the Account)
2 Beneficiary Information (The future or current student)
SSN
TIN
CFNC.org/NC529 800-600-3453 page 2 of 6 CFI Form C446 (04/19)
Complete either Section A (Qualified Withdrawal) or Section B (Non-Qualified Withdrawal)
Depending on which Withdrawal type applies to your request, check the box under Qualified Withdrawal (Section A on this
page) or Non-Qualified Withdrawal (Section B on the next page) to identify the reason for the request and furnish any
additional information required.
Withdrawal requests for qualified expenses must be requested in same year expenses incurred.
A. Qualified Withdrawal
a. For Payment of Qualified Higher Education Expenses due to Beneficiary’s enrollment in and attendance at an
Eligible Institution.
b. For Payment of K-12 Tuition Expenses.
c. For Rollover to:
Another state’s Qualified Tuition Program.
An ABLE account.
Note: A $50 transaction fee is charged for processing this Rollover request; payment will be withheld from the total
amount.
Name of Qualified Tuition Program or ABLE Program to which you wish to roll over funds
New account number (if known)
Mailing Address of Qualified Tuition Program or ABLE Program
City State Zip
To be considered a qualifying Rollover, the transaction must meet the following criteria: 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.
Rollovers to an ABLE account must not exceed the maximum allowable total contribution for the tax year. The total
you indicate in Section 4, when aggregated with other contributions made during the same tax year, must be within the
limit.
By signing and submitting this form, the Participant affirms that the Rollover meets the above criteria.
3 Reason for Withdrawal
CFNC.org/NC529 800-600-3453 page 3 of 6 CFI Form C446 (04/19)
B. Non-Qualified Withdrawal
B. Non-Qualified Withdrawal
Per federal regulations, the earnings portion of the following Non-Qualified Withdrawals are subject to an additional federal
income tax of 10% and, potentially, state income tax.
Note: A $50 transaction fee is charged for processing; payment will be withheld from total amount of the Account balance.
a. To pay expenses not related to Qualified Higher Education Expenses or K-12 Tuition Expenses.
b. To pay any taxes due on the Withdrawal.
c. Refund of an Excess Contribution.
d. Account termination and disbursement of Account balance by direction of the Authority.
Per federal regulations, the following Non-Qualified Withdrawals are exempt from the 10% additional tax. There is no
transaction fee for processing.
e. Withdrawal due to Receipt of Scholarship. Amount of Withdrawal requested cannot exceed the amount of the
Scholarship. Participant must submit verification of the Beneficiary’s enrollment and a letter from the Scholarship
provider that (1) identifies the Beneficiary by name and Social Security or Taxpayer Identification Number as the
recipient; (2) states the amount of the Scholarship; (3) indicates the period of enrollment or number of credits or units to
which the Scholarship applies or the date of the Scholarship; and (4) if applicable, identifies the Eligible Institution to
which the Scholarship is to be applied.
f. Withdrawal Due to Attendance at a U.S. Military Academy. Participant must submit written third-party confirmation of
the Beneficiary’s enrollment in a U.S. Military Academy. (Note: Requires Full Balance Withdrawal)
g. Withdrawal Due to Death. Participant must submit a certified death certificate containing the name and Social Security
or Taxpayer Identification Number of the Beneficiary issued by an applicable governmental agency or another
satisfactory proof of death. (Note: Requires Full Balance Withdrawal)
h. Withdrawal Due to Permanent Disability. Participant must submit certification of the Beneficiary’s Permanent
Disability, such as a letter from a doctor of medicine or osteopathy who is duly authorized to practice in the United
States. (Note: Requires Full Balance Withdrawal. Do not send medical records.)
3 Reason for Withdrawal (continued)
CFNC.org/NC529 800-600-3453 page 4 of 6 CFI Form C446 (04/19)
Amount requested must be at least $250, unless the Withdrawal is to close your Account. In most cases, a Withdrawal
request received in good order will be processed on the date your form is received.
Check either Full or Partial Balance Withdrawal and provide additional direction underneath your choice. Withdrawals
can be made only from available funds. (Contributions not yet settled in your Account are considered unavailable funds.)
Full Balance Withdrawal (Required in case of attendance at a U.S. Military Academy, death, or permanent disability.)
Check one. If no selection is made, your Account will be closed.
Close Account. Withdraw the full amount available in each Investment Option in my Account, discontinue my
automatic investment plan (if applicable), and close my Account.
Note: This automatically applies to any full balance Non-Qualified Withdrawal or rollover to another Qualified Tuition
Program.
Leave Account open. Withdraw the entire amount available in each Investment Option in my Account, but continue
my automatic investment plan (if applicable) and leave my Account open for future Contributions. (Available only for
Qualified Withdrawals.)
Partial Balance Withdrawal
Withdraw $ , .
Check one. If no selection is made, the Withdrawal will be taken proportionately from each available Investment Option.
Leave Account open and withdraw proportionately from each of my current Investment Options with available
funds.
Leave Account open and withdraw as specified below.
Note: The amount you may receive may vary from the amount requested due to market fluctuations. If the dollar amount you
indicate for a particular Investment Option below exceeds the amount invested in that option due to market fluctuations, the
Program will liquidate the option’s entire balance.
If withdrawing to roll over to an ABLE account, you must indicate an amount below that, when aggregated with other
contributions to the ABLE account, will not exceed the limitation imposed by the IRS for the maximum contribution allowable to
the ABLE account for the taxable year.
Name of Investment Option
Dollar Amount
(for partial amounts)
or
Total Balance
(check if applicable)
____________________________________________________
$ , .
____________________________________________________
$ , .
____________________________________________________
$ , .
____________________________________________________
$ , .
____________________________________________________
$ , .
4 Amount of Withdrawal
CFNC.org/NC529 800-600-3453 page 5 of 6 CFI Form C446 (04/19)
If you selected a Qualified Withdrawal (in Section 3A) to pay college expenses or K-12 tuition expenses, check one of
the payees below and provide information requested. If no payee is indicated, funds will be sent to the Participant.
If you selected (in Section 3A or 3B) either a Rollover Qualified Withdrawal or a Non-Qualified Withdrawal, do not
check a payee below.
Rollover funds will be sent to the Qualified Tuition Program or ABLE Program specified above;
Non-Qualified Withdrawal or K-12 tuition expenses must be paid to the Participant.
Participant (Withdrawals for K-12 tuition expenses or Non-Qualified Withdrawals must be paid to Participant.)
Withdrawal check will be sent to the address of record.)
College or University on behalf of the Beneficiary. (Does not include K-12 schools.) If college requires a Student
Identification Number to process check, please provide Student ID Number here ___________________________________.
Name of College or University
College or University Mailing Address (line 1)
(line 2)
City State Zip
Note: Do you wish to save the college/university information entered above for future use? Yes No
Beneficiary (This option is not available for K-12 tuition expenses or Non-Qualified Withdrawals, because such
Withdrawals must be distributed to the Participant.)
Beneficiary Mailing Address (line 1)
(line 2)
City State Zip
Note: Do you wish to save the Beneficiary information entered above for future use? Yes No
5 Payee Information
CFNC.org/NC529 800-600-3453 page 6 of 6 CFI Form C446 (04/19)
Check one and provide information requested.
Deliver by Electronic Funds Transfer (EFT) Note: Available only for payment to Participant (Account owner)
To receive payment by EFT, a Participant must do the following: (1) make at least one successfully completed automatic
draft ACH or one-time EFT Contribution from your financial institution account to your NC 529 Account; (2) have your
confirmed institutional account on file with the NC 529 program for at least 10 business days; and (3) make no change to
your financial institution account information within the 10 business days prior to your request. An EFT payment will be
made If all criteria are met; if not, a Withdrawal check will be mailed to your address on record.
Please indicate below the confirmed financial institution account to credit with this payment.
Financial Institution Name
Routing Number Account Number
Deliver check by USPS First Class
Deliver check by standard overnight delivery (street address only) - A $22 fee will be deducted from your NC 529 Account
for this service.
I understand that by signing this Request for Withdrawal form and submitting it to College Foundation, Inc., I hereby certify
that all the information contained in this form is true, complete and correct, and I authorize College Foundation, Inc.,
to make the Withdrawal, less any charge that may apply, based on this completed form.
_________________________________________________________
Signature of Participant Date (month, day, year)
Account Type (check one)
Checking Savings
6 Payment Method
7 Participant Signature --- You Must Sign Below
Please print, sign, and mail to the NC 529 Plan
to complete your Withdrawal request.
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C446e Request For Withdrawal (College Foundation of North Carolina)

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Completed 9 February 2021

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