Fillable Enrollment and Participation Agreement Supplement (College Foundation of North Carolina)

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Enrollment and Participation Agreement Supplement (College Foundation of North Carolina)

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NC 529 Plan
North Carolina’s National College Savings Program
Enrollment and Participation Agreement Supplement
Please print clearly in capital letters and dark ink.
Name of Participant (First, Middle, Last, Suffix)
Account Number
Changes made in this section will be applied to every Account you hold in North Carolina’s National College Savings Program.
Use this section to update or replace information about yourself as the current Participant (Account owner). If you are
requesting a name change, attach a copy of your court order, marriage certificate, adoption papers, divorce decree or other
official documentation.
If you want to transfer ownership of your Account to a new Participant, complete a Supplement for Immediate Replacement
of Participant (Form C422) instead of this form.
Name of Participant (First, Middle, Last, Suffix)
Check Type and enter the number.
If changing your SSN or TIN, attach Social Security or Birth Date (month, day, year)
a copy of your card. Taxpayer Identification Number
Address (line 1)
Address (line 2)
City State Zip or Postal Code Country (if not U.S.)
Primary Telephone Number (8:00 a.m. to 5:00 p.m.) Alternate Telephone Number
Email Address
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 CHANGES or CORRECTIONS to your
original Enrollment and Participation Agreement. Follow the
steps below, printing clearly in capital letters and dark ink:
Enter required information directly below.
Complete only the numbered sections that contain the
information you want to change in your Enrollment
Agreement. For details and definitions, refer to the Program
Description for North Carolina’s National College Savings
Program (“the Program Description”).
Sign and date the form in Section 7 and mail it to the NC
529 Plan.
Make checks payable to: “NC 529 Plan”
Re
q
uired Information
SSN
TIN
Electronic Delivery: I prefer online notification of quarterly Account statements and
other communication using my e-mail address above instead of receiving paper
statements and notices via standard mail.
Yes No
1 Update of Current Participant Record
CFNC.org/NC529 800-600-3453 CFI Form C421 (08/18)
Changes made in Sections 2 through 6 will be applied only to the specific Account Number entered in the Required
Information section of this form. Complete a separate Agreement Supplement for each individual Account for changes that
pertain to multiple Accounts.
Use this section to change information about the current Successor Participant, to add a Successor Participant (if one was not
designated in your original Enrollment Agreement form), or to replace the current Successor Participant with a new one. To
request immediate succession, complete a Supplement for Immediate Replacement of Participant (Form C422) instead of this
form.
The Successor Participant is the individual you may designate to replace you as Participant in the event of your death or
incapacity; he or she must be at least 18 years old. Until the time that a Successor Participant may take over your Account, this
person does not have any access to the Account or any information related to it.
Check one:
Name of Successor Participant (First, Middle, Last, Suffix)
Check type and enter the number.
If changing the current Successor Social Security or Taxpayer Identification Number
Participant’s SSN or TIN, attach a
copy of the Successor Participant’s
identification card.
Birth Date (month, day, year) Telephone Number
Use this section to update information about the current Beneficiary or to replace the current Beneficiary with a new one.
You may replace the current Beneficiary with a new one only if (i) the new Beneficiary is a Member of the Family of the replaced
Beneficiary; (ii) the change in Beneficiary would not result in an Excess Contribution on behalf of the new Beneficiary; and (iii)
the change does not involve an UGMA/UTMA Account. The Member of the Family criteria does not apply to a Governmental
Entity or a 501(c)(3) Organization that has established a Scholarship Account without a named Beneficiary.
Note: Request for a new Beneficiary should be submitted to the Program Administrator no later than 60 days before the first
date of any Withdrawal request.
Check one:
I designate the individual named below as Beneficiary of this Account. If updating current Beneficiary’s name, attach a copy of the
court order, marriage certificate, adoption papers, divorce decree, or other official documentation.
Name of Beneficiary (First, Middle, Last, Suffix)
Check type and enter the number.
Social Security or Taxpayer Identification Number
Birth Date (month, day, year)
State of Residence
Relationship to Previous Beneficiary (required if replacing the current Beneficiary.)
SSN
TIN
SSN
TIN
3 Beneficiary Information
Delete Successor Participant.
Update Successor Participant Information.
Add First-time or Replacement Successor Participant
2 Successor Participant Information
Update current Beneficiary information.
Replace the current Beneficiary. (A new Account number will be assigned.)
If changing the current Beneficiary’s
SSN or TIN, attach a copy of the
Beneficiary’s identification card
CFNC.org/NC529 800-600-3453 CFI Form C421 (08/18)
The duplicate statement recipient is anyone you want to receive copies of your Account statements, such as a financial advisor
or relative. This person is not authorized to access or make any changes to your Account.
Check one:
Name (First, Middle, Last, Suffix)
Address (line 1)
Address (line 2)
City State Zip or Postal Code
Refer to the Program Description for detailed information on each Investment Option.
Allocation of Current Assets: Use the Current Assets column to change Investment Options for funds currently in your Account.
Changes made in this column apply only to current funds; future Contributions will continue to be allocated in the manner that you
indicated previously unless you also enter information in the corresponding Future Contributions column.
Allocation of Future Contributions: Use the Future Contributions column to change Investment Options for future Contributions,
including automatic Contributions. Allocation of future Contributions may be changed at any time.
Use only whole numbers, not fractions, for your Contribution percentages. Your total investment must equal 100%.
Investment Options
You have multiple choices for your Investment Options. You may choose one of the age-based options and/or one or more of
the individual options. Use only whole numbers, not fractions, for your Contribution percentages. Your total investment must
equal 100%.
Vanguard Age-Based Options
The Program will automatically place assets into the appropriate age range and
migrate them based on Beneficiary’s birth date.
Allocations of
Current Assets
Allocations of
Future Contributions
Select only one age-based track:
%
%
%
%
%
%
Delete Current Recipient
Update Current Recipient Information
Add First-time or Replacement Recipient
Aggressive Track
Moderate Track
Conservative Track
5 Investment Options
4 Duplicate Statement Request
CFNC.org/NC529 800-600-3453 CFI Form C421 (08/18)
Individual Options
Allocations of
Current Assets
Allocations of
Future Contributions
Federally-Insured Deposit Account (Provided by State Employees’ Credit Union)
% %
Vanguard Aggressive Growth Portfolio
% %
Vanguard Growth Portfolio
% %
Vanguard Moderate Growth Portfolio
% %
Vanguard Conservative Growth Portfolio
% %
Vanguard Income Portfolio
% %
*Vanguard Interest Accumulation Portfolio
% %
Vanguard Total Stock Market Index Portfolio
% %
Vanguard Total International Stock Index Portfolio
% %
Vanguard Total Bond Market Index Portfolio
% %
TOTAL
% %
A. Automatic Draft (Payroll deduction change instructions in 6C.)
Complete this section to stop, start, or change your instructions for regular electronic Contributions from your financial
institution account to your 529 Account. It may take up to 5 days to set up an automatic draft with your financial institution.
The Investment Options to which your Contributions are allocated will remain the same as your allocations on file unless
you requested changes in Section 5 of this form.
Check one:
Note: If a Contribution is not honored by your financial institution, you will be assessed a transaction fee.
Amount ($25 minimum) $
, .
Frequency
Check one and include the day(s) on which you want funds debited.
Note: If you are starting or changing Automatic Draft, your account will be debited on the 20th of each month, unless
you select a different schedule below. If a debit date is scheduled for a weekend or holiday, the debit will occur on the
next business day.
You must select a debit date that falls within the first 28 days of the month.
Once a month on the day of the month.
Twice a month on the and days of the month.
6 Contribution Methods
1 0 0 1 0 0
Stop current automatic Contributions. (Your request will be processed immediately; however, it may
take one draft cycle to go into effect.)
Start new regular automatic Contributions. (Also complete 6B.)
Change current instructions for automatic Contributions. (Also complete 6B.)
*This Portfolio has certain limitations restricting direct transfers out to the first
Investment Option listed above. See the “Equity Wash Rule” in the Program
Description under “
INVESTMENT OPTIONS – VANGUARD AGE-BASED AND INDIVIDUAL
INVESTMENT OPTIONS
– Vanguard Interest Accumulation Portfolio.”
0
CFNC.org/NC529 800-600-3453 CFI Form C421 (08/18)
B. Financial Institution Information
Complete this section to add or replace the account information for Automatic Draft.
If replacing, enter below the last 4 digits of the account you wish to replace.
4 digits
Note: Automatic Draft is available only from a U.S. bank, savings and loan association, or credit union that is a member of
the Automated Clearing House (ACH) network.
Account Type
Check one.
Financial Institution Name
Telephone Number
Routing Number Account Number
Note: This check image is an example of a format many financial institutions use; however, you should confirm your
routing and account number for electronic drafts with your financial institution before submitting this information.
C. Payroll Deduction
To change payroll deduction instructions, complete a new Payroll Deduction Authorization Agreement (Form C426). The
Investment Options to which future payroll deduction Contributions are allocated will remain the same as your allocations
on file unless you requested changes in Section 5 of this form.
I understand that by signing this Enrollment and Participation Agreement Supplement and submitting it to College
Foundation, Inc., the Program Administrator, I hereby certify that all of the information contained in this Enrollment
Supplement is true, complete and correct, and I authorize College Foundation, Inc. to change Account information based
upon this completed Enrollment Supplement. I understand that the terms and conditions of the Enrollment Agreement
continue in full force and effect.
_________________________________________________________
Signature of Participant Date (month, day, year)
Checking Savings
Routing Number
Account Number Check Number (do not enter)
7 Authorization – You Must Sign Below
Please print, sign, and mail to the NC 529 Plan to
complete your enrollment supplement.
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Completed 9 February 2021

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