Fillable NC 529 Plan Incoming Rollover Form (College Foundation of North Carolina)

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NC 529 Plan Incoming Rollover Form (College Foundation of North Carolina)

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The NC 529 Plan Incoming Rollover Form (College Foundation of North Carolina) form is 3 pages long and contains:

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  • 6 check-boxes
  • 37 other fields

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Your Current 529 Program Manager or Coverdell ESA Custodian
The 529 plan or Coverdell Education Saving Account (ESA) from which you are moving assets must have the same Participant
name as well as Social Security or Taxpayer Identication Number as your Account in the NC 529 Plan.
h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h
Account Number of 529 Program or Coverdell ESA
h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h
Name of Current Program Manager or Coverdell Custodian
h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h
Address (line 1)
h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h
Address (line 2)
h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h
City State Zip or Postal Code Country (if not U.S.)
h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h
Contact Person (First, Middle, Last, Sufx)
h h h – h h h – h h h h h h h – h h h – h h h h
Primary Telephone Number (8:00 a.m. to 5:00 p.m.) Alternate Telephone Number
h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h
E-mail Address
o Check this box if the Beneciary on this Account is different from the Beneciary associated with your NC 529 Account
named in Section 3.
1
NC 529 Plan
North Carolina’s National College Savings Program
Incoming Rollover Form
WHEN COMPLETE, PLEASE SEND THIS FORM TO
YOUR CURRENT PLAN ADMINISTRATOR.
Note: If funds for this Rollover are from an UGMA/UTMA Custodial Account, you must place them into an
NC 529 Plan Account established as an UGMA/UTMA.
To complete this form, please print clearly, preferably in capital letters and
black ink.
This form will initiate a Rollover of assets from another 529 plan or Coverdell
Education Savings Account (ESA) to an existing Account in North Carolina’s
National College Savings Program.
Note: If you have not yet established your NC 529 Account, you must
complete an Enrollment and Participation Agreement (Form C420) online or by
mail to set up an Account to receive the incoming Rollover.
When this form is completed, send it to your current plan administrator, not
to the NC 529 Plan.
To order any form or ask questions about the Program, please call us toll
free at 800-600-3453, Monday -- Thursday, 8 a.m. -- 8 p.m. and Friday,
8 a.m. -- 5 p.m. ET. Forms and information are also available online at
CFNC.org/NC529.
C F I Form C427 (10/11)
CFNC.org/NC529 800-600-3453
2
Participant Instructions to Your Current 529 Program Manager or Coverdell ESA Custodian
The assets you list must all be held by the nancial institution indicated in Section 1. If you are moving assets from more than one institution,
ll out a separate form for each. If you already have an Account in the NC 529 Plan, your rollover proceeds will be invested according to the
allocation instructions on le at the time the assets are received. If you are establishing a new Account, the proceeds will be invested according
to your instructions in your Enrollment and Participation Agreement.
To current 529 Program Manager or Coverdell ESA Custodian
Check one.
o
Roll over all of the assets in my account.
My estimated account value:
$ h h h , h h h . h h
o
Roll over a portion of the assets as directed below.
To list more than ve options, use a separate sheet.
Name of Investment at Current 529 Program or Coverdell ESA Dollar Amount OR Total Balance
(for partial amount) (Check if rolling over entire amount)
h h h h h h h h h h h h h h h h h h $ h h h , h h h . h h h
h h h h h h h
h h h h h h h h h h h $ h h h , h h h . h h h
h h h h h h h
h h h h h h h h h h h $ h h h , h h h . h h h
h h h h h h h
h h h h h h h h h h h $ h h h , h h h . h h h
h h h h h h h
h h h h h h h h h h h $ h h h , h h h . h h h
3
NC 529 Plan Account Information
h h h h h h h h h – h h h h h h – h h – h h h h
Account Number (If you have not established an Account, Social Security or Taxpayer Identication Number
you must complete an Enrollment and Participation Agreement.)
h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h
Name of Participant (First, Middle, Last, Sufx)
h h h – h h h – h h h h h h h – h h h – h h h h
Daytime Telephone Number Evening Telephone Number
h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h h
Name of Beneciary (First, Middle, Last, Sufx)
h h h – h h – h h h h
Beneciary Social Security or Taxpayer Identication Number
C F I Form C427 (10/11)
CFNC.org/NC529 800-600-3453
4
Participant Signature – You must sign below
If your current 529 program manager or Coverdell ESA custodian requires a signature guarantee, do not sign below until you are
in the presence of the authorized ofcer of a bank, broker, or other qualied nancial institution. The guaranteeing institution is
nancially responsible if the signature is not genuine. A notary public cannot provide a signature guarantee, nor can you guarantee
your own signature. The lack of a required signature guarantee could delay this Rollover.
I certify that I have read the Program Description and understand the rules and regulations governing Rollover and transfer
Contributions from other 529 plans and Coverdell ESA. I understand that IRS regulations permit only one such Rollover for the
same Beneciary in a 12-month period for 529 accounts.
____________________________________________________________________________ h h – h h – h h h h
Signature of Participant Date (month, day, year)
(If the Participant is a minor, the parent or guardian of record must sign.)
Signature Guarantee — if required by Your Current 529 Program Manager or Coverdell ESA Custodian
____________________________________________________________________________
Signature of Guarantor
h h h h h h h h h h h h h h h h h h h h
Title/Name of Institution
h h – h h – h h h h
Date (month, day, year)
Authorized Ofcer to Place Stamp Here
5
Instructions to 529 Program Manager or Coverdell ESA Custodian
Please send redemption proceeds by check made payable to NC 529 Plan to the address below. Include the Participant’s NC 529 Plan Account
number on the check and enclose a statement that shows the principal and earnings portions of the distribution.
Mail proceeds to:
NC 529 Plan
P.O. Box 40877
Raleigh, NC 27629-0877
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NC 529 Plan Incoming Rollover Form (College Foundation of North Carolina)

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Completed 9 February 2021

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