Fillable American Funds 529 Withdrawal Form - Distribution Request (Page 4 of 4) in pdf

Virginia529

CollegeAmerica

Distribution Request

Authorization and signature guarantee

I direct American Funds Service Company ( AFS ) to make distributions from the CollegeAmerica Account in the manner I have indicated, and

I assume sole responsibility for the tax consequences of the above election. I certify that the above information and attached documentation

are accurate, and I am entitled to receive the payments for which I have applied.

In consideration of AFS acting on such instructions and processing such transactions, or should I not be entitled to all or any part of the

payments for which I have applied, I agree to hold harmless and indemnify Virginia529; AFS; any of their affiliates or mutual funds managed

by such affiliates; and each of their respective directors; trustees; officers; employees; and agents from any losses, expenses, costs or liability

( including attorney fees ) that may be incurred as a result of AFS acting on such instructions. In addition, if direct deposit payments are

requested, I understand that this payment may be terminated by me at any time by telephone or written notification to AFS. The termination

request will be effective as soon as AFS has had reasonable time to act upon it.

First name of Account Owner ( print )

Last

Signature of Account Owner or Custodian for UGMA/UTMA

Date

( mm/dd/yyyy )

A signature guarantee is required if your redemption request is:

GUARANTOR:

•

greater than $125,000

Stamp signature guarantee or medallion guarantee here.

•

made payable to someone other than the Account Owner or an

eligible educational institution

•

made payable to the beneficial owner and is greater than $25,000

•

being electronically deposited to a bank account with a registration

that does not include the CollegeAmerica Account Owner

•

being electronically deposited to a bank account on file with AFS

and the bank information has changed in the last 10 calendar days

•

being mailed to the address of record and the address has changed in the last 10 calendar days

•

being mailed to an address other than the address of record or eligible educational institution.

If required, signatures must be guaranteed by a bank, savings association, credit union, member firm of a domestic stock exchange or

the Financial Industry Regulatory Authority that is an eligible guarantor institution. A notary public is NOT an acceptable guarantor.

The guarantee must be in the form of a stamp or a typewritten or handwritten guarantee that is accompanied by a raised corporate seal.

Note: A medallion guarantee is acceptable in place of a signature guarantee.

Virginia529

CollegeAmerica is a nationwide plan sponsored by

Indiana Service Center

Virginia Service Center

Please mail

this form to

American Funds Service Company

the appropriate

P.O. Box 6273

P.O. Box 2713

service center.

Indianapolis, IN 46206-6273

Norfolk, VA 23501-2713

( If you live outside

Overnight mail address:

the U.S., mail the

12711 N. Meridian St.

5300 Robin Hood Rd.

form to the Indiana

Carmel, IN 46032-9181

Norfolk, VA 23513-2430

Service Center. )

If you have questions or require more information, contact your financial advisor or call American Funds Service Company at ( 800 ) 421-4225.

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American Funds 529 Withdrawal Form - Distribution Request Page 4

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