Fillable Agent Authorization/ Limited Power Of Attorney Form printable pdf download

DO NOT STAPLE

CSRIA_00778H 0416 — Page 1 of 4

CollegeBound 529

Agent Authorization/

Limited Power of Attorney

• Use this form to designate a Financial Advisor (as defined in the CollegeBound 529

Program Description), individual, corporation, or other entity as your Agent with

1.877.615.4116

limited authority to act on your CollegeBound 529 Account(s). To grant an Agent

8 a.m. to 8 p.m. Eastern Time M-F

complete powers to act on your CollegeBound 529 Account(s), please complete the

Power of Attorney Form.

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• You may only designate one level of authorization in Section 3 for the

Account(s) listed on this form. To grant a different level of authorization for your

Regular mailing address:

other Account(s), please complete a separate form.

CollegeBound 529

• This Agent Authorization/Limited Power of Attorney Form must be signed by

P.O. Box 55987

the Account Owner and notarized in Section 4.

Boston, MA 02205-9722

• This Agent Authorization/Limited Power of Attorney Form must also be signed

Overnight mailing address:

by the Agent in Section 2.

CollegeBound 529

• If there is anything about this form that you do not understand, you should seek

95 Wells Ave, Suite 155

legal advice.

Newton, MA 02459

• Type in your information and print out the completed form, or print clearly,

preferably in capital letters and black ink. Mail the form to the address listed.

Do not staple.

Forms can be downloaded from our website at ,

or you can call us to order any form — or request assistance in completing this

form — at 1.877.615.4116 any business day from 8 a.m. to 8 p.m. Eastern time.

WARNING TO PERSON EXECUTING THIS DOCUMENT

THIS IS AN IMPORTANT LEGAL DOCUMENT WHICH IS AUTHORIZED BY THE RHODE ISLAND GENERAL LAWS. THE POWERS GRANTED BY

THIS DOCUMENT ARE BROAD AND SWEEPING. THE POWERS GRANTED BY THIS DOCUMENT ARE DEFINDED IN R.I.G.L. 18-16-1 ET SEQ.

ENTITLED THE RHODE ISLAND SHORT FORM POWER OF ATTORNEY ACT.

NOTICE: UNLESS YOU LIMIT THE POWER IN THIS DOCUMENT, THIS DOCUMENT GIVES YOUR AGENT THE POWER TO ACT FOR

YOU, WITHOUT YOUR FURTHER CONSENT, IN ANY WAY THAT COULD ACT FOR YOURSELF. ACTIONS TAKEN BY YOUR AGENT

WILL BIND YOU AND YOUR SUCCESSORS.

THE PURPOSE OF THIS LIMITED POWER OF ATTORNEY IS TO CONFER UPON AND GRANT TO THE PERSON YOU DESIGNATE (YOUR “AGENT”)

BROAD POWERS TO TRANSACT BUSINESS WITH COLLEGEBOUND 529, WHICH MAY INCLUDE POWERS TO MAKE INVESTMENT DECISIONS,

CONTRIBUTIONS, WITHDRAWALS, AND TAKE OTHER ACTION IN CONNECTION WITH COLLEGEBOUND 529 WITHOUT ADVANCE NOTICE TO

YOU OR APPROVAL BY YOU. THIS FORM DOES NOT IMPOSE A DUTY ON YOUR AGENT TO EXERCISE GRANTED POWERS. WHEN POWERS

ARE EXERCISED, YOUR AGENT MUST ACT FOR YOUR BENEFIT,AND USE THE CARE, COMPETENCE, AND DILIGENCE ORDINARILY EXERCISED

BY AGENTS IN SIMILAR CIRCUMSTANCES, ALL IN ACCORDANCE WITH THE PROVISIONS OF THIS LIMITED POWER OF ATTORNEY AND

APPLICABLE LAW.

UNTIL YOU REVOKE THIS LIMITED POWER OF ATTORNEY OR A COURT ACTING ON YOUR BEHALF TERMINATES IT, YOUR AGENT MAY EXERCISE

THE POWERS GIVEN HERE THROUGHOUT YOUR LIFETIME, EVEN AFTER YOU BECOME DISABLED. IF YOU WISH TO REVOKE THIS LIMITED POWER

OF ATTORNEY YOU MUST NOTIFY THE AGENT IN WRITING WITH A COPY TO COLLEGEBOUND 529 AT THE ADDRESS SET FORTH ABOVE.

THIS LIMITED POWER OF ATTORNEY IS INTENDED TO COMPLY WITH THE R.I.G.L 18-16-1 EQ SEQ. IN THE EVENT OF A CONFLICT BETWEEN

THIS LIMITED POWER OF ATTORNEY AND RHODE ISLAND LAW, RHODE ISLAND LAW SHALL CONTROL. YOU MAY HAVE OTHER RIGHTS OR

POWERS UNDER RHODE ISLAND LAW NOT SPECIFIED IN THIS FORM.

Agent Authorization/ Limited Power Of Attorney Form

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