Agent Authorization/ Limited Power Of Attorney Form Page 3
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CSRIA_00778H 0416 — Page 3 of 4
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Authorization level
I, the Account Owner listed in Section 1, appoint the Agent listed in Section 2 as my Agent.
Important: Please initial the appropriate level of access that applies to the Account(s) listed in Section 1.
Note: If you have more than one Account and you wish to designate different levels of access for your different Account(s), complete a
separate form for each Account.
Level 1 — Account Inquiry Access. To obtain information about my Account(s), and receive duplicate Account
Initial
statements from CollegeBound 529.*
Level 2 — Account Inquiry Access, Contributions, and Investment Option Changes. To obtain information
Initial
about my Account(s), and receive duplicate Account statements from CollegeBound 529. To contribute money
to the above-referenced Account(s) and to move money among Investment Options within each of the above-
referenced Account(s).*
Level 3 — Account Inquiry Access, Contributions, Investment Option Changes, and Qualified Distributions.
Initial
To obtain information about my Account(s), and receive duplicate Account statements from CollegeBound 529.
To contribute money to the above-referenced Account(s) and to move money among Investment Options within
each of the above-referenced Account(s). To make qualified distributions, now or in the future, from the
above-referenced Account(s).*
* The authority granted in Level 1, 2 or 3 Access is limited to the level of authority specified above. My Agent shall have no authority
to take any other action, including, but not limited to:
• Changing the address of record on my Account(s),
• Adding, deleting, or changing any banking information with respect to my Account(s),
• Changing the Beneficiary,
• Signing or e-signing an Enrollment Form or otherwise opening a new Account on my behalf, or
• Transferring assets to a new Account.
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