Iowa Advisor 529 Plan Withdrawal Request Form
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4Iowa Advisor 529 Plan
Withdrawal Request Form
Complete this form to request a distribution from your Iowa Advisor 529 Plan account. If you
would like help completing this application, contact your financial advisor or call 1-800-774-5127.
Information is also available online at
1
A
I
m
A
ccount
nformAtIon And
AIlIng
ddress
_____________________________________________________________________________ ___________________________________________
Name of Account Owner or Custodian (first, middle initial, last), or entity
Social Security/taxpayer ID number
___________________________________________________________________________________________
___________________________
If trust, name of trustee(s) (first, middle initial, last)
Date of trust (mm/dd/yyyy)
____________________________________________________________
___________________________
__________
______________
U.S. residential street address
City
State
ZIP code
____________________________________________________________
___________________________
__________
______________
To help ensure timely
U.S. mailing address (if different than U.S. residential street address)
City
State
ZIP code
and accurate processing
of this form, please
print clearly.
____________________________________________________________
___________________________
___________________________
E-mail address
Daytime phone
Evening phone
___________________________________________________________________________
___________________________________________
Name of designated Beneficiary (first, middle initial, last)
Social Security/taxpayer ID number
____________________________________________________________
___________________________
__________
______________
U.S. residential mailing address
City
State
ZIP code
____________________________________________________________
__________________________________________________________
Account number
Account number
Note: If the address above is different than the address currently listed on our records, we will update all
accounts for the Account Owner, Custodian, or entity. All future correspondence will be sent to the new address
until you advise us otherwise. The Beneficiary address will be updated on accounts for which the same Account
Owner, Custodian, or entity is authorized. Distributions to a new address will require your signature to be
Medallion Guaranteed if requested within 30 days of the address change.
2
t
d
ype of
IstrIbutIon
Choose one:
□
Systematic Withdrawal Plan
□
Establish this plan on an existing Iowa Advisor 529 plan account
□
Establish this plan on a new Iowa Advisor 529 plan account:
Your account must
A new Account Application must also be completed.
have a minimum
balance of $5,000 to
_________________________________________
establish a SWP.
Option name
Option name
_________________________________________
Option name
Option name
For Systematic Withdrawal, proceed to section 3
□
One Time Distribution
□
Full Distribution: Liquidate the entire Iowa Advisor 529 plan account balance
If you wish to
If the entire balance is requested, any Automatic Investment Plan on the account will be stopped, unless
distribute from more
than one Option/
you check the following box:
account, please provide
□
additional allocation
I have an existing Automatic Investment Plan and would like the contributions to continue.
instructions.
□
Partial distribution: $________________________ or %
If the amount requested is greater than the balance in the account, the entire account balance will be
liquidated.
For One Time Distribution, proceed to section 4
Page 1 of 4
I529-WITHDRAWALAPP - (032013) 166898
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