Iowa Advisor 529 Plan Withdrawal Request Form Page 3
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45
p
m
Ayment
ethod
Check the option you would like for receiving your one time distribution or SWP proceeds:
□
A Medallion Signature
Make payment directly to an eligible educational institution. Send payment by check to the mailing address listed
Guarantee may be
below. The distribution will be reported under the Beneficiary’s Social Security number.
required in section 5 of
this form. See page 4 of
___________________________________________________________
_______________________________________
this form for additional
School
Attention
information.
___________________________________________________________
_______________________________________
For the benefit of (student’s name)
Student ID or account number
______________________________________________
________________________
_______
_______________
Mailing address
City
State
ZIP code
□
Make payment directly to the Account Owner. The distribution will be reported under the Account Owner’s Social
Security number.
□
Send payment by check to the Account Owner’s address listed in section 1 of this form. (see section 6)
□
Electronically transfer the distribution via EFT to my bank account indicated below. I understand that this service is
Include a voided check
governed by the terms and conditions found in the Bank Information section of the new Account Application and
or savings deposit slip
the Program Description and Participation Agreement.
for the electronic funds
□
□
Checking (attach a voided check)
Savings (attach a deposit slip)
transfer (ETF) payment
method. If you do
_____________________________________________________
____________________________________________
not have a voided
Name of bank
ABA/routing number for Automated Clearing House (ACH)
check or a deposit slip,
please include a bank
_____________________________________________________
____________________________________________
statement showing the
Bank account registration
Bank account number
names on the account,
□
address, and account
Send payment by wire to the Account Owner’s bank account (attach a voided check). A wire fee may be deducted
number.
from the account. (This option is not available for SWP proceeds.)
□
Make payment directly to the designated Beneficiary. The distribution will be reported under the Beneficiary’s Social
Generally, the proceeds
Security number.
□
will arrive at your bank
Send payment by check to the designated Beneficiary’s address listed in section 1 of this form. (see section 6)
within two banking
□
days. Receipt of valid
Electronically transfer the distribution via EFT to the designated Beneficiary’s bank account indicated below. I
bank information and
understand that this service is governed by the terms and conditions found in the Bank Information section of the
verification by your
new Account Application and the Program Description and Participation Agreement.
□
□
bank is required before
Checking (attach a voided check)
Savings (attach a deposit slip)
your first distribution
will be made by EFT.
_____________________________________________________
____________________________________________
Name of bank
ABA/routing number for Automated Clearing House (ACH)
Note: Checks must be
_____________________________________________________
____________________________________________
preprinted with your
Bank account registration
Bank account number
name and address. We
□
cannot accept starter or
Send payment by wire to the designated Beneficiary’s bank account (attach a voided check). A wire fee may be
counter checks.
deducted from the account. (This option is not available for SWP proceeds.)
6
o
d
o
vernIght
elIvery
ptIon
□
I have requested a withdrawal payment “by check” in section 4 and I would like to have the check
delivered by next-day delivery service. I understand that a fee will be deducted from the account to cover
the cost of the delivery service, as defined in the Program Description.
Page 3 of 4
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