Fillable Iowa Advisor 529 Plan Withdrawal Request Form (Page 4 of 4) in pdf

(

)

greement And

IgnAture

I certify that the information I have provided with respect to my Iowa Advisor 529 Plan account is true, complete, and correct.

I agree to the terms set forth in the Program Description and Participation Agreement. I agree that the applicable Option,

Voya Investment Management Co. LLC, and their affiliates, subcontractors, and any officers, directors, employees, or agents

of these entities (collectively, “Program Manager”) will not be responsible for banking system delays beyond their control

or for any loss, cost, or expense for acting upon my instructions, if they follow reasonable procedures designed to prevent

unauthorized transactions.

I understand that the Program Manager and Iowa Advisor 529 Plan do not determine whether a distribution is qualified or not.

Receipts and other forms of substantiation should not be submitted to the Program. I acknowledge that I am responsible for

reporting this distribution in accordance with the current Internal Revenue Service (IRS) rules, including applicable penalties,

and further acknowledge that even though this distribution was processed, it may not be considered qualified by the IRS.

You must sign and date



Medallion Signature Guarantee*

_ _________________________________________________

here to complete this

request. A Medallion

Signature of Account Owner, Custodian or Trustee/Executor

Signature Guarantee

may also be required.

__________________________________________________

Print name

__________________________________________________

Date



Medallion Signature Guarantee*

_ _________________________________________________

Signature of Co-Trustee or Co-Executor (if applicable)

__________________________________________________

Print name

__________________________________________________

Date

HAVE ALL SIGNATURES MEDALLION GUARANTEED TO:

■

Send proceeds to a new address prior to the expiration of the 30-day hold;

■

Send proceeds to a bank account not already on file; or

■

Send proceeds to the designated Beneficiary’s bank account

*A Medallion Signature Guarantee may be obtained from any eligible guarantor institution, as defined by the Securities and

Exchange Commission. These institutions include banks, savings associations, credit unions, and brokerage firms that partici‑

pate in the Medallion Program. The bar‑coded stamp with the words “MEDALLION GUARANTEED” must be stamped near

each signature being guaranteed. The guarantee must appear with the name of the guarantor institution and the signature of

an individual authorized on behalf of the guarantor institution. Note that a Notary Public stamp or seal is not acceptable.

AIlIng

nstructIons

egulAr

AIl

vernIght

ourIer

Iowa Advisor 529 Plan

c/o Voya Investment Management

PO Box 9659

4400 Computer Drive

Providence, RI 02940-9659

Westborough, MA 01581-1722

Iowa Advisor 529 Plan is a part of the Iowa Educational Savings Plan Trust, a state-sponsored 529 college savings

plan administered by the State of Iowa, for which the Treasurer of the State of Iowa serves as the Trustee. Voya

Investment Management Co. LLC provides investment management and administrative services for the Iowa

Advisor 529 Plan. Shares in the Program are distributed by Voya Investments Distributor, LLC, Member FINRA/SIPC.

NOT FDIC INSURED • NO BANK GUARANTEE • MAY LOSE VALUE

Page 4 of 4

Iowa Advisor 529 Plan Withdrawal Request Form Page 4

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