Nebraska Law on Signing Legal Documents in Black or Blue Ink

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Nebraska Law on Signing Legal Documents in Black or Blue Ink Powered By Docstoc
					                                                                                                                                             Do not staple checks to form.

                                                                Enrollment Form
                                                                Complete all applicable sections and return to: College Savings Plan of Nebraska, P Box .O.
                                                                82644, Lincoln, NE, 68501. You may also return this form to any Union Bank location or the
                                                                Nebraska State Treasurer’s office, or you may enroll online at
                                                                Please type or print unless a signature is specifically requested. You must complete a separate
                                                                enrollment form for each beneficiary. If you are establishing an account with the assistance

   1                                                            of a financial advisor, please contact your advisor to obtain the appropriate paperwork.
               Account Owner (Please check only one and complete the appropriate information)
     print        ❒ INDIVIDUAL                       Check one:    ❒ Mr. ❒ Mrs. ❒ Ms. ❒ Dr.                          Transferring funds from UTMA/UGMA?         ❒ Yes ❒ No
  black or
 blue ink.        Account Owner’s First Name                           MI                                         Last Name

                  Account Owner’s Social Security Number                                          Date of Birth

                  Citizenship*                                                         ❒ U.S.             ❒ Resident Alien
                  *Non-resident Aliens are not eligible to participate in the Plan.

                  ❒ TrUST (Copy of trust document required.)

                  Name of Trust

                  Trust’s Taxpayer Identification Number                                                                              Date of Trust

                  Trustee (if more than one Trustee, attach a sheet with additional Trustees including Name,                          Date of Birth
                  Date of Birth, Social Security Number, and Permanent Address)

                                                                                                                                 Social Security Number

                  ❒ OrgANIzATION Check one: ❒ Governmental Entity ❒ Tax-Exempt Organization ❒ Company ❒ Corporation ❒ Other

                  Name of Entity/Organization

                  Entity’s Taxpayer Identification Number                                      Name of Person Authorized to Transact on this Account

   2           Account Owner’s Address
    owner         Mailing Address
                  City, State, Zip

                  Permanent Address (if mailing address is a P Box)

                  (         )                                                              (        )
                  Day telephone                                                            Evening telephone

                  E-mail address

               Beneficiary Information.
      is the      First Name                                           MI                                         Last Name
                  Mailing Address                                                                                 City, State, Zip
     can be
       paid       Social Security Number                                                                                              Date of Birth
  from this
                  Beneficiary’s relationship to Account Owner (no relationship required)                   ❒ child            ❒ grandchild            ❒ Other
   4          Contribution Information.
  You have      Indicate how you will contribute to your account. Check all that apply.
   ways to            Check. Make check or money order payable to College Savings Plan of Nebraska.
contribute.           You may make additional contributions at any time. (Subject to $360,000 maximum limit.)
                                                                                                                                         ,                    .
                                                                                                                                 Amount of your initial investment.

                      Payroll deduction. Check with your employer to see if payroll deduction is available.
                      Complete the Payroll Deduction Form and return with this enrollment form.
                                                                                                                          Amount to be deducted per pay period.

                      rollover from another Qualified Tuition Program. Complete the Rollover Form which can be obtained by downloading it from
             or by calling 1-888-993-3746.

                      Transfer from UgMA/UTMA, Coverdell ESA or US Savings Bond. Please review the Savings Transfer Form which can be obtained by calling

                      Automatic deduction from your bank account. Complete information below. With a minimum
                      ACH investment of $25 per month, your account will automatically receive a one-time $10 fee credit.              Checking           Savings

                To make an automatic deduction, fill out the following information and attach a voided check.       ❒ 5th of each month
                                                                                                                    ❒ 20th of each month
                $                                                                                                   ❒ 5th & 20th of each month
                                  Amount to be transferred*
                *You may transfer funds on the 5th or 20th of each month, or you may transfer funds on both days.

                    YOUR NAME                                                                                                                       123
                    AND ADDRESS
                                                                                                                                                    12 - 34

                      PAY TO THE

                      ORDER OF

                                                                                                                     SAMPLE VOID

                      BANK NAME AND ADDRESS


                       :123456789:                  34568:             1011

                                       TAPE VOIDED CHECK HErE FOr AUTOMATIC DEDUCTION

                I hereby authorize the Program Manager to initiate debit entries to the bank account indicated above, and the bank indicated above to debit the same
                amount. This authority is to remain in full force and effect until the Program Manager has received notification from me of its modification or termination
                in such time as to afford the Program Manager 10 business days to act on it. In the case of unsuccessful debits, I understand that the Program Manager
                reserves the right to cancel this authorization and that the Program Manager will notify me in writing of such action. I acknowledge that the origination
                of ACH transactions to my account must comply with the provisions of applicable law. I further agree, if my draft is dishonored for any reason, with or
                without cause, the Program Manager will not bear any liability.

                X                                                                                         X
                Signature of Bank Account Owner                                                          Signature of Joint Bank Account Owner
                Authorization must be received approximately 10 business days prior to the first transfer date. The Program Manager, on behalf of the College Savings
                Plan of Nebraska, will provide you a copy of this authorization and information on the date of the first transfer.

                 For Office Use Only

                 Name of Account Owner                                                                        Account Number
    5            Portfolio Investment Options.
                   Your initial and future contribution(s) will be invested in a College Savings Plan of Nebraska portfolio based on your following selection:
  selecting a
                   CheCk ONLY ONe bOx (A), (b), Or (C).
     see your
 Enrollment        ❒ A. Age-Based Portfolios
                      For many investors the professionally managed Age Based Portfolios will be the portfolio of choice. With the Age Based Portfolios, you as the Account
                      Owner select whether you want to be aggressive, growth-oriented, balanced or conservative with your investment strategy.
  for details.
                      Once you’ve selected your investment strategy (i.e.—aggressive, growth, balanced or conservative) the College Savings Plan of Nebraska handles the
                      rest. The portfolios automatically adjust over time as the beneficiary nears college age.
                      If you’ve checked box (A), select one of the following:

                      ❒ Aggressive Portfolio                     ❒ growth Portfolio                    ❒ Balanced Portfolio                   ❒ Conservative Portfolio

                   ❒ B. Target Portfolios
                      The Target Portfolios have a set targeted investment mix. This mix, or asset allocation, does NOT adjust over time like the Age-Based Portfolios.
                      If you’ve checked box (B), select one of the following:

                        ❒ Fund 100                                                       ❒ Fund 80                                            ❒ Fund 60
                        100% Equity Funds                                                80% Equity Funds                                     60% Equity Funds
                                                                                         5% Real Estate Funds                                 5% Real Estate Funds
                                                                                         15% Fixed Income Funds                               26% Fixed Income Funds
                                                                                                                                              9% Money Market Funds

                        ❒ Fund 40                                                        ❒ Fund 20                                            ❒ Conservative
                        40% Equity Funds                                                 20% Equity Funds                                     50% Fixed Income Funds
                        5% Real Estate Funds                                             5% Real Estate Funds                                 50% Money Market Funds
                        36% Fixed Income Funds                                           46% Fixed Income Funds
                        19% Money Market Funds                                           29% Money Market Funds

                   ❒ C. Individual Fund Portfolios
                      Each Individual Fund Portfolio will invest in a single mutual fund. Since each Portfolio invests in a single fund, the performance of each Portfolio is
                      dependent upon the performance of the underlying fund. As a result, the Individual Fund Portfolios may be more volatile than the Age-Based or Target
                      Portfolios. If you’ve checked Box C, select any combination of the following Portfolios. The percentages selected in the various Portfolio(s) must total
                      100%. Selections must be in 1% increments.

                      _____% Vanguard Prime Money Market 529 Portfolio                                 _____% Vanguard Total Stock Market Index 529 Portfolio

                      _____% Vanguard Short-Term Bond Index 529 Portfolio                              _____% Vanguard FTSE Social Index 529 Portfolio

                      _____% Vanguard Intermediate-Term Bond Index 529 Portfolio                       _____% American Century Equity Income 529 Portfolio

                      _____% Vanguard Instl. Total Bond Market Index 529 Portfolio                     _____% Vanguard Mid-Cap Index 529 Portfolio

                      _____% PIMCO Total Return 529 Portfolio                                          _____% Vanguard Extended Market Index 529 Portfolio

                      _____% Goldman Sachs Real Estate Securities 529 Portfolio                        _____% Vanguard Small-Cap Value Index 529 Portfolio

                      _____% Vanguard Value Index 529 Portfolio                                        _____% Vanguard Small-Cap Index 529 Portfolio

                      _____% Vanguard Institutional Index 529 Portfolio                                _____% Vanguard Small-Cap Growth Index 529 Portfolio

                      _____% Vanguard Growth Index 529 Portfolio                                       _____% Fidelity Advisor Diversified Int’l 529 Portfolio

                      _____% Fidelity Advisor Equity Growth 529 Portfolio                              _____% Vanguard Total International Stock Index 529 Portfolio

                                                                                                       100% Total

                   Investors in the College Savings Plan of Nebraska do not own shares of the underlying mutual funds directly, but rather own shares of a Portfolio in the
                   Nebraska Educational Savings Plan Trust.
                   Each investment option is described in more detail in the College Savings Plan of Nebraska Enrollment Handbook.
                   Investment Products: Not FDIC Insured, No Bank Guarantee, May Lose Value.
   6           Successor Account Owner (optional)
  You may
   name a         The person or entity named below will be the Successor Account Owner in the event of the death of the Account Owner. You may update the
 Successor        Successor Account Owner on this Account at any time.

                  First Name                                         MI                                          Last Name

                  Mailing Address                                                                                City, State, Zip

                  Social Security Number                                                         Date of Birth

                  Taxpayer Identification Number (if applicable)                                 Date of Trust (if applicable)

   7           Authorization.
                  The Account Owner must sign and date this section in ink. By signing below:
  have just
    opened             I consent and agree to all of the terms and conditions of the College            I acknowledge that I have received and read the College Savings Plan
   the door            Savings Plan of Nebraska Participation Agreement and Enrollment                  of Nebraska Enrollment Handbook and Participation Agreement.
    to your            Handbook, which are incorporated herein by reference.
loved one’s                                                                                             I understand an account maintenance fee of $5 per quarter will be
                       I am of legal age.
     future.                                                                                            deducted from the Account.
                       I am a U.S. citizen or resident alien.
                                                                                                        I certify, under penalties of perjury, that: (1) The taxpayer identifica-
                       I acknowledge that accounts established under the College Savings                tion numbers shown on this application are correct; and (2) I am
                       Plan of Nebraska and their earnings are not insured by the Federal               NOT currently under IrS notification that part of my dividend and
                       Deposit Insurance Corporation (FDIC) or any other governmental                   interest income is to be withheld as a result of my failure to report all
                       agency; are not a deposit or other obligation of Union Bank & Trust              dividends and interest income on my income tax return -i.e. backup
                       Company; are not guaranteed by the State of Nebraska or Union                    withholding. (Strike the word “NOT” above if you have received IrS
                       Bank & Trust Company; and are subject to investment risk, including              notification.)
                       loss of principal.

  To help the government fight the funding of terrorism and money laundering activities, Federal law requires financial institutions to obtain, verify, and
  record information that identifies each person who opens an account.What this means for you: when you open an account,we will ask for your name,
  address, date of birth and other information that will allow us to identify you.We may also ask to see your driver’s license or other identifying documents.

  If you do not provide this information when requested, the Program Manager may be delayed or unable to open your Account and accept your investment.
  If the Program Manager determines that you have not provided a correct Social Security or other tax ID number on your account application, or is not able
  to verify your identity as required by law, the Program Manager may, at its discretion, redeem your Account and distribute the proceeds to you.

                 Signature of Account Owner                                                                                                         Date

                 Print Name Here:
                                                                                                                    Title (if other than an individual is establishing the Account)

   8           Survey.
Please take
a moment          How did you learn about the College Savings Plan of Nebraska? (Check all that apply)
to respond
     to this      ❒ friend/family member                                          ❒ television                                ❒ newsletter/newpaper article
                  ❒ school presentation                                           ❒ radio                                     ❒ web site ___________________________
                  ❒ Nebraska State Treasurer’s Office                             ❒ newspaper ad                              ❒ employer___________________________
                  ❒ attorney (name)___________________________                    ❒ financial advisor (name)___________________________________________________
                  ❒ accountant (name)_________________________                    ❒ other___________________________________________________________________
                  ❒ Union Bank representative (name)___________________________________________________________

                                            1-888-993-3746 •
Enrollment Form 5/08

Description: Nebraska Law on Signing Legal Documents in Black or Blue Ink document sample