Change of Purchaser - itppv.com

1 Florida prepaid College Plan Death of account owner Change Form To Change the account owner due to the death of the current account owner on a Florida prepaid College Plan with no survivor listed, the Personal Representative/Executor/Administrator of the deceased current account owner s estate must sign the form in the space provided and have the signature properly notarized. The completed form must be mailed along with copies of the following documents: The current account owner s death certificate; Certified Letters of Administration, issued by a court and signed by a judge, naming the Personal Representative/Executor/Administrator of the deceased current account owner s estate.

2 Letters of Administration must reflect a certification date that is not more than 90 days prior to the date on which they are submitted to the Florida prepaid College Board; If an Order of Summary Administration has been entered, a certified copy of such Order must also be submitted to th e Florida prepaid College Board with a certification date that is not more than 90 days prior to the date on which it is submitted to the Florida prepaid College Board. As ther e is no curren t s urvivor lis ted on the plan, the new account owner and the new survivor (if a new survivor is designated) must com plete and sign the for m. You may des igna te y our self or another per son as the new account owner or the new survivor.

3 Any person desi gnated to be the new account owner or survivor mus t be 18 years of age or older and a citizen or resident alie n of the United States. For more information, see the Maste r C ontract at The Florida prepaid College Plan cannot appoint anyone as the new account owner without a certified copy of the Letters of Administration issued by a court appointing the Personal Representative/Executor/Administrator of the current account owner s estate. The certification date must not be more than 90 days prior to the date on which they are submitted to the Florida prepaid College Board. If there is more than one Personal Representative/Executor/Administrator, each of those persons must sign the form and have their signatures properly notarized.

4 Please remember: The personal representative s sig nature must be original and notarized. Faxed or photo copied notarized signatures will not be accepted. The nota ry must properly sign the form. The nota ry must date the form. The nota ry must print the name of the personal r epre sentative in the appropriate s ection of the form. Please m ail the complete d form and the documents listed above to: Florida prepaid College Board PO Box 6567 Tallahassee, FL 32314-6567 Once the required information is receiv ed, we will update the plan and pro vide the new accoun t owner with documents refl ec tin g the Change in accoun t ow ner.

5 In addition, if the deceased current a ccoun t ow ner had a Grou p Life Insura nce Plan for his/her p repaid plan, contact S tudent Insuran ce Services at 1-800- 552 -GRA D ( 4723) and press prompt 4 for ins tru ction s on filin g a c laim. If you have any ques tions or nee d a ssis tan ce, pl ease c all us at 1-800- 552- GRA D (4723) and press prompt 2. Sinc erely, Florida prepaid College Plan Cus tomer Service Florida prepaid College Plan Death of account owner Change Form Customer Inf or mation: Name of C urrent A ccount owner (_____) _____- _____ Daytime Telephone Number Plan Number Name of Beneficiary (Student) NEW account owner NEW SURVIVOR Name: (Last/First/Middle) SSN: _____ - _____ - _____ _____ - _____ - _____ Address: City, State, Zip Code: E-Mail: Home Phone: ( ) _____ - _____ ( ) _____ - _____ Work Ph one: ( ) _____ - _____ ( ) _____ - _____ Signature.

6 X X I aut hor ize the Florida prepaid College Plan to Change the account owner on the above-referenced plan( s). I understand that, for plans purchased on or after Feb ruary 1, 2009 that include coverage for R egis trat ion Fees, along with any associate d supplemental plan(s), the new survivor s notarized sig nature als o w ill be required for the following: ch anges of account ow ner, survivor, or beneficiary; requests for volunt ary termi nation of the pl an(s); and requests for refunds ass ociated with involuntarily terminated plans. PERSONAL REPRESENTATIVE X SIGNATURE OF PERSONAL REPRESENTATIVE REQUIRED State of , County of The f oregoing i nst rument was ac kn ow ledg ed before me This _ day of , 20_ by (PRINT NAME OF PERSONAL REPRESENTATIVE) who (sele ct one): is personally known, OR produced i dentificat ion Type of Identifi cation: State of: _ X SIGNATURE OF NOTARY REQUIRED Notary Stamp