Florida Prepaid College Plan Change of Account Owner Form

1 Flo rida Prepaid Co llege plan Change of A ccount Owner Form Changing the current Account Owner on a Florida Prepaid College plan requires the Account Owner 's notarized signature. The survivor s notarized sig nature is also required for plans purchased on or after February 1, 2009 that include coverage for Regis tratio n Fees, along with any a ssociated supplem ental plan (s). For more information, see the M aste r C ontract at apr Please remember: All s ignatures must be original and notarized. Faxed or copied notarized sig natures 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 names of the ac count Owner and survivor (if applicable) in the appropriate sect ion. A separate notary stamp is required for each si gnature even if the same individ ual notarizes both signatur es.

2 All s ignatures must be indiv idually acknow ledged by a notary. Sincerely, Florida Prepaid C ollege plan Custo mer Service Florida Prepaid College plan Change of Account Owner Form Custo mer Inf ormation: Name of C urre nt A ccount Owner or Aut horized Represe ntat iv e of Busin ess/ Org an ization/Trust ( ) Dayt ime Tele phone Num ber plan Number Name of Beneficiary (Student) NEW Account Owner S NA ME: SSN#: _ New Account Owner s S ignature: Date : Street City State Zip Home Phone #: ( ) - Work Phone #: ( ) - E-M ail Address: I (We) acknow ledge by executing this form that the current Account Owner relinqu ishes all rig hts and responsibilities, and I (we) aut horize the F lorida Prepaid C ollege Board to Change the acco unt Owner fo r the above-referenced p lan(s ).

3 The current survivor designation for th e above-referenced plan (s) is unaffected by this form; if a survivor Change is also nee ded, a separate request is req uired. A Change of Survivor Fo rm can be obtained at CURRENT Account Owner CURRENT SURVIVOR X Account OWNE R S SIGNATURE REQUIRED State of , County of X SURVIVOR S SIGNATURE-REQUIR ED for pl ans purchased on or afte r February 1, 2009 that include coverage for Regis tration Fees, along with any associated supplemental plan (s). State of , County of The f oregoing i nst rument was ac kn ow ledg ed before me This _ day of , 20 The f oregoing i nst rument was ac kn ow ledg ed before me This _ day of , 20 by (PRINT Account Owner S NAME) who (sele ct one): is personally known, OR produced i dentificat ion Type of Identifi cation: by (PRINT SURVIVOR S NAME) who (sele ct one): is personally known, OR produced i dentificat ion Type of Identifi cation: State of: _ State of: _ X SIGNATURE OF NOTARY REQUIRED X SIGNATURE OF NOTARY REQUIR ED Notary Stamp Notary Stamp Return the comple ted and notarized form to: Florida Prepa id Co llege Board, PO Box 6567, Tallahassee, FL 3231 4- 6567