Florida Prepaid College Plan Voluntary …

1 Florida Prepaid College plan Voluntary cancellation form Cancellati on of a Florida Prepaid College plan requ ires the acc ou nt owner s notarized signature and, for p lans p urch ased on or after February 1, 2009 that include covera ge for R egi strati on Fe es, along with any associated supplemental plan (s), the survi vor s n otarized signatur e. For more information, see t he Master Contract at aprep aid .com. Once t he pl an has been cancelled, the account owner w ill rec eiv e a refund of the t otal payments made minus all fee s, in cluding late fees owe d at the time of cancell ation. A ca ncellati on fee of 50 percent of the t otal payments made, n ot to e xcee d $50, may also b e ded uct ed from the refu nd amount if the plan that includes cover ag e for Reg istration Fe es has been held for l ess tha n two years from the f irst pay ment d ue dat e.

2 Re funds are made payable only t o the account owner and are usually mailed within 45 days of receipt of the com plete d c ancell ati on requ est. An inc omplete or incorrectly c ompl eted f orm may delay the ca nce lla tion pr ocess. Th e refund will be m ail ed to the address on file. If an update is requ ired, a Change of Ad dres s F orm may be d ow nloaded from com/forms. The account owner s signature i s required to chang e the addre ss on an a ccou nt. In o rder for the address update to be m ade with the ca nc ellation, the Change of Addre ss form must a ccompany this notarized for m. Please r emembe r: All signatur es must be original and notarize d. Fa xe d or p hotocopied notarized s ign atures will not be ac cepted. The notary must properl y c omplete a nd s ign the f orm. The notary must da te the f orm. The notary must print the names of the account owner and survivor (if applicable) in the appropriate s ecti on.

3 A se parate notary stamp is required for each sig nature eve n if the same indi vidual notariz es both signatures. All signa tur es must be individually acknowledge d by a nota ry. If yo u dec ide not to cancel yo ur plan , simpl y d isrega rd thi s form and continue your m onthly payments. If yo u hav e any questio ns or concerns, pl ease call 1-800-552-GRAD (4723) and press prompt 2. Sincerely, Fl orida Prepaid C ollege Pla n Custo mer Service Florida Prepaid College plan Voluntary cancellation form Customer Information: plan Number: Account Owner Name: Be neficiary Name: Daytim e Telephone Number: ( ) - Plea se us e this fo rm to canc el a F lori da Pre paid College plan . Please select ONE of the following cancellation reasons: Fi nancial h ardsh ip plan t o re -enroll la ter Beneficiary will not attend/compl ete colle ge Beneficiary rec eived a Bright Futures s cholarship Choosin g a differ ent College investm ent Beneficiary will attend an out-of-state or private Florida College Expect ations of the plan not met Death or disability of the ben efic iary Beneficiary not g oing to live in a d orm itory Beneficiary has gradu ate d, d oes not need the rem aini ng benefits Dormitory sp ace not available Cancel and transfer payments to plan #: Beneficiary rec eived a scholars hip Oth er: I (We) have be en adv ised of the alt erna tives to cancella tion an d author ize the Florida Prepa id College Board to cancel the abov e-refer enc ed plan (s).

4 ACCOUNT OWNER SURVIVOR X ACCOUNT OWNER S S IGN ATUR E R EQUIR ED State of , County of The foregoing instrument was acknowledged before me This day of , 20 X SURVIVOR S SIGNATURE-REQUIRED for pl ans purchased on or a fter February 1, 2009 that i ncl ude coverage for R egist rat ion Fees, along with any associ ated supplemental plan (s). State of , County of The foregoing instrument was acknowledged before me This day of , 20 by (PRINT ACCOUNT OWNER S NAME) who (select one): is personally known, OR produced identification Ty pe of Identi fication: by (PRINT SURVIVOR S NAME) who (select one): is personally known, OR produced identification Ty pe of Identi fication: State of: X SIGNATUR E OF NOTAR Y R EQUIR ED Nota ry Sta mp State of: X SIGNATUR E OF NOTAR Y R EQUIR ED Nota ry Sta mp Re turn the completed and notarized form to : Florida P repaid Coll ege Boa rd, PO Box 6567, Tal laha ssee, FL 32314-6567