Broker Dealer Change Form
For assistance, please contact our CollegeAccess 529 Plan Investor Services at 866-529-7462, Monday through
Thursday, 8:30am – 6:00pm and until 5:00pm on Friday, or visit our website at CollegeAccess529.com.
Please note our representatives do not offer investment advice or make recommendations about your investment(s).
Please use this form to change the Broker Dealer Information on your CollegeAccess 529 Plan account. Please send the
completed form to one of the following:
Regular Mail
College Access 529
P.O. Box 534436
Pittsburgh, PA 15253-4436
Overnight Mail
College Access 529
Attn: 534436
AIM: 154-0520
500 Ross Street
Pittsburgh, PA 15262
Fax
844-751-0047
1. Account Information
Account Owner(s) U.S. Social Security Number
Address Email Address
City, State, ZIP Code Account Number(s)
Evening Telephone Number Mobile Telephone Number
By checking the preceding box, I authorize the Program Manager to replace any conflicting information and/or add any missing
information to my account records, with regard to the address, email address and telephone numbers provided in this section.
2. Dealer (Financial Professional) Information
Check this box if you would like to remove the current Broker/Dealer without a replacement. If you have not named a new
Broker/Dealer, VP Distributors, LLC, the Program Managers’ default Broker/Dealer will be assigned to the account.
Update the Broker/Dealer, as follows:
Dealer Name Dealer Number
Branch Street Address Branch Number
Branch City, State, ZIP Code Branch Telephone Number
Financial Professional’s Name Financial Professional’s Number
Financial Professional’s Email Address Financial Professional’s Telephone Number
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3. Signature and Agreement of Account Owner(s) & Financial Professional
By signing below, I/we hereby authorize VP Distributors, LLC and its agents to make the above broker-dealer and financial professional
changes for the account(s) referenced above. I/We understand certain share classes include a sales charge which is intended to
compensate a financial intermediary for their services. This charge applies whether or not a financial intermediary is designated on an
account. In addition, some share classes pay on-going distribution and/or service fees. Like the sales charge, these fees are intended to
compensate a financial intermediary for their services and are still retained by the Plan’s distributor.
I/We authorize the Program Manager and its agents to act upon instructions (by phone, in writing, on-line, or by other means) believed
to be genuine and in accordance with the procedures described in the Plan Disclosure Statement for this account or any account into
which exchanges are made. I/We agree that neither the Plan Manager nor the Transfer Agent will be liable for any loss, cost or expense
for acting on such instructions, provided that the Transfer Agent employs reasonable procedures to confirm that instructions
communicated are genuine. I/We understand that I/we bear the risk from instructions given by an unauthorized third party that the
Transfer Agent reasonably believes to be genuine.
By signing below, if there is a Dealer assigned to my/our existing account(s) listed above or any new account established under the
same primary Social Security Number in the future, I/we hereby authorize the listed Dealer to act on my/our behalf with respect to
my/our account(s) in all aspects, including without limitation initiating contact specifically for the purposes of unclaimed property laws.
ACCOUNT OWNER AGREES THAT ANY CLAIM BY ACCOUNT OWNER OR THE DESIGNATED BENEFICIARY AGAINST THE COUNCIL, THE
STATE OF SOUTH DAKOTA OR THE MEMBERS, OFFICERS AND EMPLOYEES OF THE COUNCIL ORTHE STATE OF SOUTH DAKOTA MAY
BE MADE SOLELY AGAINST THE ASSETS IN ACCOUNT OWNER’S ACCOUNT AND THAT ALL OBLIGATIONS HEREUNDER ARE LEGALLY
BINDING CONTRACTUAL OBLIGATIONS OF THE TRUST ONLY. AS A CONDITION OF AND IN CONSIDERATION FOR THE ACCEPTANCE OF
THIS AGREEMENT BY THE PROGRAM MANAGER ON BEHALF OF THE COUNCIL, ACCOUNT OWNER AGREES TO WAIVE AND RELEASE
MY EMPLOYER, THE PROGRAM MANAGER, THE COUNCIL AND THE STATE OF SOUTH DAKOTA, AND EACH OF THE MEMBERS,
OFFICERS, AFFILIATES, AGENTS AND EMPLOYEES OF THE PROGRAM MANAGER, THE COUNCIL ANDTHE STATE OF SOUTH DAKOTA,
FROM ANY AND ALL LIABILITIES ARISING IN CONNECTION WITH RIGHTS OR OBLIGATIONS ARISING OUT OFTHIS AGREEMENT OR THE
ACCOUNT.
Print Name (account owner, custodian, trustee, partner, or officer) Signature Date
Print Name (joint owner, co-trustee, partner, or officer) Signature Date
Print Name (Financial Professional) Signature Date
NOTICE: The Account is not insured by any state and neither the principal deposited nor any investment return is
guaranteed by any state. Furthermore, the accounts are not insured, nor the principal or any investment return
guaranteed, by the federal government or any federal agency.
The CollegeAccess 529 Plan is issued by the South Dakota Higher Education Savings Trust. The Program Manager and Underwriter for the
CollegeAccess 529 Plan is VP Distributors, LLC, One Financial Plaza, Hartford, CT 06103, 800-243-4361.
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