Bright Start Withdrawal Request – Fill Out and Use This PDF

1.Current Account Information

Account Number:

Account Owner Legal Name (First, M.I., Last):

Account Owner Social Security Number or Taxpayer Identification Number:

Daytime Phone Number:

Beneficiary Legal Name (First, M.I., Last):

Beneficiary Social Security Number or Taxpayer Identification Number:

2.Type of Withdrawal (Please check only one box)

See the Program Disclosure Statement for a general explanation of Qualified and Non-Qualified Withdrawals and possible tax and penalty considerations. Consult your tax advisor, the IRS, or Illinois Department of Revenue.

Qualified Withdrawal

IRS Publication 970 defines qualified education expenses as follows: These are expenses related to enrollment or attendance at an eligible educational institution. As shown in the following list, to be qualified, some of the expenses must be required by the institution and some must be incurred by students who are enrolled at least half-time.

1.The following expenses must be required for enrollment or attendance of a Designated Beneficiary at an eligible educational institution.

a.Tuition and fees.

b.Books, supplies, and equipment.

4.The purchase of computer or peripheral equipment, computer software, or Internet access and related services if it is to be used primarily by the beneficiary during any of the years the beneficiary is enrolled at an eligible educational institution. (This does not include expenses for computer software for sports, games, or hobbies unless the software is predominately educational in nature.)

Taxable Distribution due to: (Check Box A, B, C, or D)

3.Amount of Withdrawal

Partial Liquidation: (Check Box A or B)

A. Partial Liquidation in the Amount of $

(This withdrawal amount will be liquidated pro-rata based on the current balances in my Account) B. Partial Liquidation from Specific Portfolios

529 Portfolio

Total Withdrawal Amount:

4.Payment Instructions (Check Box A or B)

A. Check Payable to: (Check one)

Account Owner (check sent to the address on record)

Proceeds of this withdrawal will be used at an institution of higher education: (Check one)

Yes Name of School:City, State:

No

Beneficiary – A check payable to the Designated Beneficiary listed in Section 1 will be mailed to the following address: Street Address:

City, State, ZIP:

Institution of Higher Education (please attach copy of invoice or billing statement from institution) Name of Institution:

Department or Office:

Street Address:

City, State, ZIP:

Student ID Number:

4.Payment Instructions (continued from previous page)

B. Electronic Funds Transfer: (Check one)

To Account Owner’s Bank Account on File

Bank Name:

Bank Account Number:

To Account Owner’s Bank Account Not on File with Bright Start (complete below bank information)

•  Please have your signature Medallion-guaranteed in Section 6.

5.Authorization

I understand that the tax treatment of a withdrawal needs to be coordinated with the American Opportunity and Lifetime Learning Credits, the Tuition and Fees Deduction, Coverdell Education Savings Account distributions, and all other education related benefits. For specific tax guidance, I will consult with my tax professional.

By signing this form, I certify that I am the Account Owner of the Account indicated in Section I and that the information contained on this withdrawal form is true, complete, and correct. I authorize the Program Manager to make this distribution from my Account as indicated. I assume sole responsibility for the tax consequences of the above election and understand that the earnings portion of a Non-Qualified Withdrawal is subject to federal and state income tax, as well as an additional 10% federal penalty tax, and the recapture of any previous Illinois tax deductions taken for the contribution portion of the withdrawal.

By selecting the electronic transfer service in Section 4, I acknowledge that the bank account in Section 4 will be linked to my Bright Start Account, and I hereby authorize Union Bank & Trust Company to initiate debit and/or credit entries to the bank account indicated above, and the bank indicated above to debit the same amount. I acknowledge that the referenced bank account will be linked to my Bright Start College Savings Program Account so that I may purchase or sell shares by telephone or online at BrightStartSavings.com. This authority is to remain in full force and effect until Union Bank & Trust Company has received notification from me of its modification or termination in such time as to afford Union Bank & Trust Company reasonable time to act on it. I understand that if a transaction cannot be made because of insufficient funds or because either account has been closed, this service will be cancelled by Union Bank & Trust Company. I acknowledge that the origination of Automated Clearing House (“ACH”) transactions to my account must comply with the provisions of applicable law. I further agree that if my draft is dishonored for any reason, with or without cause, Union Bank & Trust Company will not bear any liability. Union Bank & Trust Company may correct any transaction errors with a debit or credit to my financial institution account and/or my Bright Start College Savings Program Account. (Please retain a copy of this authorization for your records.)

I understand that it is my responsibility to maintain accurate records as may be required by the IRS to substantiate this distribution for tax purposes.

6.Authorization (continued from previous page)

Signature and Date Required

X

Print Name Here

Title (if other than an individual is establishing the Account)

If the Account Owner is a trust and there is more than one trustee, the additional trustee must sign here.

X

Signature of Co-Trustee

7.Medallion Signature Guarantee

Medallion Signature Guarantee is Required if:

•  The address of record has changed within 15 days of the withdrawal request.

•  The bank account information in Section 5 is not already on file with the Bright Start College Savings Program. •  The withdrawal request is greater than $50,000

Note to Guarantor:

Medallion imprints must be fully legible and must not be dated or annotated.

June 2019