
Florida Prepaid College Plan
Voluntary Cancellation Form
Customer Information:
Plan Number: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Account Owner Name: ___________________________________
Beneficiary Name:__________________________________
Daytime Telephone Number: (_________)_________-____________
Please use this form to cancel a Florida Prepaid College Plan.
Please select ONE of the following cancellation reasons:
___ Financial hardship ___ Plan to re-enroll later
___ Beneficiary will not attend/complete college ___ Beneficiary received a Bright Futures scholarship
___ Choosing a different college investment ___ Beneficiary will attend an out-of-state or private Florida college
___ Expectations of the plan not met ___ Death or disability of the beneficiary
___ Beneficiary not going to live in a dormitory ___ Beneficiary has graduated, does not need the remaining benefits
___ Dormitory space not available ___ Cancel and transfer payments to plan #: __________________
___ Beneficiary received a scholarship ___ Other: _______________________________________________
I (We) have been advised of the alternatives besides cancellation and authorize the Florida Prepaid College Board to cancel the
above referenced plan(s):
ACCOUNT OWNER SURVIVOR
X _______________________________________
ACCOUNT OWNER’S SIGNATURE – REQUIRED
State of _______, County of ______________________________
The foregoing instrument was acknowledged before me
This _________ day of __________________, 20____
by ____________________________________________________
(PRINT ACCOUNT OWNER’S NAME)
who is (select one): ___Personally known, OR ___Produced identification
Type of Identification:________________________________________
State of:___________________________________________________
X ________________________________________
SIGNATURE OF NOTARY – REQUIRED
X _______________________________________
SURVIVOR’S SIGNATURE-REQUIRED – For plans purchased on or after
February 1, 2009, that include coverage for Registration Fees, and any
associated supplemental plan(s).
State of _______, County of ______________________________
The foregoing instrument was acknowledged before me
This _________ day of __________________, 20____
by ____________________________________________________
(PRINT SURVIVOR’S NAME)
who is (select one): ___Personally known, OR ___Produced identification
Type of Identification:________________________________________
State of:___________________________________________________
X ________________________________________
SIGNATURE OF NOTARY – REQUIRED
Return the completed and notarized form to: Florida Prepaid College Board, P.O. Box 6567, Tallahassee, FL 32314-6567