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PLEASE READ: Important Information About Opening a Jumpstart Savings Account ("Account") Before completing this form, carefully read the West Virginia Jumpstart Savings Program Account Disclosure Statement and Informational Booklet & Participation Agreement.

Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an Account to fight the funding of terrorism and money laundering activities. What this means for you: To be approved to open an Account, you will be required to provide your name, address, date of birth, and other information that identifies you, such as Social Security number or Tax Identification Number. Additionally, any designated beneficiary you name below will be required to provide similar information for verification purposes.

This Program Application must be completed and submitted to the Board of Trustees of the College and Jumpstart Savings Programs ("the Board") to open and become the Account Owner for a West Virginia Jumpstart Savings Account ("Account") offered by the Program's Savings Account Manager, United Bank, in the West Virginia Jumpstart Savings Program ("the Program").

If this Program Application is approved, the successful applicant will be notified of approval by the Board and be provided with instructions for opening the Account through United Bank. A successful applicant must follow all instructions and complete all steps required by the Board and United Bank to open an Account and become an Account Owner in the Program.
Owner Information
Account Owner Legal Name:
First:
 
Middle:
Last:
 
Account Owner Social Security Number or Taxpayer Identification Number:       
Account Owner Date of Birth (mm/dd/yyyy):
 
 
Gender:
US Permanent Resident?
Citizenship:
UGMA/UTMA Custodian Name:
First:
 
Middle:
Last:
 
UGMA/UTMA Custodian Social Security Number or Taxpayer Identification Number:         
UGMA/UTMA Custodian Date of Birth (mm/dd/yyyy):
 
 
Gender:
Select the state in which the UGMA/UTMA custodial account was opened:
Citizenship:
(Please provide country of citizenship if Account Owner is a resident alien).
Name of Trust:
 
Trust Tax ID Number:         
Date of Trust (mm/dd/yyyy):
 
 
Name of Trustee:
First:
 
Middle:
Last:
 
Trustee Social Security or Taxpayer Identification Number:         
Trustee Date of Birth (mm/dd/yyyy):
 
 
Gender:
Citizenship:
(Please provide country of citizenship if Account Owner is a resident alien).