Maryland Prepaid College Trust Claim Form

This claim form is solely for claims submitted in accordance with § 18-1917 of the Education Article of the Annotated Code of Maryland (the “Claims Statute”).

Under the Claims Statute, a claim may be submitted only for an account that was open and existing on or after November 1, 2021, by: (1) an MPCT account holder; or (2) an MPCT qualified beneficiary for a distribution that was made to the qualified beneficiary or to an eligible educational institution on the beneficiary’s behalf.

Additional information regarding the claims process can be found at https://maryland529.com/home/mpct-earnings-decision.html under “Earnings Rate Decision FAQs”.

NOTE: You must complete and submit this form in one sitting. Please allow yourself time to complete the online forms, as they cannot be saved for further editing. Forms are only saved upon submitting the final, completed form at which time you will receive a confirmation page to print for your records.

If you have any questions completing the form, please contact us at claimsMD529@treasurer.state.md.us or call us at 410-316-6367. Once submitted, all communications should be with your assigned representative.

Claimant Submitted Data

A separate claim should be filed for each individual account number.

Submitter Type

Please select your status with respect to this claim

Submitter Information

Prefix

First Name

Middle Name

Last Name

Suffix

Preferred Phone Number

Preferred Phone Number Extension

Alternate Phone Number

Alternate Phone Number Extension

Email Address

Law Firm Name

Street Address 1

Street Address 2

City

State

Zip Code

Country

Claim Information

Please provide the account number for the Maryland Prepaid College Trust Account to which this claim relates:

Note: Submit one claim per account number

Was this account open and existing on November 1, 2021?

Please provide a concise statement of facts that sets forth the nature of your claim:

Does this claim relate to a distribution that was made to a qualified beneficiary or to an eligible educational institution on the qualified beneficiary's behalf?

Acknowledgement and Acceptance

Customer

By electronically signing and clicking on this statement you acknowledge that you : (i) are either the Claimant or an approved representative of the Claimant legally empowered to submit this form on the Claimant's behalf; (ii) certify that all the information provided by you is true, accurate, and complete to the best of your knowledge; (iii) authorize the processing and investigation of this claim by the State Treasurer’s Office; (iv) may be required to provide supporting documentation to substantiate this claim and agree to provide any necessary documents promptly and cooperate fully with the claims process; (v) accept that the submission of this claim does not guarantee its acceptance or approval and that the final decision regarding the claim rests with the State Treasurer, as fiduciary of the Maryland Prepaid College Trust; (vi) accept that the State Treasurer’s Office may submit your claim information to a third-party administrator for the purposes of processing or evaluating the claim; (vii) agree to promptly notify the State Treasurer’s Office of any changes in the circumstances that may affect the accuracy or validity of the claim; and (viii) understand that any person who knowingly and willfully presents a false or fraudulent claim for payment of a loss may be found guilty of a civil violation or crime and may be subject to fines and confinement in prison.

By typing my name below, I am electronically signing this claim

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Claimant Submitted Data

A separate claim should be filed for each individual account number.Submitter Type

Submitter Information

Claim Information

Acknowledgement and Acceptance

A separate claim should be filed for each individual account number.

Submitter Type