Custodian Information Sample Clauses

Custodian Information. (required if investing through a self-directed IXX) Entity Name: Jurisdiction: Principal Address: Primary Contact: Email: Phone: Taxpayer Identification Number:

Custodian Information. If the investment in being held in a brokerage account or through a third-party custodian please enter the information below. Contact info will be used for valuation, distributions, & tax information. Iroquois Valley requires information for all natural persons associated with the investment. Please complete the following information for all natural persons associated with, or benefitting from, the investment.

Custodian Information. Healthcare Bank, 0000 00xx Xxx XX, Xxxxx, XX 00000. Healthcare Bank is a division of Bell State Bank & Trust, a wholly owned subsidiary of State Bankshares, Inc. The Health Savings Account (“HSA”) Accountholder named on the Healthcare Bank Custodial Agreement and Disclosure Statement (“Accountholder”) hereby appoints, designates, and authorizes Advantage Administrators(“TPA”) to serve as its Designated Representative and HSA Administrator. The TPA hereby accepts the appointment by the Accountholder, subject to the terms and conditions set forth below.

Custodian Information. Healthcare Bank, 0000 00xx Xxx XX, Xxxxx, XX 00000. Healthcare Bank is a division of Bell State Bank & Trust, a wholly owned subsidiary of State Bankshares, Inc.

Custodian Information. Upon acceptance of the Adoption Agreement, the name and address of the Plan’s Custodian will be:

Custodian Information. If the investment in being held in a brokerage account or through a third-party custodian please enter the information below. Contact info will be used for valuation, distributions, & tax in formation. Custodian Company:_____________________________________________ Custodian Contact Person(s):______________________________________ Address:______________________________________________________ Email(s): ______________________________ Use as Contact: ❑ YES ❑ NO Phone:_________________________ Relationship to Investment:________

Custodian Information. State Bank of Cross Plains, 0000 X. Xxxx Xxxxxx, Xxxxx Xxxxxx, XX 00000. State Bank of Cross Plains is a Wisconsin, state-chartered bank and wholly owned subsidiary of S.B.C.P. Bancorp, Inc.

Custodian Information. If applicable, please provide the following information:2 Custodian Name: Custodian Tax ID: Custodian’s W9 Form Please print, sign, and scan this page if applicable. See Appendix A for supplemental documents requirements by investor type. Custodian Signature / Stamp 2This section is applicable to investors that are investing through a third-party intermediary. Fidelity Private Credit Fund | Subscription Agreement 2

Custodian Information. Healthcare Bank, 0000 00xx Xxx XX, Xxxxx, XX 00000. Healthcare Bank is a division of Bell State Bank & Trust, a wholly owned subsidiary of State Bankshares, Inc. The Health Savings Account (“HSA”) Accountholder named on the Healthcare Bank Custodial Agreement and Disclosure Statement (“Accountholder”) hereby appoints, designates, and authorizes EBS-RMSCO, Inc. (“TPA”) to serve as its Designated Representative and HSA Administrator. EBS-RMSCO, Inc. xxxxxx accepts the appointment by the Accountholder, subject to the terms and conditions set forth below.

Custodian Information. Must be completed for IRAs and ALL accounts held at a custodian. Custodian Name DTC Number Custodian Tax ID Phone Number Custodian Mailing Address (Branch) City State Zip Custodian Bank Name Bank Account Number For Further Credit Name ABA Number For Further Credit Account Number