Common Contracts

HEALTH SAVINGS ACCOUNT CUSTODIAL AGREEMENT

Account Custodial Agreement • December 19th, 2003

• Contract Type
  Account Custodial Agreement
• Filed
  December 19th, 2003

The depositor whose name appears on the attached Application is establishing a Health Savings Account under Section 223(a) of the Internal Revenue Code (“Code”) for the purpose of paying qualified medical expenses, as defined under Section 223(d)(2) of the Code, of the Depositor. The Depositor has assigned the custodial account the sum indicated on the Application.