Custodial Agreement and Disclosure StatementHealth Savings Custodial Account • April 10th, 2019
The individual whose name appears on the accompanying Application Form (hereinafter called "Depositor") is establishing a Health Savings Account with New Vision Trust Company or its successor (hereinafter referred to as "Custodian"). This Health Savings Account is established for the exclusive benefit of the individual (or his beneficiaries) within the meaning of §223(a) of the Internal Revenue Code and the related Treasury regulations. Custodian has delegated certain Custodial Account recordkeeping and administrative functions ("Administrative Services") to the administrator whose name appears on the Application form (the "Administrator").
