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Click ‘Get Form’ to open the HSA TRUSTEE OR CUSTODIAN document in the editor.
Begin by filling out the HSA OWNER section, including your name, Social Security Number, and contact information. Ensure accuracy as this information is crucial for identification.
In the HSA TRUSTEE OR CUSTODIAN section, enter the name of the trustee or custodian, along with their address and phone number. This identifies who manages your HSA.
Proceed to PART 3: CONTRIBUTION INFORMATION. Specify the contribution amount and date, then select the contribution type (Regular, Rollover, or Transfer) that applies to your situation.
In PART 4: INVESTMENT AND DEPOSIT INFORMATION, provide details about any investments you wish to make. Fill in each field accurately regarding investment description, quantity, status, and interest rate.
Finally, complete PART 5: SIGNATURE by certifying that all provided information is accurate. Sign and date the form to finalize your submission.

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