Form 5305-C Health Savings Custodial Account {5305-C}

Form 5305-C (Rev. October 2016), Health Savings Custodial Account (Under section 223(a) of the Internal Revenue Code), this form is a model custodial account agreement that has been approved by the IRS. An HSA is established after the form is fully executed by both the account owner and the custodian. The form can be completed at any time during the tax year. This account must be created in the United States for the exclusive benefit of the account owner. www.FormsWorkflow.com