MSA Contribution and Eligibility Form

Purpose of Form: This form is designed to help the customer determine whether he or she is eligible for an MSA contribution. The administrative information needed to process the contribution is gathered.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.

Instruction and Authorization to transfer MSA Funds

Purpose of Form: Transfer of MSA funds must be documented in writing. This transfer form is specifically designed for MSA funds. The accountholder identifies exactly what dollars are to be transferred to a new trustee or custodian.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.

MSA Distribution Form

Purpose of Form: Distributions of MSA funds must be documented in writing. There are special IRS reporting rules. This form gathers all of the information needed to do this reporting. At this time, it does not appear that the withholding rules apply to distributions from MSA accounts.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.

MSA Beneficiary Designation

Purpose of Form: The accountholder has the right to designate a beneficiary with respect to his or her MSA funds. This form is used for that prupose. This form advises the accountholder what options a beneficiary will have after the accountholder's deathh.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.

Rollover Certification For Rollovers To An MSA

Purpose of Form: Rollovers of funds into an MSA must be documented in writing. this rollover form is specifically designed for MSA funds. The accountholder must certify that the involved distribution qualifies to be rolled over into this MSA.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.

Special Explanation To MSA Accountholder Regarding Withdrawal of an Excess Contribution

Purpose of Form: As with IRAs, there is a special rule which allows the withdrawal of an excess contribution. This form gathers the necessary information and furnishes an explanation to the accoutnholder.

This form can be imprinted. Call 800-346-3961 for details.

Package contains 25 forms. Call for quantity pricing or for imprint orders.