Form 5305-RA

(Rev. April 2017)

Department of the Treasury 

Internal Revenue Service 

Roth Individual Retirement Custodial Account

(Under section 408A of the Internal Revenue Code) 

Do not file 

with the Internal

Revenue Service 

Name of depositor Date of birth of depositor Account number

Address of depositor

Check if amendment . . . ▶

Name of custodian Address or principal place of business of custodian

The depositor named above is establishing a Roth individual retirement account (Roth IRA) under section 408A to provide for 

his or her retirement and for the support of his or her beneficiaries after death. 

The custodian named above has given the depositor the disclosure statement required by Regulations section 1.408-6. 

The depositor assigned the custodial account . $ 

The depositor and the custodian make the following agreement. 

Article I 

Except in the case of a qualified rollover contribution described in section 408A(e) or a recharacterized contribution described in 

section 408A(d)(6), the custodian will accept only cash contributions up to $5,500 per year for 2013 through 2017. For individuals who 

have reached the age of 50 by the end of the year, the contribution limit is increased to $6,500 per year for 2013 through 2017. For 

years after 2017, these limits will be increased to reflect a cost-of-living adjustment, if any.

Article II 

1. The annual contribution limit described in Article I is gradually reduced to $0 for higher income levels. For a grantor who is single 

or treated as single, the annual contribution is phased out between adjusted gross income (AGI) of $118,000 and $133,000; for a 

married grantor filing jointly, between AGI of $186,000 and $196,000; and for a married grantor filing separately, between AGI of $0 

and $10,000. These phase-out ranges are for 2017. For years after 2017, the phase-out ranges, except for the $0 to $10,000 range, 

will be increased to reflect a cost-of-living adjustment, if any. Adjusted gross income is defined in section 408A(c)(3).

2. In the case of a joint return, the AGI limits in the preceding paragraph apply to the combined AGI of the depositor and his or her 

spouse. 

Article III 

The depositor’s interest in the balance in the custodial account is nonforfeitable. 

Article IV 

1. No part of the custodial account funds may be invested in life insurance contracts, nor may the assets of the custodial account 

be commingled with other property except in a common trust fund or common investment fund (within the meaning of section

408(a)(5)). 

2. No part of the custodial account funds may be invested in collectibles (within the meaning of section 408(m)) except as otherwise 

permitted by section 408(m)(3), which provides an exception for certain gold, silver, and platinum coins, coins issued under the laws 

of any state, and certain bullion. 

Article V 

1. If the depositor dies before his or her entire interest is distributed to him or her and the depositor’s surviving spouse is not the 

designated beneficiary, the remaining interest will be distributed in accordance with paragraph (a) below or, if elected or there is no 

designated beneficiary, in accordance with paragraph (b) below. 

(a) The remaining interest will be distributed, starting by the end of the calendar year following the year of the depositor’s death, 

over the designated beneficiary’s remaining life expectancy as determined in the year following the death of the depositor. 

(b) The remaining interest will be distributed by the end of the calendar year containing the fifth anniversary of the depositor’s 

death. 

2. The minimum amount that must be distributed each year under paragraph 1(a) above is the account value at the close of 

business on December 31 of the preceding year divided by the life expectancy (in the single life table in Regulations section 

1.401(a)(9)-9) of the designated beneficiary using the attained age of the beneficiary in the year following the year of the depositor’s 

death and subtracting 1 from the divisor for each subsequent year. 

3. If the depositor’s surviving spouse is the designated beneficiary, such spouse will then be treated as the depositor. 

Article VI 

1. The depositor agrees to provide the custodian with all information necessary to prepare any reports required by sections 408(i) 

and 408A(d)(3)(E), Regulations sections 1.408-5 and 1.408-6, or other guidance published by the Internal Revenue Service (IRS). 

Cat. No. 25094Y Form 5305-RA (Rev. 4-2017)
Form 5305-RA (Rev. 4-2017) Page 2 

2. The custodian agrees to submit to the IRS and depositor the reports prescribed by the IRS. 

Article VII 

Notwithstanding any other articles which may be added or incorporated, the provisions of Articles I through IV and this sentence will 

be controlling. Any additional articles inconsistent with section 408A, the related regulations, and other published guidance will be 

invalid. 

Article VIII 

This agreement will be amended as necessary to comply with the provisions of the Code, the related regulations, and other 

published guidance. Other amendments may be made with the consent of the persons whose signatures appear below. 

Article IX 

Article IX may be used for any additional provisions. If no other provisions will be added, draw a line through this space. If 

provisions are added, they must comply with applicable requirements of state law and the Internal Revenue Code and may not imply 

that they have been reviewed or pre-approved by the IRS.

Depositor’s signature Date 

Custodian’s signature Date 

Witness’ signature Date 

(Use only if signature of the depositor or the custodian is required to be witnessed.) 

General Instructions 

Section references are to the Internal 

Revenue Code unless otherwise noted. 

Purpose of Form 

Form 5305-RA is a model custodial 

account agreement that meets the 

requirements of section 408A. However, 

only Articles I through VIII have been 

reviewed by the IRS. A Roth individual 

retirement account (Roth IRA) is 

established after the form is fully 

executed by both the individual 

(depositor) and the custodian. This 

account must be created in the United 

States for the exclusive benefit of the 

depositor and his or her beneficiaries. 

Do not file Form 5305-RA with the 

IRS. Instead, keep it with your records. 

Unlike contributions to traditional 

individual retirement arrangements, 

contributions to a Roth IRA are not 

deductible from the depositor’s gross 

income; and distributions after 5 years 

that are made when the depositor is 

591/2 years of age or older or on account 

of death, disability, or the purchase of a 

home by a first-time homebuyer (limited 

to $10,000), are not includible in gross 

to $10,000), are not includible in gross 

income. For more information on Roth 

IRAs, including the required disclosures 

the custodian must give the depositor, 

see Pub. 590-A, Contributions to 

Individual Retirement Arrangements 

(IRAs), and Pub. 590-B, Distributions 

from Individual Retirement Arrangements 

(IRAs).

Definitions 

Custodian. The custodian must be a 

bank or savings and loan association, as 

defined in section 408(n), or any person 

who has the approval of the IRS to act 

as custodian. 

Depositor. The depositor is the person 

who establishes the custodial account. 

Specific Instructions 

Article I. The depositor may be subject 

to a 6% tax on excess contributions if

(1) contributions to other individual 

retirement arrangements of the depositor 

have been made for the same tax year, 

(2) the depositor’s adjusted gross 

income exceeds the applicable limits in 

Article II for the tax year, or (3) the 

depositor’s and spouse’s 

compensation is less than the amount 

contributed by or on behalf of them for 

the tax year. 

Article V. This article describes how 

distributions will be made from the Roth 

IRA after the depositor’s death. Elections 

made pursuant to this article should be 

reviewed periodically to ensure they 

correspond to the depositor’s intent. 

Under paragraph 3 of Article V, the 

depositor’s spouse is treated as the 

owner of the Roth IRA upon the death of 

the depositor, rather than as the 

beneficiary. If the spouse is to be treated 

as the beneficiary, and not the owner, an

overriding provision should be added to

Article IX. 

Article IX. Article IX and any that follow 

it may incorporate additional provisions 

that are agreed to by the depositor and 

custodian to complete the agreement. 

They may include, for example, 

definitions, investment powers, voting 

rights, exculpatory provisions, 

amendment and termination, removal of 

the custodian, custodian’s fees, state 

law requirements, beginning date of 

distributions, accepting only cash, 

treatment of excess contributions, 

prohibited transactions with the 

depositor, etc. Attach additional pages if 

necessary. 

Form 5305-RA (Rev. 4-2017)