Form 5305-E Do not file

with the Internal

Revenue Service

Coverdell Education Savings Trust Account

(Rev. March 2002)

Department of the Treasury (Under section 530 of the Internal Revenue Code) Internal Revenue Service

The grantor named above is establishing a Coverdell education savings trust account under section 530 for the benefit of the 

designated beneficiary exclusively to pay for the qualified elementary, secondary, and higher education expenses, within the meaning of

section 530(b)(2), of such designated beneficiary.

The grantor and the trustee make the following agreement:

Article I

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

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

530(b)(1)(D)).

Cat. No. 25205V Form 5305-E (Rev. 3-2002)

Check if amendment 

Name of grantor

Date of birth of designated beneficiary

Grantor’s identification number

Name of designated beneficiary

Address of designated beneficiary

Name of responsible individual (generally the parent or guardian of the designated beneficiary)

The grantor has assigned the trust dollars ($ ) in cash.

Designated beneficiary’s identification number

Address of responsible individual

Name of trustee Address or principal place of business of trustee

1. Any balance to the credit of the designated beneficiary on the date on which he or she attains age 30 shall be distributed to him or

her within 30 days of such date.

Article III

The trustee may accept additional cash contributions provided the designated beneficiary has not attained the age of 18 as of the

date such contributions are made. Contributions by an individual contributor may be made for the tax year of the designated beneficiary

by the due date of the beneficiary’s tax return for that year (excluding extensions). Total contributions that are not rollover contributions

described in section 530(d)(5) are limited to $2,000 for the tax year. In the case of an individual contributor, the $2,000 limitation for any

year is phased out between modified adjusted gross income (AGI) of $95,000 and $110,000. For married individuals filing jointly, the

phase-out occurs between modified AGI of $190,000 and $220,000. Modified AGI is defined in section 530(c)(2).

Article II

Article IV

The grantor shall have the power to direct the trustee regarding the investment of the above-listed amount assigned to the trust

(including earnings thereon) in the investment choices offered by the trustee. The responsible individual, however, shall have the power

to redirect the trustee regarding the investment of such amounts, as well as the power to direct the trustee regarding the investment of

all additional contributions (including earnings thereon) to the trust. In the event that the responsible individual does not direct the

trustee regarding the investment of additional contributions (including earnings thereon), the initial investment direction of the grantor

also will govern all additional contributions made to the trust account until such time as the responsible individual otherwise directs the

trustee. Unless otherwise provided in this agreement, the responsible individual also shall have the power to direct the trustee regarding

the administration, management, and distribution of the account.

Article V

The “responsible individual” named by the grantor shall be a parent or guardian of the designated beneficiary. The trust shall have

only one responsible individual at any time. If the responsible individual becomes incapacitated or dies while the designated beneficiary

is a minor under state law, the successor responsible individual shall be the person named to succeed in that capacity by the preceding

responsible individual in a witnessed writing or, if no successor is so named, the successor responsible individual shall be the

designated beneficiary’s other parent or successor guardian. Unless otherwise directed by checking the option below, at the time that

the designated beneficiary attains the age of majority under state law, the designated beneficiary becomes the responsible individual. If

a family member under the age of majority under state law becomes the designated beneficiary by reason of being a named death

beneficiary, the responsible individual shall be such designated beneficiary’s parent or guardian.

Option (This provision is effective only if checked): The responsible individual shall continue to serve as the responsible individual

for the trust after the designated beneficiary attains the age of majority under state law and until such time as all assets have been

distributed from the trust and the trust terminates. If the responsible individual becomes incapacitated or dies after the designated

beneficiary reaches the age of majority under state law, the responsible individual shall be the designated beneficiary.

2. Any balance to the credit of the designated beneficiary shall be distributed within 30 days of his or her death unless the designated

death beneficiary is a family member of the designated beneficiary and is under the age of 30 on the date of death. In such case,

that family member shall become the designated beneficiary as of the date of death.
Notwithstanding any other articles which may be added or incorporated, the provisions of Articles I through III will be controlling. Any

additional articles inconsistent with section 530 and the related regulations will be invalid.

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

amendments may be made with the consent of the grantor and trustee whose signatures appear below.

Form 5305-E (Rev. 3-2002) Page 2

Article VIII

Article X 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.

Grantor’s signature Date

Trustee’s signature Date

(Use only if signature of the grantor or the trustee is required to be witnessed.)

Specific Instructions

General Instructions

Section references are to the Internal

Revenue Code unless otherwise noted.

Purpose of Form

Form 5305-E is a model trust account

agreement that meets the requirements of

section 530(b)(1) and has been pre-approved

by the IRS. A Coverdell education savings

account (ESA) is established after the form is

fully executed by both the grantor and the

trustee. This account must be created in the

United States for the exclusive purpose of

paying the qualified elementary, secondary,

and higher education expenses of the

designated beneficiary.

Article X. Article X and any that follow may

incorporate additional provisions that are

agreed to by the grantor and trustee to

complete the agreement. They may include,

for example, provisions relating to: definitions,

investment powers, voting rights, exculpatory

provisions, amendment and termination,

removal of the trustee, trustee’s fees, state

law requirements, treatment of excess

contributions, and prohibited transactions

with the grantor, designated beneficiary, or

responsible individual, etc. Attach additional

pages as necessary.

Identification Numbers

Definitions

Note: The age limitation restricting

contributions, distributions, rollover

contributions, and change of beneficiary are

waived for a designated beneficiary with

special needs.

Trustee. The trustee 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 trustee. Any

person who may serve as a trustee of a

traditional IRA may serve as the trustee of a

Coverdell ESA.

Do not file Form 5305-E with the IRS.

Instead, the grantor must keep the completed

form in its records.

The grantor and designated beneficiary’s

social security numbers will serve as their

identification numbers. If the grantor is a

nonresident alien and does not have an

identification number, write “Foreign” in the

block where the number is requested. The

designated beneficiary’s social security

number is the identification number of his or

her Coverdell ESA. If the designated

beneficiary is a nonresident alien, the

designated beneficiary’s individual taxpayer

Article IX

Designated beneficiary. The designated

beneficiary is the individual on whose behalf

the trust account has been established.

1. The grantor agrees to provide the trustee with all information necessary to prepare any reports required by section 530(h).

2. The trustee agrees to submit to the Internal Revenue Service (IRS) and responsible individual the reports prescribed by the IRS.

Article VI

Article VII

The responsible individual may or may not change the beneficiary designated under this agreement to another member of

the designated beneficiary’s family described in section 529(e)(2) in accordance with the trustee’s procedures.

Responsible individual. The responsible

individual, generally, is a parent or guardian of

the designated beneficiary. However, under

certain circumstances, the responsible

individual may be the designated beneficiary.

Optional provisions in Article V and Article

VI. Form 5305-E may be reproduced in a

manner that provides only those optional

provisions offered by the trustee.

Grantor. The grantor is the person who

establishes the trust account.

Witness’ signature Date

If the model account is a custodial account,

see Form 5305-EA, Coverdell Education

Savings Custodial Account.

Family member. Family members of the

designated beneficiary include his or her

spouse, child, grandchild, sibling, parent,

niece or nephew, son-in-law, daughter-in-law,

father-in-law, mother-in-law, brother-in-law, or

sister-in-law, and the spouse of any such

individual. A first cousin, but not his or her

spouse, is also a “family member.”

identification number is the identification

number of his or her Coverdell ESA. An

employer identification number (EIN) is

required only for a Coverdell ESA for which a

return is filed to report unrelated business

income. An EIN is required for a common

fund created for Coverdell ESAs.

Article X

Form 5305-E (Rev. 3-2002)