Form 5305-EA Do not file

with the Internal

Revenue Service

Coverdell Education Savings Custodial Account (Rev. March 2002)

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

The depositor named above is establishing a Coverdell education savings 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 depositor and the custodian make the following agreement:

Article I

Article III

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 a common investment fund (within the meaning of section

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

Cat. No. 25204K Form 5305-EA (Rev. 3-2002)

Check if amendment 

Name of depositor

Date of birth of designated beneficiary

Depositor’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 depositor assigned the custodial account dollars ($ ) in cash.

Designated beneficiary’s identification number

Address of responsible individual

Name of custodian Address or principal place of business of custodian

Article II

Article IV

The depositor shall have the power to direct the custodian regarding the investment of the above-listed amount assigned to the

custodial account (including earnings thereon) in the investment choices offered by the custodian. The responsible individual, however,

shall have the power to redirect the custodian regarding the investment of such amounts, as well as the power to direct the custodian

regarding the investment of all additional contributions (including earnings thereon) to the custodial account. In the event that the

responsible individual does not direct the custodian regarding the investment of additional contributions (including earnings thereon), the

initial investment direction of the depositor also will govern all additional contributions made to the custodial account until such time as

the responsible individual otherwise directs the custodian. Unless otherwise provided in this agreement, the responsible individual also

shall have the power to direct the custodian regarding the administration, management, and distribution of the account.

Article V

The “responsible individual” named by the depositor shall be a parent or guardian of the designated beneficiary. The custodial

account 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 custodial account after the designated beneficiary attains the age of majority under state law and until such time as all assets have

been distributed from the custodial account and the custodial account 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.

The custodian 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).

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.

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.
Form 5305-EA (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.

Depositor’s signature

Custodian’s signature

Witness’ signature

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

Depositor. The depositor is the person who

establishes the custodial account.

Specific Instructions

General Instructions

Section references are to the Internal

Revenue Code unless otherwise noted.

Purpose of Form

Form 5305-EA is a model custodial 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 depositor and the

custodian. 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 depositor and custodian 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 custodian, custodian’s fees,

state law requirements, treatment of excess

contributions, and prohibited transactions

with the depositor, 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.

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. Any

person who may serve as a custodian of a

traditional IRA may serve as the custodian of

a Coverdell ESA.

Do not file Form 5305-EA with the IRS.

Instead, the depositor must keep the

completed form in its records.

The depositor’s and designated beneficiary’s

social security numbers will serve as their

identification numbers. If the depositor 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

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 depositor and the custodian whose signatures appear below.

Designated beneficiary. The designated

beneficiary is the individual on whose behalf

the custodial account has been established.

Article VI

Article VII

The responsible individual

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

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

Date

Date

Date

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-EA may be reproduced in a

manner that provides only those optional

provisions offered by the custodian.

If the model account is a trust account, see

Form 5305-E, Coverdell Education Savings

Trust 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.”

Article X

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.

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 custodian’s procedures.

Form 5305-EA (Rev. 3-2002)