Custodial Deposit Account FDIC Coverage Declaration Form
Please complete this form to declare FDIC coverage details for your custodial deposit account. Do not include any sensitive or confidential information.
Custodian's Full Name
*
First Name
Last Name
Institution Name
*
General Account Identifier (e.g., Reference Code or Nickname)
*
Type of Custodial Account
*
Please Select
Uniform Transfers to Minors Act (UTMA)
Uniform Gifts to Minors Act (UGMA)
Trust Account
Pooled Custodial Account
Other
Number of Beneficiaries Represented
*
List of Beneficiary Names or Entities (separate by comma or line)
*
Purpose of the Account
Please Select
Personal
Business
Estate
Trust
Other
Declaration Statement (Please confirm the account is structured to comply with FDIC coverage requirements)
*
I confirm this custodial account is structured to comply with FDIC coverage requirements.
I am not sure and require assistance.
Contact Email Address
*
example@example.com
Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Submit Declaration
Should be Empty: