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WELCOME TO OUR HSA INVESTMENT SOLUTIONThank you for your interest in the brokerage services provided by HSA Investment Services. Our dedicatedcustomer service and variety of resources will assist you in confidently investing your HSA funds. Pleasebe advised that this is a self-directed investment account. Your brokerage account will give you access to anumber of investment products including individual stocks and mutual funds.Enclosed you will find detailed information necessary to open your investment account.After we receive all of your completed paperwork, you will receive an email providing your accountnumber, password, and a tutorial on initiating your first trade.If you have any questions regarding the completion of these forms, please contact us at: 1.800.650.5863.Please keep in mind that the investment account is separate from your HSA and funds will not sweepto cover checks or debit card transactions. You should not establish an investment account until youare prepared to begin trading. Funds invested are subject to investment risk. Please see our Investmentrequirements acceptance document for additional details.We look forward to serving your investment needs!Securities offered by: HSA Investment Services are:* not FDIC insured * not deposits, obligations of, or guaranteed byany bank, and * are subject to investment risks, including the possible loss of principle amount invested.06/2013
Application ChecklistPlease make sure all subsequent sections are filled out completely:Investment Requirements Acceptance DocumentPart 1 - Account Set-upPart 2 - Primary Account HolderPart 3 - SuitabilityPart 4 - Customer Agreement and SignatureContact Information:For questions about this application please contact:Customer Service 1.800.650.5863 or e-mail hsainvestments@thebancorp.comPlease mail completed application to:The Bancorp Bank409 Silverside RoadSuite 105Wilmington, DE 19809You may also securely fax your completed application to: 1.302.385.509906/2013
Investment Requirement Acceptance DocumentPlease read carefully and sign before completing your application. In order to establish an investment account, your current balance must exceed 2500.00. This is a self-directed service with no investment guidance available via customer service.(Please see your financial advisor for any financial advice.) A minimum balance of 1000.00 is required to be maintained in your HSA. If you do not maintain thisbalance, an investment fee of 3.50 per month will be assessed until the account balance is increasedover the minimum*. A 25.00 custody fee for inactivity will be assessed on any brokerage account holding a balance if notrades are conducted within the calendar year. At least one instance of new trading activity (identifiedwith a “BUY” or “SEL” mnemonic) must settle on or prior to December 31st to exempt the accountfrom this fee. The following transactions are not defined as trading activity: Mutual fund dividendreinvestments or EFT transactions resulting from PIPs or SWPs. Stocks valued below 5.00 per share are restricted from trading. The minimum amount for each trade is 100.00. Please view mutual fund prospectus before trading toobtain knowledge of any fund-specific minimum trading requirements. There is a daily trading limit up to 10,000.00 for each investment account. You will receive a charge of 25.99 per trade with the exception of certain mutual funds that have beenreduced to 5.99 per trade (see list of low-cost mutual funds available on our Web site). Margin and Option trading is not permitted. Funds in this brokerage account may not be accessed for medical expenses without selling a portion ofyour portfolio to allow the funds to flow back into your Health Savings Account. In addition, you maynot transfer this HSA brokerage balance “in-kind” to another brokerage account. If you wish to movefunds, you must divest your portfolio and transfer monies directly from the core Health Savings Account(either through a rollover request or regular distribution). Please contact customer service at 1.800.650.5863 or hsainvestments@thebancorp.com with anyquestions.Print NameSignatureDatePlease sign this form and submit with investment account application.* If there are insufficient funds in the account, fees will accumulate and be assessed when available.Please retain a copy of this document and application for your records.06/2013
BROKERAGE ACCOUNT INSTRUCTIONSIMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNTTo help the government fight the funding of terrorism and money-laundering activities, Federal law and contractual obligations toHSA Investment Services require that The Bancorp Bank verifies your identity by obtaining your name, date of birth, address, anda government-issued identification number before opening your account. In certain circumstances, The Bancorp Bank may obtainand verify this information with respect to any person(s) authorized to effect transactions in an account. For certain entities, such astrusts, estates, corporations, partnerships, or other organizations, identifying documentation is also required. Your account may berestricted and/or closed if The Bancorp Bank cannot verify this information. Neither The Bancorp Bank nor HSA Investment Serviceswill be responsible for any losses or damages (including, but not limited to, lost opportunities) resulting from any failure to provide thisinformation, or from any restriction placed upon, or closing of, your account.1. ACCOUNT SETUPPlease select the appropriate account registration by checking the box. Consult with your investment representative if you are unsureof the registration type that you would like listed on the account. Health Savings Accounts are individually owned, therefore thecorresponding brokerage account may only have one account name.2. PRIMARY ACCOUNT HOLDERPlease complete this section with the information for the Primary Account Holder only (such as the primary owner, authorized individual,custodian, administrator, trustee, partner, or participant). Every account requires a Primary Account Holder.3. SUITABILITYThe Bancorp Bank is required by the NASD and other regulators to obtain certain information. Refer to the Customer Agreement for thedescriptions of the investment objectives.4. CUSTOMER AGREEMENT AND SIGNATUREBefore signing the Brokerage Account Application, you must carefully read the Brokerage Account Customer Agreement.06/2013
BROKERAGE ACCOUNT APPLICATIONImportant Information To help the government fight the funding of terrorism and money-laundering activities, Federal law andcontractual obligations require that The Bancorp Bank verify your identity by obtaining your name, date of birth, address, and agovernment-issued identification number before opening your account. In certain circumstances, The Bancorp Bank may obtain andverify this information with respect to any person(s) authorized to effect transactions in an account. Your account may be restrictedand/or closed if The Bancorp Bank cannot verify this information. Neither The Bancorp Bank nor HSA Investment Services will beresponsible for any losses or damages (including, but not limited to , lost opportunities) resulting from any failure to provide thisinformation, or from any restriction placed upon, or closing of, your account.Applications that are missing required information will not be processed.1. ACCOUNT SETUPNo. of Account Holders:1Please note that only one account holder is permitted to own an HSA and the corresponding HSA brokerage account.Account TypeIndividual2. ACCOUNT HOLDER INFORMATIONProvide personal information on the account holder associated with this account. Only the HSA account holder may be listed.Personal InformationFULL LEGAL NAME first, middle, lastDATE OF BIRTH mm/dd/yyyyDAY PHONEEVENING PHONEE-MAILCOUNTRY OF CITIZENSHIPSOCIAL SECURITY NO.TAXPAYER ID NO. COUNTRY OF TAX RESIDENCETYPE OF GOVERNMENT-ISSUED IDSingle/Divorced/WidowedMarriedNo. of Dependents:STATE/COUNTRY OF ID ISSUANCELegal Address No P.O. boxesMailing AddressADDRESS LINE 1ADDRESS LINE 1ADDRESS LINE 2ADDRESS LINE 2CITYSTATE/PROVIDENCEID NUMBERZIP/POSTAL CODECOUNTRYCITYID ISSUANCE DATEID EXPIRATION DATESame as Legal AddressSTATE/PROVIDENCEZIP/POSTAL CODECOUNTRYService InstructionsProceeds from Sales will be sent by external bank (EFT) to HSADividend/Distribution Income Choose one. Note that any dividend/distribution income sent to a DVP account will remain there pending additional instructions.Reinvest equity dividends, handle all other distributions like sales proceedsReinvest mutual fund dividends, handle all other distributions like sales proceedsReinvest mutual fund and equity dividends, handle all other distributions like sales proceedsHandle all dividends and distributions like sales proceeds06/20131
2. ACCOUNT HOLDER INFORMATION (continued)HSA ACCOUNT NUMBEREmployer Information and Affiliations Attach additional sheet if needed.Employment StatusEmployedOCCUPATIONRetiredNot EmployedINCOME SOURCE If retired or not employedIf yes, provide name of company:.EMPLOYER NAMEADDRESS LINE 1COMPANY NAMECOMPANY SYMBOL/CUSIPI amI am not affiliated with, or employed by, a stockexchange or member firm of either an exchange, the FINRA, or amunicipal securities Broker/Dealer. If yes, provide name of entity:ADDRESS LINE 2CITYI amI am not a control person or affiliate of a publiccompany under SEC Rule 144 (such as a director, 10%shareholder, or policy-making officer), or an immediate family orhousehold member of such a person.STATE/PROVIDENCEZIP/POSTAL CODEAFFILIATED ENTITY NAMECOUNTRYADDRESS LINE 1a senior foreign political figure, or a familymember or close relative of a senior foreign political figure.I amI am notADDRESS LINE 2CITYSTATE/PROVIDENCEZIP/POSTAL CODECOUNTRY3. SUITABILITYFinancial ProfileEmployment StatusFrom all sourcesEstimated Net WorthExcluding primary residenceInvestable/Liquid AssetsFederal Tax BracketIncluding cash and securitiesUnder 25,000Under 50,000Under 50,00015% or below 25,000 - 50,000 50,000 - 100,000 50,000 - 100,00025%-27.5% 50,001 - 100,000 100,001 - 500,000 100,001 - 500,000Over 27.5%Over 100,000 Over 500,000 Over 500,000 Investment ProfileInvestment ObjectivesRank your investment objectives forthis account in order of importance(1 being the highest). Review theattached Customer Agreement forimportant information on investmentobjectives.Preservation of capitalIncomeCapital appreciationSpeculationTrading profitsOther:Risk ToleranceConservativeModerateGeneral Investment KnowledgeInvestment Time HorizonShort (0-5 years)Intermediate (6-10 years)GoodExtensiveInvestment Product KnowledgePlease enter the account holder’s level of knowledge in each of the GoodExtensiveStocksBondsMutual FundsOptionsLong (over 10 years)Variable ContractsCombination:Limited Partnerships206/2013
4. CUSTOMER AGREEMENT AND SIGNATURETo The Bancorp BankNotice to HSA Investment ServicesI am at least 18 years of age and am of full legal age in the statein which I reside. In consideration of your accepting one or moreaccounts, I hereby acknowledge that I have read, understoodand agree to the terms set forth in the Customer Agreementherein. I understand that upon issuer’s request, in accordancewith applicable rules and regulations, The Bancorp Bank willdisclose my name to issuers of securities if securities are held inmy account so that I can receive important information unless Ido not consent to disclosure, and I will notify The Bancorp Bankif I do not consent (I may not be able to object to this disclosurefor certain securities issued by investment companies that areregistered under the Investment Company Act of 1940, or asrequired by law).This is to advise you that I have instructed The BancorpBank to establish, in my behalf, and as my agent an accountwith you. I have appointed The Bancorp Bank as myexclusive agent to act for and on my behalf with respect toall matters regarding my account with you, including, butnot limited to, the placing of securities purchase and saleorders. I acknowledge that no fiduciary relationship existswith The Bancorp Bank.If I am a U.S. person (including a U.S. resident alien), Icertify under penalties of perjury that: (1) I am a U.S. person(including a U.S. resident alien) and the Social Security orTaxpayer Identification Number provided is correct (or thatI am waiting for a number to be issued to me); and (2) I amnot subject to backup withholding because: (a) I am exemptfrom backup withholding; or (b) I have not been notifiedby the Internal Revenue Service (IRS) that I am subject tobackup withholding for failure to report all dividend andinterest income; or (c) I have been notified by the IRS that Iam no longer subject to backup withholding.I understand that telephone calls to The Bancorp Bank maybe recorded, and I hereby consent to such recording. Reportsof executions of orders and statements of my account shall beconclusive if not objected to in writing within five (5) days andten (10) days, respectively, after transmitted to me by mail orotherwise.Check this box if item (2) above does not apply to youbecause you have been notified by the IRS that you arecurrently subject to backup withholding because youhave failed to report all interest and dividends on yourtax return.I understand that it is my responsibility to read theprospectus for any mutual fund into which I purchase orexchange. I have received and read the prospectus for themutual fund in which I am investing — including, but notlimited to, any mutual fund that I choose for my Core Fund— and I agree to the terms of the prospectus and the CoreAccount section of the Customer Agreement.Pre-Dispute ArbitrationThis account is governed by a pre-dispute arbitration clause,which appears on the last page of the Client Agreement, and youacknowledge that you have received a copy of this clause.If I am not a U.S. person (including a U.S. resident alien),I am submitting the applicable Form W-8 with this form tocertify my foreign status and, if applicable, claim tax treatybenefits.The Internal Revenue Service does not require yourconsent to any provision of this document other than thecertifications required to avoid backup withholdingSIGNATURE.Account holder must sign in accordance with the signature requirements outlined in the account’s supporting documents.XSIGNATUREDATE mm/dd/yyyyFor Branch Use Only06/2013REGISTERED REP. NO/NAMESIGNATUREDATE mm/dd/yyyyOFFICE MANAGER/PRINCIPAL NAMESIGNATUREDATE mm/dd/yyyy3
BROKERAGE ACCOUNT CUSTOMER AGREEMENTThis is the agreement for your brokerageaccount. It describes the features andpolicies associated with the account.Please review this document and keep itfor your records. Do not return it with yourapplication.Who’s Who in This AgreementIn this document, “us,” “we,” and “our” referto The Bancorp Bank. “HSA InvestmentServices” is a NYSE member whom wehave engaged to provide custody andclearing services for us.The terms “account owner,” “you,” and “your”refer to the owner(s) indicated on the accountCOMMITMENTS BETWEEN YOU AND USOur Commitments to YouWhen we accept your account application,we are agreeing to serve as your brokerand to maintain an account for you. Weagree, subject to our acceptance of anauthorized order, to buy, sell, or otherwisedispose of securities for you according toyour instructions. We and HSA InvestmentServices also agree to provide variousservices and features, as described below.Note that HSA Investment Services hasno fiduciary responsibilities to you or thisaccount, and does not offer any tax, legal,or investment advice, or opinions on thesuitability of any investment in connectionwith this account.Your Commitments to UsMany of these commitments are spelled outmore completely on the following pages,but in general, when you sign the accountapplication, you agree to the following: to accept full responsibility for thecontent and accuracy of all authorizedinstructions placed on your account, andfor all results and consequences of theseinstructions; this includes all investmentdecisions and trading orders, and allinstructions placed by you or any otherperson you authorize to pay all fees, charges, and expensesincurred in your account to maintain enough assets in youraccount to satisfy all obligations as theybecome due, and to authorize us or HSAInvestment Services to take whateversteps we or HSA Investment Servicesmay consider necessary to resolveunpaid debts or other obligations if you choose a mutual fund for your coreaccount, to authorize liquidating sharesof that account to satisfy any and alldebits against your account to use the account and its featuresaccording to this agreement06/2013 to let us or HSA Investment Servicesmonitor and/or record any phoneconversations with you to let us or HSA Investment Servicesverify the information you provide andobtain credit reports and other creditrelated information about you at anytime, such as payment and employmentinformation to let us or HSA Investment Servicesshare with third parties any informationyou provide, but only as required by lawor as permitted by our and/or HSA Investment Services’s privacypolicy to resolve disputes concerning yourrelationship with us or HSA InvestmentServices (other than class actions)through arbitration rather than in a courtof law to abide by the HSA minimum balancerequirement and retain at least 1,000 inthe Health Savings Account.COMMITMENTS BETWEEN YOU AND USStatementsHSA Investment Services will send to theaddress of record a statement of account: every calendar quarter, at a minimum for any month when you have trading orcash management activityYour account statements will show allactivity in your account for the statedperiod, including securities transactions,credits and debits to your core account,and all fees paid directly from your account.HSA Investment Services will also sendconfirmation for every securities transactionin your account. The only exceptionsare automatic investments, automaticwithdrawals, dividend reinvestments,transfers to other accounts, andtransactions that involve only your coreHSA account; for these activities, yourregular account statement serves in placeof a confirmation.Account ProtectionYour brokerage account is not FDIC insuredagainst market losses. The securities inyour account are protected in accordancewith FINRA for up to 500,000 (includingup to 100,000 for uninvested cash). HSAInvestment Services also has arrangedfor additional coverage above these limits.Neither coverage protects against a declinein the value of your securities, nor doeseither coverage extend to certain securitiesthat are considered ineligible for coverage.Transferring Money ElectronicallyCash in and out of your HSA account istransferred electronically via fund transfers(EFTs), which work like and electroniccheck.Dividend ReinvestmentIn addition to reinvestment of mutual funddividends, reinvestment of dividends fromeligible equities and closed-end funds is anoption for most accounts. You can chooseto have the service apply to all eligiblesecurities in your account, or only to certainones, although during the time when asecurity is enrolled for reinvestment, all ofthat security’s eligible distributions must bereinvested through this service.With certain securities (such as mutualfunds), the reinvestment options availablein this account may be different than thoseyou would have if you were to investdirectly with the issuer.INVESTMENT OBJECTIVESBelow are five common investmentobjectives. As the account owner, it is upto you to select the account’s investmentobjective. Neither we nor HSA InvestmentServices can assure you that any giveninvestment or strategy will achieve yourinvestment objective. Note that the typicalinvestments listed are only examples of thetypes of investments historically associatedwith each objective.Capital Preservation seek to m
HSA Investment Services require that The Bancorp Bank verifies your identity by obtaining your name, date of birth, address, and a government-issued identification number before opening your account. In certain ci
