Get Mercermarketplaceaccounts Serviceaccount Com

Completing the Mercermarketplaceaccounts Serviceaccount Com form is essential for managing HSA distributions and account closures. This guide provides clear instructions for each section of the form to ensure accurate completion.

Follow the steps to fill out the HSA distribution request/account closure form

1. Click the ‘Get Form’ button to obtain the form and open it for editing.
2. In the first section, provide the account holder information. Fill in the employer name, participant's name (first, middle initial, last), social security number, physical address (note that a PO Box is not acceptable), city, day telephone number, state, zip code, and date of birth in the format MM/DD/YYYY.
3. If you intend to close your HSA, proceed to Step 2 and select one of the options provided. Indicate whether you want to close the HSA and issue a final normal distribution for the total balance or close the HSA due to mistaken enrollment or ineligibility, ensuring the account has a $0 balance.
4. In Step 3, select the distribution type. Specify the requested amount and choose one of the following distribution options: normal, excess contribution removal (including the date of excess contribution), rollover, transfer (including new custodian’s name and address), disability, divorce, prohibited transaction, or mistaken contribution.
5. For Step 4, provide the authorized signatures. Certify that you are the proper party to receive payments from this HSA, that all provided information is true and accurate, and acknowledge that you have read and understood the applicable rules and conditions. Include the account holder's signature and date.
6. Once all information is accurately filled out, review the form for completeness. You can then save the changes, download it, print it, or share it as needed.

Complete your HSA distribution request or account closure form online today!