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Health Savings Account Distribution Request/Account Closure Form Use this form to request a distribution from your HSA. If you have any questions about HSAs or completing this form, please contact
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How to fill out wex-hsa-distribution-request-account-closure-form

01
Download the Wex HSA distribution request account closure form from the official website.
02
Fill out personal information such as name, address, and HSA account number.
03
Specify the reason for closing the account.
04
Indicate how you would like to receive the remaining funds, either via check or direct deposit.
05
Sign and date the form, ensuring all information is accurate and complete.
06
Submit the form as instructed on the document.

Who needs wex-hsa-distribution-request-account-closure-form?

01
Individuals who have a Wex HSA account and wish to close it.
02
Those who want to request a distribution of funds from their HSA account.
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The WEX HSA Distribution Request Account Closure Form is a document used to request the closure of a Health Savings Account (HSA) and to facilitate the distribution of the remaining funds.
Individuals who wish to close their Health Savings Account and withdraw their remaining funds are required to file the WEX HSA Distribution Request Account Closure Form.
To fill out the WEX HSA Distribution Request Account Closure Form, provide personal identification information, account details, indicate the reason for closure, and specify how you would like to receive any remaining funds.
The purpose of the form is to formally initiate the process of closing a Health Savings Account and to ensure the correct disbursement of funds according to the account holder's instructions.
The form must include personal information (name, address, etc.), account number, details of the requested distribution, and signature of the account holder.
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