Finance Resident Funds Agreement

FINANCE RESIDENT FUNDS AGREEMENT

Parties

Resident Name:

Resident ID / Account Reference:

Facility / Funds Custodian Name:

Facility Contact Phone:    Email:

Recitals and Purpose

This Finance Resident Funds Agreement (the "Agreement") sets forth the terms by which the Facility will receive, hold, invest (if applicable), account for, disburse, and otherwise manage funds on behalf of the Resident for purposes of the Resident's personal expenditure, payment of fees owed to the Facility, or other authorized distributions. The Facility acknowledges its fiduciary duty to administer Resident funds consistently with this Agreement and applicable law.

Funds and Account Details

Account / Ledger Reference Number:

Date of Initial Deposit:

Funds will be held in: Trust/segregated account    Operating/pooled account

Interest, Fees, and Charges

Interest applied to resident funds (if any): % per annum.

Interest accrual method and compounding:

Management or administrative fee authorized by Resident:

I authorize the Facility to deduct authorized fees and charges from the Resident funds:

Deposits, Withdrawals and Authorization

Withdrawals and disbursements from Resident funds will be made only upon written authorization by the Resident or by an authorized representative designated below, except as required to satisfy unpaid Facility charges and lawful deductions. Authorized representative(s):

Notice period required for non-emergency withdrawal requests: days.

Records, Statements and Audit

Frequency of account statements provided to Resident: .

Records retention period for Resident funds records: .

Default, Liability and Remedies

In the event of misapplication, negligent recordkeeping, or unauthorized disbursement, the Facility shall be liable to the Resident to the extent required by governing law and shall promptly restore funds as appropriate. The Resident's exclusive remedies shall include reconciliation, restitution of misapplied funds, and repayment of interest or penalties where applicable. The Facility's liability shall not extend to losses caused by events beyond its reasonable control, provided reasonable safeguards and ordinary care were exercised.

Confidentiality and Access

The Facility shall maintain confidentiality of the Resident's financial records and shall permit access only to the Resident, authorized representatives, auditors with Resident consent, or as required by law. Requests for copies of records will be provided in accordance with Facility policy and applicable law.

Notices

Governing Law and Dispute Resolution

This Agreement shall be governed by the laws of the state of: . Disputes arising under this Agreement shall be resolved through the following method selected by the parties:

Dispute resolution method:

Acknowledgment and Certifications

By signing below, the Resident certifies that: (a) the information provided herein is true and complete to the best of the Resident's knowledge; (b) the Resident authorizes the Facility to hold and manage Resident funds under the terms of this Agreement; and (c) the Resident has received a copy of this Agreement.

Resident expressly authorizes the Facility to deduct outstanding Facility charges, authorized fees, and other lawful amounts from the Resident funds as set forth in this Agreement:

Execution

The parties below have read and agree to the terms of this Finance Resident Funds Agreement and execute it voluntarily on the dates indicated.

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