Affidavit of Financial Support and Bank Certification - University of North Florida

Instructions
1. The financial sponsor must fully and properly complete this form. Incomplete Affidavits will not satisfy the financial
support requirement and thus may cause a delay in the immigration process for the applicant.
2. More than one sponsor is allowable. However, an individual Affidavit must be completed by each sponsor.
3. Only an original Affidavit or a certified true copy of the original is accepted. No changes, alterations, or modifications
may be made to any information on this form. Please type or print clearly in ink.
NAME OF APPLICANT: __________________________________________________________________________
(family name) (first name) (middle name)
On separate page list name(s), relationship(s), date(s) of birth, and country of birth for dependent(s) expected to accompany applicant.
Part I. Sponsor Information and Oath/Affirmation
1. Name: __________________________ ___________________________
(family name) (first name)
Relationship to applicant:
2. _____________________________
3. Address: ______________________________________________________________________________________
4. E-mail: _______________________________________ 5. Telephone: ___________________________________
(include country and area codes)
6. Country of permanent residence: __________________ 7. Country of citizenship: ___________________________
I make this Affidavit for the purpo se of assurin g the Un ited St ates Gove rnment that the applicant, as well a s the
applicant’s dependents in the U.S., will not become a public charge while in th e United States. By my signature I state
that I have th e following amount of funds (U.S. dollars) available for the academic year indicated and will make available
additional funds in similar amounts for subsequent years of study:
US $ _____ 8,000 USD______ for the period: ___August 2015__ to _December 2015_
(beginning month/year) (ending month/year)
I acknowledge that I am aware of my responsibilities as the sponsor of the applicant. I swear or affirm that
(1) I understand the contents of this Affidavit signed by me and (2) the statements are true and correct.
Signature of Sponsor: _______________________________________________ Date: _______________________
Part II. Bank Certification
I certify that the total amount of readily available funds in the Sponsor’s bank account meets or exceeds the amount specified in
Part I above. Further, I certify that the information provided above is, to the best of my knowledge, true and complete.
THIS SPACE IS FOR STAMP/SEAL
OF BANK OR BANK OFFICIAL
Bank Official Signature: ______________________________
Bank Official Name/Title: _____________________________
Bank Name: _______________________________________
Bank Address: _____________________________________
Bank Telephone: ___________________________________
Bank Fax: ________________________________________
Date: ____________________________________________
AFFIDAVIT OF FINANCIAL SUPPORT
AND BANK CERTIFICATION
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