Affidavit Of Support
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1Affidavit of Support
Please fill out legibly. Use black or blue ink only.
SPONSOR
(person who will assume full responsibility for the trip)
1 FULL NAME:
:
2. DATE OF BIRTH
(DD/MM/YYYY)
_________ / __________ / ____________
3. DOCUMENT TYPE AND NUMBER:
4. ISSUING POST:
5. DATE OF ISSUE
:
(DD/MM/YYYY)
__________ / __________ / ____________
6. TELEPHONE:
7. FULL ADDRESS (city, state and country):
___
8. CITY, STATE AND COUNTRY OF BIRTH:
9. NATIONALITY:
BENEFICIARY
(the person to whom the visa will be processed, if approved):
10. FULL NAME:
:
11. DATE OF BIRTH
(DD/MM/YYYY)
___________ / ______________ / ___________
12. . DOCUMENT TYPE AND NUMBER:
13. ISSUING POST:
14. DATE OF ISSUE
:
(DD/MM/YYYY)
___________ / ______________ / ___________
15. CITY, STATE AND COUNTRY OF BIRTH:
16. NATIONALITY:
17. RELATIONSHIP WITH THE SPONSOR:
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□
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CÔNJUGE
FILHO
IRMÃO
GENITOR
OUTRO. Especifique: _______________________________
I, the sponsor identified above, certify under penalty of perjury under Brazilian Law, that I have executed freely
and willfully this affidavit on behalf of the beneficiary identified above. This document is made for the purpose of
assuring the Brazilian Government that the person named herein will abide by all Brazilian laws, regulations or
ordinances made for foreigners willing to travel to Brazil. I am able to and will assume total responsibility to supporting
his or her trip to Brazil, and I do affirm that the person sponsored by me will not become a public charge during his or
her stay in Brazil as well as he or she will maintain his or her legal status, and will depart prior to the expiration of his or
her authorized stay in Brazil. I am including to this form my personal financial documents to support this affidavit as
prove of my capability to act as a sponsor. I can guarantee that he or she have made appropriate arrangements for
lodging and health insurance in case of emergencies.
I acknowledge that I understand the extension of my responsabilities as a sponsor, certify that the information
provided herein is true and correct.
Signature: _____________________________________
Date (DD/MM/YYYY): ______ / _______/ ________
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