Заранее спасибо

Date: ___________, 2008
To:

Please answer the following questions:

1) What is the origin of the Funds? Please describe, giving specific details. Attach statements, Bank letters, and other documents to verify and confirm your explanation._____________________________________________________________________________________________________________________________________________________________________________

2) Have the Funds been on deposit for at least three (3) years? Y / N

3) If not, please provide a history of the previous banking information and describe the form in which the assets were deposited and/or transferred.

Previous Bank: _________________________________________
Address: _________________________________________________ _______________________________________________
Bank Officer: ___________________________________________
Telephone Number: _____________________________________
Account Holder’s Name: __________________________________
Reason for Transfer: ________________________________________
Transfer Date:

It is agreed that facsimile copies of this Funds History Statement, or any other associated documents to this transaction, are as valid and legal as delivered originals.

All statements made herein are true and complete and subject to penalty of perjury.

Information prepared this ____ day of _______, 2006.

For and on behalf of:

_________________________
_____________, Individual
Passport Number:
Country of Origin: ___________

IN WITNESS/CERTIFIED
Name of Witness /Certifying Authority

Возможно есть устаканившийся местечково-банковский вариант документа. В каждом банке может быть по-разному.