MODELO DE BANK STATEMENT
Nome do Banco (timbre)
Statement
To: Nome da universidade de destino
Endereço
NOME DO BANCO S.A., with offices at ENDEREÇO, in the city of São Paulo, State
of São Paulo, Federative Republic of Brazil (the .Bank.),hereby declares, on a
confidential basis, as expressly requested by the Customer (as defined herein) that (i)
[TITULAR / RESPONSÁVEL DA CONTA CORRENTE], bearer of identity Card
(RG) n°.... enrolled at Taxpayer Registry (CPF/MF) under n°..... (The Customer.),
maintains a current account with the Bank since [DATA] that on the date hereof,
the Customer has some applications in certain investments funds with the Bank in the
value of R$................ [VALOR POR EXTENSO] representing U.S. ..... [VALOR
POR EXTENSO] pursuant to the exchange rate for sale of U.S. Dollars in the Brazil
exchange market PTAX Com on the date hereof at HORÁRIO DA COTAÇÃO DO
DOLÁR (São Paulo time), announced by the Central Bank of Brazil (Banco central do
Brasil) trough SISBACEN Date System, Exchange and Market Rates, transaction
PTAX 800, option 5, currency 220, (ii) that the Customer is a reputable customer, with
reliance solely on the history of dealings of such Customer with the Bank until this date.
[DATA]
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Assinatura do Gerente Administrativo
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Assinatura do Gerente de Contas