Katholieke Hogeschool Leuven Abdij van 't Park 9 3001 Heverlee

Financial guarantee
(written according to article 60 the Law Decree of 15-12-1981 regarding the entry, the stay and the departure of foreigners)

I, the undersigned Born in (town): Date of birth: Nationality: Profession: Resident at: Pledge to the Belgian State and the named Born in (town): Date of birth: Nationality: Resident at: going to Belgium to study in Belgium studying (1)
(name of institute)

to be responsible for the health care, living expenses, study and repatriation expenses of the above mentioned person. This present financial guarantee is effective from the date of the signature and is valid: during the academic year of for the complete duration of the studies in Belgium (1) I guarantee, however, the payment of repatriation expenses beyond the above mentioned fixed date, within the term (3 months) following the expiry of his/her residence permit if the person concerned has been officially requested to leave the country. This present financial guarantee is also valid for the student's spouse and for their children under 21 who live at their expense and whose name are as follows: Spouse: Children:

Seen for notarization of the signature of on the (date) Signature of the authorized civil servant

Date et signature (3)

Seal

(1) Indicate the appropriate answer (2) Exact name and adresse of the organising institution, recognised and financed by the State (3) Signature, followed by 'read and approved' written by hand, must be validated by the local administration, the Belgian Consulate or its Representative diplomatic l'tranger