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Bank Account Verification Form

Financial Institution _____________________________ Address _____________________________ _____________________________ Phone Number _____________________________

To Whom It May Concern: This is to certify that ________________________________(Account Holder) Maintains the following accounts with _________________________________ (Financial Institution) Acct.type Acct.No. Date opened Balance as of today *US dollar equivalent ------------ ----------- -------------- ------------------------- ------------------------------------ ----------- -------------- ------------------------- -------------------------

____________________________ Name of institution official

________________________ Title

____________________________ Signature of the institution official

________________________ Date

Place official bank seal in the area provided below

Bank Seal________________________

Date____________________

*A minimum account balance of US $15,000.00 is required

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