Fillable Printable Bank Affidavit Form - Texas

Bank Affidavit Form - Texas

University Of Texas At El Paso

Phone: (915)747-5664

Office of International Programs

Division of Student Affairs

500 W. University Drive

Union East Room 203

www.sa.utep.edu/oip

The University of Texas at El Paso

oip@utep.edu

Fax (915) 747-5794

Bank affidavit Form

F1 - F3 Students

STUDENT NAME: UTEP ID#:

Account Holder : please sign below to authorize the release of your information from the bank. Then take this form to the bank to complete.

Account Holder authorization for release of information (sign here):

Name of Bank:

Regarding account of: (Name of account holder)

Type of account: Account number:

Does this account represent a loan? Yes No

Account balance (amount of funds in the account): Currency:

Are funds available to be withdrawn at any time? Yes No

If yes, are the funds subject to an early withdrawal penalty? Yes No

If yes, what is the value of the funds after penalty deduction?

If no, when may the funds be withdrawn?

Are these funds subject to market fluctuation? Yes No

Name of bank employee (in English): Title:

Signature of bank employee:

Date: Official Bank Seal:

08/28/2013