1. The financial sponsor must fully and properly complete this form. Incomplete Affidavits will not satisfy the financial
support requirement and thus may cause a delay in the immigration process for the applicant.
2. More than one sponsor is allowable. However, an individual Affidavit must be completed by each sponsor.
3. Only an original Affidavit or a certified true copy of the original is accepted. No changes, alterations, or modifications
may be made to any information on this form. Please type or print clearly in ink.
NAME OF APPLICANT: __________________________________________________________________________
(family name) (first name) (middle name)
On separate page list name(s), relationship(s), date(s) of birth, and country of birth for dependent(s) expected to accompany applicant.
Part I. Sponsor Information and Oath/Affirmation
1. Name: __________________________ ___________________________
(family name) (first name)
Relationship to applicant:
3. Address: ______________________________________________________________________________________
4. E-mail: _______________________________________ 5. Telephone: ___________________________________
(include country and area codes)
6. Country of permanent residence: __________________
7. Country of citizenship: ___________________________
I make this Affidavit for the purpose of assuring the United States Government that the applicant, as well as the
applicant’s dependents in the U.S., will not become a public charge while in the United States. By my signature I state
that I have the following amo