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CA Statement

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FINANCIAL DATA QUESTIONNAIRE

STUDENT VISA APPLICATION


AMERICAN CONSULATE GENERAL, CHENNAI

I, <Auditor Name>, Partner of <Auditing Company>., Chartered Accountants, Member of


the Institute of Chartered Accountants of India (Membership No.*****) do hereby certify
that I have reviewed the financial condition of Mr. <applicant> S/o Mr.R.<applicant’s
Father> and with a view of establishing his ability to pay the educational and living cost
at University of ***********, U.S.A., which has been
estimated to be $ ****** for 12(Up to 12) months.

SOURCE OF FUNDS:

A. Personal / Family Savings $ ***** Rs. *****

B. Current Annual Income $ ***** Rs. *****

C. Educational Loan $ ***** Rs. *****

D. Immovable Properties $ ***** Rs. *****

======= =========
Total $***** Rs. *****
======= =========

NOTE:

1) Income / Assets of parents of the student have been included.

2) Exchange Rate: US $1 = Rs.43/-

For <Auditing company>.,


Chartered Accountants

<Auditor Name>
Partner
Date:
Details of balances of Mr.<applicant’s Sponsor>(<Relation> of the applicant) &
<applicant’s Sponsor>(<relation> of the applicant) referred in page 1 and
documents reviewed

A. Savings of Mr. <applicant’s Sponsor>(<Relation> of the applicant)

I. Deposit with Bank:

1. Fixed deposit with Indian overseas Bank,


Mahalingapuram Branch, (RDP No.*************) Rs. *****

2. Fixed deposit with Indian Bank, Nungambakkam,


Chennai, jointly in the name of ******(A/C No.******) Rs. *****

========
Total Rs.******
========

II. Other Investments & Movable Assets:

1. Paid up value of Investment with LIC, in the


Name of *****. (Policy No.*****, ******,
**** & ****) Rs. *****

2. CAR Rs. *****

3. BIKE Rs. *****

4. Jewellery - as per present market value Rs. *****

(add ur shares, mutual funds, bonds and other liquid details over here)

========
Total Rs. *****
========
B. Current Annual Income:

1. Gross Annual Income of Mr. <applicant’s Sponsor>as per


Form 16 Rs. *****
========
Total Rs. *****
========

C. Educational Loan

1. Educational loan from Indian Bank, Nanganallur,


Chennai as per sanction letter Rs. *****
========
Total Rs. *****
========

C. Immovable Assets:

1. Land & Building <address>


Owned by <applicant’s Sponsor>
As per valuation report Rs. *****

2. Land & Building, at <address> owned by


<applicant’s Sponsor> as per Valuation Report. Rs. *****
========
Total Rs. *****
========

For <Auditing company>.,


Chartered Accountants

<Auditor Name>
Partner
Date:

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