1. The first section is information from a responsible

Verpflichtungserklärung
(Formal Obligation)
1. The first section is
information from a responsible
third party.
Note: even if you are financially
independent, you much have a
third party supporter.
Ich, die/der Unterzeichnende (I, the undersigned)
Supporter Last Name
Name (Family name / Surname):
_______________________________________
Supporter First Name
Vorname (First name):
_______________________________________
Supporter Date of Birth
geboren am (date of birth):
_______________________________________
Supporter Nationality
Staatsangehörigkeit (nationality):
_______________________________________
Supporter Address
wohnhaft in (place of residence):
2. The second section is
your information.
_______________________________________
_______________________________________
________________________________________
Personalausweis-/Pass-Nr. (Identity-Card/Passport-No.)
Supporter ID Number
_______________________________________
Tip: If your third party
supportmich
does
not have
verpflichte
gegenüber
der aZAV für folgende Person (declare myself responsible to the ZAV for the following person)
passport, they can use a
Participants Last Name
driver's
license
Name
(Family
name /number.
Surname):
________________________________________
They should indicate that
Participant First Name
Vorname (First name):
________________________________________
the number refers to a
Participant Date of Birth
driver's
geboren
amlicense.
(date of birth):
________________________________________
Participant Nationality
Staatsangehörigkeit (nationality):
________________________________________
wohnhaft in (place of residence):
________________________________________
Participant Address
________________________________________
_________________________________________
Participant ID Number
Personalausweis-/Pass-Nr. (Identity-Card/Passport-No.) ________________________________________
für die Dauer des gesamten Praktikums-Zeitraumes die Kosten für den Lebensunterhalt und die Ausreise zu tragen
(During the whole time of the internship I will bear the living expenses and the costs for the departure)
Ich bestätige, zu dieser Verpflichtungserklärung aufgrund meiner wirtschaftlichen Verhältnisse in der Lage zu sein
(I confirm that I am in a position to undertake this responsibility on the grounds of my financial circumstances)
Date in blue ink
Datum (date):
Third party original signature in blue ink
Unterschrift (signature)
3. The third party supporter should sign and date the bottom of the form on the line
in blue ink. A hard copy with the original signature (not an electronic signature)
should be sent in to our New York office. 5