[DATE]

DIRECCIÓN GENERAL DE MIGRACIÓN Y EXTRANJERÍA
DEPARTAMENTO DE RESIDENTES PENSIONADOS Y RENTISTAS
SAN JOSÉ, COSTA RICA

Dear Sirs:

The undersigned, [OFFICER’S NAME], [OFFICER’S POSITION] of [NAME OF BANK] hereby certifies the obligation of [NAME OF BANK] of sending to Costa Rica the monthly amount of two thousand five hundred United States Dollars to [FULL NAME AS APPEARING IN PASSPORT], >[PASSPORT NUMBER], [MARITAL STATUS], [FULL DOMICILE], [OCCUPATION], [CITIZENSHIP], for a term of no less than five years, in a permanent, stable and irrevocable manner.

Sincerely,

[OFFICER’S NAME]
[OFFICER’S POSITION]
[NAME OF BANK]

**LETTER NEEDS TO BE CONSULARIZED BY COSTA RICAN CONSULATE IF IT COMES FROM A NON-COSTA RICAN BANK**