An Example of Form

Kingdom of Belgium

ANNEX 32

(stake at 06/09/2003)

Province:

Precinct:

Township:

Ref:

Prose engagement in charge

Subscribed in accordance with arrangements of Article 60 of the law of December 15, 1981 one access to the territory, the stay, establishment and remoteness of the strangers

I undersign (has)....................................................................................................

has....................................................., him........................................................

of nationality..........................................................................................................

practicing the profession of ...................................................................................

domicile  has : .....................................................................................................

commit has the consideration of the Belgian state and him (her) Named:....................................

................................................................................................................................

has......................................................, him........................................................

Nationality..........................................................................................................

residing has ............................................................................................................

who comes in Belgium for fair of the studies (1)

who himself finds in Belgium heart fair of the studies has

................................................................................................................................

has take in loads the cares of health, the fails of stay, studies and of repatriation of him (her) calls (e)

The present handling takes course has the date of the signature

and is valid            for School Scholar / academic.........................................

                             for the whole length of the studies in Belgium (1)

I guarantee of tutorial, the payment of the need of repatriate beyond the term fixed  which has the condition that has measure of remoteness has to price has concentrate of the concerned person (e) in the quarter that follows the expiration dates of his/her/its residence permitted.

Contd. P/2

Page-2

The present price in charge spreads to the spouse of the student (s) and has them (s) infant(s) minor (s) has load whose names follows:

Conjoined:...............................................................................................................

Child (s)................................................................................................................

................................................................................................................................

Date and signature, (3)

Seen for the legalization of the signature of.................

Makes has..........................................................................

Signature of the Authority

 

Seal

(1)     To block the useless mention

(2)     Denomination and exact address of the teaching establishment organizes, recognized or subsidies by the state.

(3)     The signature, preceded of the Read mention " and approve"  entire of the signatory's hand, must be legalized by the local administration / the representative diplomatic or consular Belgian has the stranger.