ESCLARECIMENTOS

Eu, ___________________________________________________________________________, inscrito(a)

no RG, sob o nº: _________________, expedito pelo: _______________, CPF: ________________________, residente e
domiciliado(a) no endereço: ____________________________________________________________, Nº __________,
cidade: __________________________, UF:_______, venho por meio deste, nos termos da Lei nº 7.115/1983, nº
11.096/2005 e Art. 299, do Código Penal Brasileiro, DECLARAR, junto à Instituição de Ensino:
________________________________________________ que os valores de numerários creditados em minha conta
bancária, agência: __________________, conta: __________________, são valores correspondentes há: (descrever de
maneira detalhada a origem dos valores creditados na conta, ou seja, os valores veio de onde, como eles surgiram, quem realizou os depósitos/as transferências,
porque depositaram/transferiram, com qual objetivo, finalidade, etc.)

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Por ser esta, a expressão da verdade, RATIFICO com o reconhecimento de firma a minha assinatura e data a
presente declaração.

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ASSINATURA

__________________________________- ______, ______de _____________________de_____________.

(Cidade, UF, dia, mês e ano)