Name of applicant for Visa: ______. There currently exists in (Country) a need for qualified medical practitioners in the speciality of ______. (Name of applicant for Visa) has filed a written assurance with the government of this country that he/she will return to this country upon completion of training in the United States and intends to enter the practice of medicine in the specialty for which training is being sought. Stamp (or Seal and signature) of issuing official of named country.
Dated: _______________________________
_______________________________
Official of Named Country.
This certifies that the program in which (name of physician) is to be engaged does not include any clinical activities involving direct patient care.
22 C.F.R. §62.27