This agreement is made on [DD/MM/YYYY] between the following parties:
| Representative |
TON NU HUY CHAU – Branch Director |
| Tel: | (0236)391 8000 |
| Fax: | (0236)391 8811 |
| Tax Code: | 2300953399-002 |
| Account No.: | 700007474100 (VND) |
| At Shinhan Vietnam Bank – Ho Chi Minh Branch | |
| (LRAC) | |
| [Customer name / Company name] | |
| Address | |
| Representative: | |
| Tel: | |
| Fax: | |
| Tax Code: | |
| (Renter) | |
The parties mutually agree as follows:
| Vehicle model | Quantity | Specification | Vehicle Registration No. |
| Total | |||
| Coverage | Limits of Liability | ||||||
| 1. Physical Damage | Indemnity the total loss except as specifically excluded by the policy wording. | ||||||
| 2. Third Party Liability |
Legal liability for personal injury and/or property damage to
third party(ies) by the use of the insured vehicle.
|
||||||
| 3. Driver and Passenger |
Injury or death to driver and/or passengers caused by the traffic
accident
|
Executed as an agreement:
Signed and sealed for and on behalf of.
By:
Date: DD/MM/YYYY
Signed and sealed for and on behalf of
LOTTE Rent-a-car Vina Da Nang Branch
By:
Date: DD/MM/YYYY