Indemnity Clause

I ( ) Name, ( )Nric hereby waive all claims for damages,

compensation and/or cost in respect of:

i) bodily injury or illness to me and/or to others
ii) damage or loss to my property caused by, or arising out of, the
incident.
Upon payment of $100, I hereby release, hold harmless, and discharge the other
party from all liability in connection with the incident that occurred on 31
st
July
2014 at 9:35AM therewith.



Signature Signature