1011812018 ——_ips:finranett irasia.comfoxternalsTIsfthargeVouchorRleaselndomnityForm jsp7stPir=DPRASUId-DPRCGK 1BAGOSOBErep0, Ay Aciacom 7iU7 1SU. DISCHARGE VOUCHER RELEASE AND INDEMNITY | Guest Information Guest Name — Ms. RITA RENATA Ic Number P. Nationality : Indonesia Passport No, X146095 | Permanent Address Temporary Address ~ Contact No. Handphone No. 081321972265 HomeNo. - Office No. - Fax No. - Email Address _joni7768@yahoo.com : Flight Information Report Information Flight No. (Eg. ‘AK1234') Q2253 Report ID. OPROGK18A00508 Origin Flight Date 17-Oct-2018 Date Reported 18-Oct-2018 | Connesting Flight No. = Reported Station Jakarta Connecting Flight Date - Date Printed 18-Oct-2018 Donmuang Airport « Origin-Destination Printed By GroundHandlercGK | Jakarta Booking Number JJJ8NV VWe Ms, RITA RENATA_the undersigned hereby accept from PT, INDONESIA AIRASIA_ the sum of IDR200.000_as payment made without admission of liability in full and final settlement of all claims of \wialsoever nature afising oul of or in connection with the alleged DAMAGE BAGGAGE and in consideration of tho said paymont. Wo _Ms, RITA RENATA hereby agree to indemnify and keep indemnified PT. INDONESIA AIRASIA , PT. INDONESIA AIRASIA 's Officers, Employees and Agents against all further or other claims by whomsoever made in respect therect. Bank Holder Name _ XXXXXKXXXXXXXKHXXXXXKX XXX XXIHH KHAKI | hank Name. XXXXXXXXXXXXXXXXOHRRXXXXXX HHH HX HHH XO HH HX HX HHH AHHH HH HK Bank Brameh . XXXXXXXXXXXXHXXXXXXXXXXXXXXXX XXX HR KH HK Bank A/C Number | XXXXXXXXXXXXXXXXXXXXXXHHKHIK HHH XXX RECEIVED BY GUEST Signature \ 7 Fin Rewer Date _R Oct 2018 7 ATTENDED BY AA Staff Name | Signature chandiercoK Date ___-1@ Oct qo" « Intpsulintranettairasia.comfoxtornalBTldlschargeVaucherReleaselndemnityFonn jap stPir=DPR&sitid-OPRCGK1@AD0GO88reporName=dprPri.. 11