Title of statement (tường trình về vụ việc): ……………………………………………….
Guest name (họ và tên): ............................................................................................. …….. Room number (phòng số): .................................................................................................. . Statement (nội dung tường trình): ............................................................................................................................................... ............................................................................................................................................... ............................................................................................................................................... ............................................................................................................................................... ............................................................................................................................................... ............................................................................................................................................... ............................................................................................................................................... ............................................................................................................................................... ............................................................................................................................................... ............................................................................................................................................... ............................................................................................................................................... ............................................................................................................................................... ............................................................................................................................................... ............................................................................................................................................... ............................................................................................................................................... ............................................................................................................................................... ............................................................................................................................................... I assure that I will hold fully responsibility in relation with any claim on the above mentioned statement. (tôi cam đoan sẽ chịu mọi trách nhiệm liên quan đến nội dung tường trình nêu trên)