CONFIRMATION AND REFUND REQUEST FORM

No.: ……………………………………
To: Nova Homes Trading Joint Stock Company (Novahomes)

We are:....................................................................................................................................................
Certificate for enterprise registration/investment registration No.: …….…………...… issued by.......
............................................................................................................................................................on
Head office: .......................................................................................................................................
Represented by:..................................................................................................................................
Title:...................................................................................................................................................

Being a party, who has registered the reservation for the priority in carrying out transaction of the
real estate product with code of ……….. at the ……………… project as described in the priority
registration form dated …………
Now, We/I confirm the failure to sign the Deposit Form as agreed in the priority registration form
because:
 We/I have not demanded to purchase products
 We/I have not got the right to reserve
 We/I have not carried out Transformation Procedures as described in the Priority Registration
Form
 Other reason: ................................................................................................................................
Therefore, We/I request that within 07 (seven) working days after we/I signed and submitted this
form to Novahomes, Novahomes will refund to us/me the registration amount which equivalent to
………. by the following method:
 Cash
 Wire transfer to bank account in Vietnam with the following information:
Account name:............................................................................................................................
Account No.:...............................................................................................................................
At:..............................................................................................................................................
We/I warrant that all contents of this document are accurate and to have full the right to establish and
implement this document; otherwise, We/I bear liability for any damage suffered by Novahomes.
Ho Chi Minh City, [date] [month] [year]
CUSTOMER