INDEMNITY FORM

This is to confirm that I WONG ZI HAO will be participating in the following activity at the
time and place specified below:

Activity : KK Night 2022

Venue : Geneva Winery Banquet

Jalan Setia Tropika 1/14, Setia Tropika, 81200 Johor Bahru, Johor

Date : 16 December 2022, Sunday, 5.00 pm to 10.55 pm.

With such,

I understand and agree that this event may risk loss or damage to personal belongings, and I
may be injured.

I SHALL NOT hold the Organizing Committee responsible for any form of mishaps and/or
injuries that may occur to me throughout the event.

I SHALL NOT hold the Organizing Committee to be liable should I be contracted with
COVID-19 disease or any form of illness that I may be exposed to throughout the event.

I understand and agree that the Organizing Committee shall not be responsible for any
accident, damage, theft, losses, or cost suffered at or as a result of the event or any part of it.

I understand and agree that the Organizing Committee shall not be responsible for any refund
for the registration fee if I am not able to attend the night. Refund is able to be made before
30th November 2022.
WONG
…………………………………………..

Contact No.: 0139586970

Date: 14/10/2022