Letter Of Indemnity
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1Letter of Indemnity
(for refund of deposit/charges)
The Water Authority
HONG KONG
Dear Sir,
I _______________________________(*HKID No./Business Registration No./Passport
No.________________) apply for refund of deposit/ charges set out in the table below:
Account number
Name of Registered Consumer
Refund amount ($)
Service address
In consideration of the refund to me of the amount set out in the above table, I hereby undertake to
indemnify the Water Authority and the Government of the Hong Kong Special Administrative Region against
all claims, demands, proceedings, liabilities, losses, damages, costs, charges and expenses whatsoever arising
out of or in relation to the said refund.
I fully understand the purpose and agree to the Water Authority using data collected from me for the
purpose of or directly related to processing this letter of indemnity. If I do not provide sufficient data, the
Water Authority may not be able to process my letter of indemnity. I agree that these data and other related
information may be transferred to other Government bureaux and departments for the purposes for which the
personal data was collected or for a purpose directly related to such purposes. I understand that I can request
the Departmental Secretary of the Water Supplies Department at 48/F, Immigration Tower, 7 Gloucestor
Road Hong Kong for access to and correction of the personal data.
Particulars of Witness and Signature
Particulars of Applicant and Signature
Signature
Signature
Name
(In Block Letters)
Name
Date
(In Block Letters)
Address
Address
Correspondence Address
(if different from the above)
.
* Delete where inappropriate
Contact Telephone No
Please return this letter of indemnity together with the following documents whichever applicable proving the
entitlement to the said amount to this office.
1.
Original deposit receipt/
LOSS OF WATER DEPOSIT RECEIPT–APPLICATION FOR REFUND (WWO213)
(applicable to the Account to which deposit receipt has been issued before)
2.
Payment record/ receipt bearing the name of applicant
3.
Photocopy of HK Identity card/ Business Registration/ Passport for non-resident of applicant
4.
Letter from registered consumer authorising the applicant to receive the refund on behalf of registered
consumer.
F Please “a”whichever appropriate
WWO 368 (Rev. 09/09)
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Parent category: Letters