I/We confirm I/We have no other policy which will provide a similar indemnity in respect of this loss.
I/We acknowledge that any valuation used in calculating Insurers’ liability for this loss does not constitute a valuation for subsequent insurance claims or loss adjustments.
Compensation will be paid directly to Krung Thai Bank Public Company Limited.
Company Seal:
Signature: …………….……………. Witness Signature: ……...………..………
Name: …...……………...…….…..… Name: ……...……………….……….....…
Date: …………………………………