Travel Care Declaration

I hereby declare that I have been duly authorised by each of the persons covered under this application including guardian(s) of the child(ren) mentioned in this application form (together, the "Insured Persons" and each an "Insured Person") to apply for Travel Care and to make the following declarations for and on his/her/their behalf. I also hereby declare that each of the Insured Persons has agreed to the information under this application including under these Declarations, and that it is a condition precedent to obtaining coverage for each such person that such Insured Person has agreed to all such information. (This declaration is not applicable to an applicant applying for his/her own insurance only.)

I, and on behalf of each of the Insured Person(s), hereby apply for Travel Care, deemed and accepted to constitute separate insurance in respect of each such Insured Person, and declare that the statements and particulars given in this application are to the best of the knowledge and belief of each of the Insured Person(s), true and complete and that this application will form the basis of the contract of the Insured Person(s) with Bao Viet Insurance Corporation. I/Each of the Insured Person(s) understand(s) and agree(s) that no insurance will be effective until the application is approved and the premium is successfully debited from my HSBC account(s).

I, and on behalf of the Insured Person(s), confirm that (i) I/all the Insured Person(s) are 85 years of age or younger; (ii) all children are no younger than six months and no older than 16 years of age; and (iii) all persons described in (i) and (ii) above are residents of the Vietnam and have never been denied travel insurance.

I, and on behalf of the Insured Person(s), hereby acknowledge and warrant that: I will not/None of the Insured Person(s) will be travelling contrary to the advice of any medical practitioner or travelling in order to receive medical treatment. I do not know/None of the Insured Person(s) know(s) of any condition, cause or circumstance existing that may necessitate the cancellation or curtailment of the planned journey.

I and each of the Insured Persons have read and understood the Terms and Conditions and the Policy Wording of this Travel Care insurance and agree to be bound by the same.