Voucher indemnity statement

First name

Last name

Address line 1

Address line 2

Address line 3

Address line 4

Postcode

Declaration

I, the above, declare that I have not received any of the goods posted to me by Parking Services. The details of the items that are missing are:

Purchased goods

Please declare the name of the person the goods were purchased by and who made a payment to the London Borough of Islington.

State your original order reference number, if known

This reference number would have been provided with your original voucher purchase.

I promise to refund and/or return the goods in good condition, should they later come into my possession. I will indemnify the London Borough of Islington any loss, financial or otherwise, including any costs the authority may suffer or incur in the event of fraud, theft or irregularity if I am proven to be party to such an act. The authority may also take legal action as appropriate.

Name and contact details