贵重物品寄存表(中英文)

保险箱申请单SAFEDEPOSITAPPLICATIONFORM房间号码RoomNO.客人姓名GuestName保险箱号码BoxNO.国籍NationalityIDNO./PassportNO.身份证号码/护照号码使用协议AGREEMENT1、本人确认领取____号保险箱钥匙（“该保险箱”），并明白使用该保险箱需遵守之有关条件及规则，并承诺不将违禁品存放在该保险箱内。IherebyconfirmtoreceivethekeyoftheSafeDepositBoxNo.____andunderstandthatusingtheSafeDepositBoxneedtoabidebytherules.Andcommitnottoputtheprohibiteditemsinit.2、本人授权酒店在本人或本人授权代表亲自向酒店柜台交出钥匙时，准许酒店查阅保险箱，本人或本人授权的代表签字模式如下文所示。IauthorizethehotelwhenthekeyisreturnedbymeormyAuthorizedRepresentationtochecktheSafeDepositBox.MeandmyAuthorizedRepresentationSignatureSpecimenareshownbelow.3、本人承诺妥善保管该保险箱钥匙，如有遗失，当即通知酒店，酒店不须承担本人因失误而导致任何物品遗失的责任;且同意赔偿500人民币作为该保险箱及钥匙费用。Iconfirmtosafekeepthekeyandinformthehotelimmediatelyifitlost.Thehotelwillnotbeliableforloss.Ialsoagreetopay￥500ascompensationforhotelandthekey.4、本人同意，如本人在退房时未亲自退还钥匙及提取存放的财物，酒店有权处置存放在该保险箱内的所有财物，且无须承担任何责任。IherebyagreethatifIdonotreturnthekeyandextracttheitemsintheboxpersonallyaftercheckingout.Thehotelhasrighttodisposeanyitemsintheboxandhasnoresponsibly.5、酒店对于保险箱内存放物品的遗失或损坏不承担任何责任。ThehotelwillnotberesponsibleforallthelossanddamageofthecontentsintheBox.本人授权酒店允许_________________其签名式样如下，可随时开启及提取该保险箱内所有物品或新增物品。IherebyauthorizetheHoteltopermit_____Whosespecimensignatureappearsbelow.Theauthorizerepresentationcouldopenandextractallitemsinthesafedepositboxoraddnewitemsinit.__________________________________________________________________________使用宾客签名授权代表签字式样经办人日期GuestSignatureAuthorizedRepresentationIssuedByDateSignaturespecimen保险箱开启登记表IDENTIFICATIONCARD-SAFEDEPOSIT日期Date时间Time客人签名Guestsignature员工签名Staffsignature保险箱归还RETURNTHEBOX我特此归还保险箱钥匙号码为______并声明所寄存物品已取回,酒店对于任何索赔概不负责。IherebyreturntheKeyNo.____andcertifyalltheitemsstoredinthisboxhasbeenwithdrawndedbytheowner.Thehotelisnotresponsibleforanyclaimsagainstit._______________________________________客人签名日期员工签名GuestSignatureDatestaff