THIS FORM MUST BE COMPLETED AND SIGNED BY ALL PERSONS WISHING TO RENT A VEHICLE FROM MOKE TURKS AND CAICOS TOURS AND RENTALS. PLEASE READ THIS DOCUMENT CAREFULLY, AS IT CONTAINS CERTAIN INDEMNIFICATION AND ASSUMPTION OF RISK PROVISIONS BY WHICH YOU AGREE TO BE BOUND.

By signing below, I, the undersigned, am requesting to rent the vehicle described below (the “Vehicle”), from Moke Turks and Caicos Tours and Rentals, (the “Company”).

I acknowledge that I have been provided with the Company’s Rental Rules and Regulations (the “Rules”), which I have read and understand, and a copy of which is attached hereto and incorporated herein by reference.

I acknowledge that I have been provided with a detailed explanation of how to operate and safely use the Vehicle, which I have read and understand.

I acknowledge that I have been provided with and understand the Company’s Vehicle Damage and Theft Protection policy (the “Policy”), which is attached hereto and incorporated herein by reference.

I hereby agree to rent the Vehicle from the Company and, in consideration of the Company renting the Vehicle to me, I hereby agree as follows:

1. Vehicle Damage and Theft Protection

I understand that the Policy provides protection in the event of damage to or theft of the Vehicle, subject to certain exceptions and limitations.

I further understand that the Policy does NOT waive or limit my obligations set forth in this Agreement and the Rules, including my obligation to pay for damage to the Vehicle or other property, or for personal injury, regardless of fault. I understand that the Vehicle is not covered by the Policy if I, or any other authorized driver, am/are under the influence of alcohol or illegal drugs, operate the Vehicle in a reckless or negligent manner, violate any provision of the Rules, drive the Vehicle outside of the island of Providenciales, Turks and Caicos Islands, or otherwise breach this Agreement. I understand that the Policy does NOT provide coverage for damage to or theft of the Vehicle if the Vehicle is operated by an unauthorized driver, or if I fail to report the theft of the Vehicle to the appropriate authorities and to the Company in a timely manner. If I violate any provision of this Agreement or the Rules, I understand that the Company may repossess the Vehicle without notice to me. I understand that the Policy may be cancelled by the Company at any time if I or any authorized driver operate the Vehicle in a reckless or negligent manner or violate any provision of this Agreement or the Rules. I understand that the Policy may be cancelled by the Company at any time if I or any authorized driver operate the Vehicle while under the influence of alcohol or illegal drugs. If the Policy is cancelled for any of these reasons, I hereby agree that I will be held responsible for all damage to the Vehicle, as well as all other property damage and personal injury, regardless of fault.

2. Assumption of Risk

I understand and acknowledge that my use of the Vehicle, including the operation of the Vehicle in the course of normal rental activities, may result in personal injuries or death, property damage, and other injuries and damages. I understand and acknowledge that the laws, regulations, and legal duties applicable to the operation of the Vehicle may differ from those in my home jurisdiction, and that the operation of the Vehicle in the Turks and Caicos Islands may subject me to different risks than I would be subject to in the United States or other territories. I further understand that the Turks and Caicos Islands government agencies, local law enforcement, and other officials have broad discretion and authority to take actions that may be harmful to me, including but not limited to arresting me, taking possession of the Vehicle, and otherwise responding to what they believe to be violations of applicable law. I understand and acknowledge that the Company is not responsible for the actions of any government agency, law enforcement, or other official while I am using the Vehicle. I understand and acknowledge that the Company does not make any representations regarding the condition of the Vehicle, the roads, or the ability to safely navigate the roads. I further understand and acknowledge that the Company does not make any representations regarding the availability of roadside assistance or emergency services, or the actions of such services. I understand that the Turks and Caicos Islands is a foreign country and that my use of the Vehicle may be subject to certain risks and dangers, including but not limited to: (a) accidents or illness occurring in areas without immediate access to emergency medical services; (b) the adequacy of medical facilities and treatment; (c) the dangers associated with wild animals, insects, or contaminated food or water; (d) the dangers associated with civil unrest, protest, terrorism, and other acts of violence; (e) the dangers associated with local customs and practices which may be offensive, illegal, or dangerous; (f) the dangers associated with the inadequacy of local search and rescue services, and (g) the dangers associated with the inadequacy of local law enforcement or legal resources. Notwithstanding these and other risks, I hereby voluntarily assume all risks associated with the use of the Vehicle, and I agree to take all precautions to protect myself, including but not limited to wearing a seatbelt and using child seats, and to keep the Vehicle in good condition.

3. Release of Liability

I hereby voluntarily, forever, and unconditionally release, discharge, waive, and covenant not to sue the Company, its affiliates, and their respective officers, employees, agents, representatives, successors, parents, subsidiaries, and assigns (collectively, the “Released Parties”), from any and all liability, claims, demands, causes of action, obligations, costs, expenses, and compensation of any kind which may arise out of or in connection with my use of the Vehicle (the “Released Claims”). I acknowledge and agree that the Released Claims include, but are not limited to: (a) any and all Released Claims arising from the Released Parties’ negligence, carelessness, or gross negligence; (b) any and all Released Claims arising from the design, manufacture, maintenance, selection, or use of the Vehicle; (c) any and all Released Claims arising from the condition, safety, legality, or other aspects of the roads; (d) any and all Released Claims arising from the presence, condition, or actions of other persons, animals, or objects; (e) any and all Released Claims arising from travel or activities in remote or isolated areas; (f) any and all Released Claims arising from the adequacy of medical facilities or treatment; (g) any and all Released Claims arising from the adequacy of emergency services; (h) any and all Released Claims arising from the adequacy of local law enforcement or legal resources; (i) any and all Released Claims arising from the actions of local law enforcement or government officials; (j) any and all Released Claims arising from the adequacy of security; and (k) any and all Released Claims arising from the adequacy of local resources and facilities. I further acknowledge and agree that the Released Claims include, but are not limited to: (a) any and all liabilities, claims, demands, causes of action, obligations, costs, expenses, and compensation of any kind which may arise out of or in connection with my presence at or use of the Vehicle; (b) any and all liabilities, claims, demands, causes of action, obligations, costs, expenses, and compensation of any kind which may arise out of or in connection with the presence at or use of the Vehicle by any other person or entity; and (c) any and all liabilities, claims, demands, causes of action, obligations, costs, expenses, and compensation of any kind which may arise out of or in connection with the actions of the Released Parties.

4. Indemnity

I hereby agree to indemnify, defend, hold harmless, and reimburse the Released Parties from and for any and all losses, liabilities, claims, demands, obligations, costs, expenses, and compensation of any kind, including any sums paid or incurred in any settlement, that the Released Parties may incur arising out of or in connection with (a) any breach of this Agreement or the Rules; (b) any accident, injury, or damage of any kind occurring in the course of my use of the Vehicle; (c) any accident, injury, or damage of any kind occurring in the course of the use of the Vehicle by any other person or entity; (d) any accident, injury, or damage of any kind occurring in the course of the use of the Vehicle by any other authorized driver; (e) any accident, injury, or damage of any kind occurring in the course of the use of the Vehicle by any unauthorized driver; and (f) any accident, injury, or damage of any kind occurring in the course of the use of the Vehicle that is or is alleged to be caused by the actions of the Released Parties.

5. Miscellaneous

This Agreement shall be governed by and construed in accordance with the laws of the Turks and Caicos Islands. This Agreement constitutes the entire agreement between the parties with respect to the subject matter contained herein and supersedes all prior understandings, agreements, and representations between the parties, whether written or oral, with respect to such subject matter. This Agreement may not be amended, modified, or waived except by an instrument in writing signed by all parties. If any provision of this Agreement is held to be invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other provision or any other rights or obligations of any party in any other jurisdiction. This Agreement shall not be construed as creating any rights enforceable by any person or entity not a party hereto, whether as a third-party beneficiary or otherwise. The waiver by any party of a breach of or a default under any provision of this Agreement shall not be construed as a waiver of any other provision, nor shall any waiver of any subsequent breach or default under the same or different provision of this Agreement. I HAVE CAREFULLY READ THIS AGREEMENT AND UNDERSTAND AND AGREE TO ALL ITS

TERMS AND CONDITIONS. I UNDERSTAND THAT BY SIGNING THIS AGREEMENT, I AM WAIVING VALUABLE LEGAL RIGHTS. I ACKNOWLEDGE AND AGREE THAT I HAVE RECEIVED A COPY OF THIS AGREEMENT AND THAT I MAY KEEP IT FOR MY RECORDS.