RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT

Date of Flight:
Departure:
Time of Flight:
Destination:

In consideration of Isuzu Motors South Africa (“IMSAf”) transporting me as set out above, thereto and back, by means of a charter plane and all activities associated therewith, I/we, the undersigned, agree as follows:

  1. I/we are aware of the inherent risks involved in flying, which risks include loss of damage to personal property, injury or fatality, accident or illness and weather. Knowing the inherent risks and dangers involved I/we certify that I/we are fully capable of participating in flying and that I/we will obey the lawful instructions of the pilot in command covering any aspects of the flight and I/we acknowledge that I/we are fully bound and will comply with those instructions. I/we voluntarily assume the risk inherent in taking part in the flight. My/our general health is good and there is nothing to my/our knowledge which renders me/us unfit to participate in the flight.

  2. To accept full responsibility for any loss I/we might suffer as a result of injury, illness, loss of life or damage or loss of property that I/we may sustain during the proposed flight from any cause in the air or on the ground whatsoever or howsoever arising and I/we indemnify and hold IMSAf, the pilot in command, (NATIONAL AIRWAYS CORPORATION) and its directors, officers, employees, agents, associates, suppliers and/or independent contractors harmless against any such claim whether or not such injury, loss or damage can be attributed directly or indirectly to the negligence of whatsoever nature or degree on the part of IMSAf, the pilot in command, (NATIONAL AIRWAYS CORPORATION) and its directors, officers, employees, agents, associates, suppliers and/or independent contractors.

  3. Notwithstanding anything to the contrary contained in this Indemnity, "claim" means any liability in excess of the sum/s insured by the pilot in command, (NATIONAL AIRWAYS CORPORATION) or its directors, officers, employees, agents, associates, suppliers and/or independent contractors in respect of all sums which the latter entities shall become legally liable to pay and shall pay as compensatory damages in respect of accidental bodily injury and/or accidental damage to property caused by the aircraft or by any person in terms of any insurance policy currently in force. It is recorded that such limitations on insurance applies in aggregate in any one accident or occurrence and not in respect of each passenger. I/we waive and abandon any claims over and above funds available from such insurance currently in force arising from an accident or occurrence.

  4. In entering into this Agreement, I/we are not relying upon any oral or written representations or statements made by IMSAf, the pilot in command, (NATIONAL AIRWAYS CORPORATION) or its directors, officers, employees, agents, associates, suppliers and/or independent contractors other than what is set forth in this Agreement.

  5. I declare that the below supplied information is correct and true.

  6. This Agreement is binding upon and inure to the benefit of my executors, administrators, personal representatives, collectors, heirs, dependants and/or successors.

  7. This Agreement is effective as of the date of my signature below.

BY SIGNING THIS AGREEMENT, THE UNDERSIGNED WARRANTS THAT I/WE HAVE READ, FULLY UNDERSTAND AND ACCEPT THE ABOVE TERMS AND CONDITIONS AND SIGN IT OF MY/OUR OWN FREE WILL. THE UNDERSIGNED FURTHER CERTIFIES THAT I/WE ARE EIGHTEEN (18) YEARS OF AGE OR OLDER.

FIRST NAME:
SURNAME:
ID NO:
CELL PHONE NO:
NEXT OF KIN NAME:
CONTACT NO.
SIGNATURE:
DATE: