(Association not for gain incorporated under section 21 of the Companies Act 61 of 1973 (as amended) (Company registration

number
1967/013618/08)

NSRI VOLUNTEER PERSONNEL INDEMNITY

WHEREAS I …………………………………………………………………………………………………...
(NAME IN BLOCK LETTERS) am a member of the National Sea Rescue Institute (hereinafter referred to as the "NSRI");

AS WHEREAS, in my capacity as a member of the NSRI, I shall from time to time help to organise, and/or participate in rescue operations,
assist in launching of, and serve as a crew member on lifesaving boats, aircraft and vehicles, and generally assist in carrying out the
objectives of the NSRI;

AND WHEREAS, I acknowledge in doing so I shall be subjecting myself to danger and the possibility of personal injury and/or the loss of
my life, and/or the loss of my personal possessions;

NOW THEREFORE I …………………………………………………………………………………………

(NAME IN BLOCK LETTERS) do hereby acknowledge that I have freely and voluntarily fully accepted the risk referred to above to myself
and my dependants, and I hereby on behalf of myself, my dependants, heirs, executors, administrators and assigns forever waive,
discharge and release the NSRI and its members and directors (whether voluntary or otherwise) from, and indemnify the NSRI and its
members and directors (whether voluntary or otherwise) against any and all claims of whatsoever nature and howsoever caused, arising
directly from or as a result of my activities referred to above, including but not limited to claims arising as a result of any act or omission of
the NSRI and/or any of its members and/or directors acting in the course and scope of their duty with NSRI, prior to , or after the date
hereof, and particularly as a result of any activity of whatsoever nature in which the NSRI may in any way be involved;

I further for myself, my heirs, executors, administrators and assigns indemnify the NSRI and/or all of its members and directors, (when
acting in the course and scope of their duty with the NSRI) against any and all such claims which may be referred against them by any other
person or body, and in particular, but without limiting the aforegoing, against claims made against the NSRI and/or any member or director
of NSRI (when acting within the course and scope of their duty with the NSRI) by my dependants or any one or more of them. This
indemnity shall remain of full force and effect notwithstanding the fact that I may resign from and re-join NSRI as a member at any time
hereafter

I certify that I am conversant with the terms of the personal accident insurance provided by the NSRI and understand that the cover is
intended to supplement and not replace any other insurance's necessary for my own or my dependant's protection, acknowledging hereby
that it is my responsibility to place such other insurance cover.

I hereby declare that I will not claim any monetary or other rewards for the salvage of any property which may be saved by the NSRI and/or
myself while I am on NSRI duty, or otherwise, nor will use any NSRI craft or equipment to undertake salvage in a private capacity.

I acknowledge that in the event that I have suffered any injury whilst serving as a crew member, pursuant to which NSRI or its insurer, or
medical scheme provider has contributed toward my medical expenses, and I thereafter again serve as a crew member, then neither NSRI
nor its insurer, nor medical scheme provider will bear any responsibility for any medical costs thereafter incurred by me, from whatsoever
cause arising.

DATED at ……………………………………. this ……………… day of ………………………. 20………

Signature of member …………………………………………………. I.D.

Full Name (Block letters)………………………………………………………….

IF MARRIED IN COMMUNITY OF PROPERTY:

I.D
Signature of Spouse………………..……………………………………………. .

Full Name (Block letters) ………………………………………………………………………………………….

IF VOLUNTEER MEMBER IS UNDER THE AGE OF 18;

ASSISTED BY ME, HIS/HER GUARDIAN Signature……………………………………………………………

Full name of Guardian (Block letters) ………………...…………………………………………………………………………….

Address…………………………………………………………………………………………………………………………………...

WITNESSES:
1. Full Name ……………………………………………………………….….Signature………………………………….
(Block letters)
Address ……………………………………………………………………………………………………………………………….

2. Full name ………………………………………………………………….. Signature…………………………………

(Block letters))
Address ………………………………………………………………………………………………………………………………

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