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Personal details
Surname: First Name:
Home address: Business address:
Passport number:    
Email address: Confirm Email address:
Home tel: Business tel:
Home fax: Business fax:
Cellphone number: Date of birth (Year/month/day):
Emergency Contact details
Name and Surname: Emergency tel:
Emergency fax: Emergency email:
Safari Dates and Information
Number of days: Observers:
Children: Number in your party:
Dates from: To:
Will you bring your own firearm? Yes No    
Animal species you are planning on hunting
Lion Springbuck Black Wildebeest Birds
Lioness Kudu Blue Wildebeest Vermont
Bushbuck Eland Caracal Varmint
Elephant Ostrich Bontebuck Cape Buffalo
Roan Waterbuck Oribi Rhino
Klipspringer African wildcat Fallow Deer Red Lechwe
Grey Reedbuck Reedbuck Impala Hippo
Steenbuck Warthog Red Hartebeest Crocodile
Jackal Oryx Giraffe Blesbuck
Zebra Duiker Baboon Sable
Note: Animals will not be taken in any specific order, but at random as they present themselves
Please give us your itinerary
Arrival date: Arrival airline:
Arrival time: Arrival flight number:
Departure date: Departure airline:
Departure time: Departure flight number:
If you plan to sight before or after your hunt, please indicate your interest
Game parks Tribal life Diamond industry Golfing
Southern Africa Hiking Blue train Winelands
Gold mines Fishing Museums Shopping
Cape garden route Casinos        
Other interests            
Catering: So that our kitchen and household staff can make your stay enjoyable. Please tell us.
Food preferences: Food allergies / Dislikes:
Do you require a low-salt or other special diet? Yes No Low salt or special diet details:
Beverage Preferences
Beer Wine Spirits Soda's Water
Please tell us about your health
Allergies: Special medical conditions:
Special medication Bloodtype
Are you diabetic Yes No    
Idemnity
I, The undersigned, do hereby indemnify the members and staff of Ubathi South Africa and any and all of its associate companies, organizations, or persons acting for , or on its behalf, against any loss or damage, whether it is caused directly or indirectly by delays, sickness, injury, death, or loss or damage to property, whether occurred by negligence or not, or any expenses arising there from, which I may suffer while with Ubathi South Africa or while under its control or custody. I agree to abide to the decision of my Professional Hunter to take down any trophy with his weapon, that I have shot at; if in his discretion, the animal holds a threat to human life or needs to be put out of misery. I agree to pay all costs in full, that are incurred, before termination of the hunt, which may arise from my Professional Hunter taking down these wounded or life threatening animals. I also agree that photographs taken during the safari may be used for promotion and/ or publicity purposes by Ubathi South Africa. This indemnity is binding to the laws of the country of the client, as well as the country of the outfitter. I specifically submit myself to the jurisdiction of any competent South African Court of Law for any cause of action.