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MEDICAL_INDEMNITY_FORM
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Form E-mail Subject
MEDICAL INDEMNITY IN FAVOUR OF AIRLINK (PTY) LIMITED
Form Page Title
MEDICAL INDEMNITY IN FAVOUR OF AIRLINK (PTY) LIMITED
Form Submission Email
specialassistance@flyairlink.com
Form Submitter Email Parameter
email_address
Form Submitter Response Email Body
Dear User,
Your form has been successfully submitted.
Medical components
Form fields
Field Title
Name
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ID Value
name
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3
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Body
I have booked passage on flight/s to be operated by Airlink (Pty) Limited as follows:
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Flight Number Prefix Value
4Z
Body
I have disclosed to Airlink that I have a temporary or permanent medical or physical condition and that as a result I require
additional assistance in relation to the Airlink flight that I am going to take.
additional assistance in relation to the Airlink flight that I am going to take.
Body
I acknowledge that Airlink will use reasonable endeavors to accommodate my specific needs but also ensure the safety and comfort of other passengers on board the flight.
Body
I indemnify and hold Airlink harmless for:
Points
any loss, damage, or injury of whatsoever nature that I may suffer in the course of being a passenger on the flight, embarking or disembarking from the aircraft in question or being conveyed at any time through either the airport of departure or arrival. I understand that this indemnity does not extend to any loss, damage, or injury that I may sustain because of any conduct which is of a grossly negligent nature; and
any loss of a damage to any medication, therapeutic or medical equipment of any nature (including but not limited to assisted mobility devices such as crutches or wheelchairs) that I may bring with me on the flight whether it stowed in the baggage hold of the aircraft or kept in any portion of the main cabin during the flight. Once again, I understand that this indemnity does not extend to any loss or damage to such equipment that may be caused by any grossly negligent conduct.
Body
I understand that as set out in this document, I am otherwise entitled to the same rights and benefits as all other Airlink
passengers as described in the Conditions of Carriage.
passengers as described in the Conditions of Carriage.
Body
I confirm that I am aware that it is my duty to ensure that I am declared fit to travel on the flight by a suitably qualified medical practitioner and further that I have procured that I am insured against any loss or injury which I may sustain, whether to my person or property and in respect of which I indemnified Airlink, alternatively I have chosen not to avail myself of such insurance but in either event, this in no way impacts upon the extent of the indemnities that I have freely given, as described above.
Body
I confirm further that Airlink’s requirement that I give this indemnity and make these declarations is reasonable in the
circumstances and not unfairly discriminatory. I understand the nature of the indemnity that I have given, and the
content of the declarations made in this document, and I confirm them to be correct.
circumstances and not unfairly discriminatory. I understand the nature of the indemnity that I have given, and the
content of the declarations made in this document, and I confirm them to be correct.
Form fields
Field Title
Signed at
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signed_at
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Field Title
Signed on
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ID Value
signed_on
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Field Title
RSA ID number or Passport number
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ID Value
rsa_id_passport_number
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declaration Text
Body Content
I confirm that I have read and understood this medical indemnity form and agree to this consent.
