H eritage Insurance Company of Zimbabwe (Private) Limited

BARD HOUSE, 69 SAMORA MACHEL AVENUE, P.O. BOX 2469, HARARE Tele: 705221-7/727294-8
Fax: 705228/727299
E-Mail: insure@heritage.co.zw

PUBLIC LIABILITY INSURANCE FOR SAFARI OPERATORS PROPOSAL FORM

Name of Proposer

Business Address

Situation of Premises

Type of Safari Operations. Please state whether in National Parks, State Land, Hunting Areas, or Private Land and
please attach list of Premises and state whether owned or leased.

YES/NO PLEASE DELETE IF NOT APPLICABLE

(a) Please provide a detailed description of the business, which you undertake in Zimbabwe.

(b) Please provide details of Principals and Directors

(c) Do you operate this business outside Zimbabwe as well? YES/NO

If yes please give details of countries involved

(d) What are the hazardous aspects of your business?

(i) Do you use fire arms YES/NO?

Please provide licence details together with qualifications and experience of firearms handlers.

(ii) Big Game Hunting YES/NO?

(iii) Small Game Hunting YES/NO?

(iv) Game Viewing:-

By Car? YES/NO?

On foot? YES/NO?

On foot with armed guides YES/NO?

(v) In respect of questions d (iii) and (iv) above please advise whether these occur in areas where there are any
of the big five or where there are so called tame wild animals BIG 5/OTHERS?

(vi) Hippo Hunting/Hippo Hunting by boat YES/NO?

(vii) White Water Rafting YES/NO?

(viii) Bungee Jumping YES/NO?

(ix) Bird Shoots YES/NO?

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 (x) Canoeing YES/NO?

(e) Are there any activities/risks which you are involved in not mentioned above which might increase the chances of
claims from your customers?

(f) Do you cater for both locals and foreigners YES/NO?

And in what proportion on average Zimbabweans %

Americans %
Others %

(g) Give details of Annual Turnover

(h) What form of disclaimer/indemnity form are signed by clients before tours commence. (Please attach a sample in
use by your Company)

(i) Are you a member of the Safari Operators Association

(j) Please specify how many persons you employ on safari operations together with positions held and their
qualifications and experience if not already provided above

(k) Give particulars of losses/claims made upon you during the past five years?

(l) If previously insured against this risk state name of insurer.

(m) Give details of other policies held by yourself and when they will be transferred to the Heritage?

(n) Has any Company ever:

a. Declined a Proposal from you for Public Liability Insurance?

b. Refused to renew your Policy?
c. Increased your premium at any time?
d. Cancelled your Policy

(o) Have you got any other insurance with this Company. If so give details

Indemnity Limit Required ($100 000.00 Minimum)

Commencement Date of Insurance

Retroactive Date

PLEASE NOTE THAT ACCEPTANCE OF THIS INSURANCE IS SUBJECT TO A DISCLAIMER HAVING BEEN SIGNED
IN RESPECT OF ACTIVITIES LISTED UNDER ITEM (d) ABOVE AND LODGED WITH THE COMPANY. IN ADDITION
PLEASE NOTE THAT COVER IS SUBJECT TO ZIMBABWEAN JURISDICTION.

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DECLARATION

We declare that

1. The particulars entered on this proposal are correct

2. During the currency of this Policy we will maintain the property in a good state of repair and all reasonable
precautions will be observed for the prevention or minimisation of personal injury or any loss or damage.

3. This proposal and declaration shall be the basis of the contract between us and the Company and we will accept the
Company’s policy subject to the terms and conditions contained therein.

4. We will give written notice to the Company of any alteration of risk.

PROPOSER’S SIGNATURE

DATE:

∗NB

The Liability of the Company does not commence until the acceptance of the proposal by the Company.

PLSO 9/2001 3