In Favour of Microsoft (Pty) Ltd ( Microsoft )

Indemnity Form

In favour of Microsoft (Pty) Ltd (“Microsoft”)

WHEREAS I, the undersigned,______(Full names and surname) ______(Identity/Passport Number) of: ______(Full physical address)

Tel No: ______Cell No: ______hereby agree to participate in the ______provided at______by______on the______(“the event”), NOW THEREFORE: 1. I confirm that my participation in the event and the related activities (“the activities”) is entirely voluntary and I accept all risks involved therein. Accordingly, neither Microsoft nor any of Microsoft’s employees, successors, officers, suppliers, contractors, agents, consultants, directors and shareholders (collectively, “the Indemnified Parties”) shall be liable for any loss, damage or medical or other costs howsoever arising out of, based upon, or in connection with any accident, injury, death or illness of whatsoever nature and howsoever caused, suffered by me (to my person or property) as a result, directly or indirectly, of attending the event and/or participating in the activities and neither Microsoft nor any of the Indemnified Parties shall be liable for any loss and/or damage (including direct, indirect or consequential loss and/or damage) arising therefrom.

2. I hereby unconditionally and irrevocably indemnify and hold Microsoft and the Indemnified Parties harmless against all liabilities, claims, losses, proceedings, actions and damages (whether direct, indirect, consequential or otherwise) of whatsoever nature which Microsoft and/or any of the Indemnified Parties and/or any other person may sustain as a result, directly or indirectly, of Microsoft having made the activities available to me and/or as a result of me attending the event and/or participating in the activities, where such claims, losses, proceedings, actions and damages are caused by my negligent or wilful act or omission.

3. If I am incapacitated for any reason, I hereby grant permission to Microsoft or the Indemnified Parties to render or arrange for immediate medical or other treatment as may be immediately necessary. I shall be fully responsible for any risk, costs or liability arising out of such medical or other treatment.

SIGNED AT ……………………… on this ………..……. day of ………………………….………2016.

SIGNATURE ………………………………………………………………….. * (*Where applicable assisted by parent/guardian if under age 18 Indemnity Form 2

or assisted by husband if married in community of property)