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Your Information


Justine
Pietersen
34 years old
0818717018
Bryan Pietersen
Husband
Discovery
593009130
NA
Justine
Jud
Please be aware that if your information has not changed then you do not need to complete the Your Information/Spouse/Child 1/Child 2/Child 3 sections again.

SPOUSE


By entering these details below, you are confirming that your spouse has authorised you to enter into and agree to our indemnity, conditions and code of conduct on their behalf, that your spouse has been made aware of the indemnity, conditions and code of conduct and furthermore they bind themselves to the indemnity, conditions and code of conduct.

CHILD 1


By entering these details below, and agreeing to the INDEMNITY, CONDITIONS AND CODE OF CONDUCT that follows, you are confirming that you are authorised to enter into and agree to the INDEMNITY, CONDITIONS AND CODE OF CONDUCT on behalf of the child, that you are responsible for ensuring that the child is properly supervised at all times and furthermore that you bind yourself and the child to the INDEMNITY, CONDITIONS AND CODE OF CONDUCT.

CHILD 2


By entering these details below, and agreeing to the INDEMNITY, CONDITIONS AND CODE OF CONDUCT that follows, you are confirming that you are authorised to enter into and agree to the INDEMNITY, CONDITIONS AND CODE OF CONDUCT on behalf of the child, that you are responsible for ensuring that the child is properly supervised at all times and furthermore that you bind yourself and the child to the INDEMNITY, CONDITIONS AND CODE OF CONDUCT.

CHILD 3


By entering these details below, and agreeing to the INDEMNITY, CONDITIONS AND CODE OF CONDUCT that follows, you are confirming that you are authorised to enter into and agree to the INDEMNITY, CONDITIONS AND CODE OF CONDUCT on behalf of the child, that you are responsible for ensuring that the child is properly supervised at all times and furthermore that you bind yourself and the child to the INDEMNITY, CONDITIONS AND CODE OF CONDUCT.
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