Title First Name Last Name Gender Date of Birth Passport No ID No Nationality Mobile No Email Address Travel Option Booking No / Car Registration / Vessel No Departure City Final Destination City Final Destination Country Departure Date and Time Transit Medical Center Test Type Preferred Booking Day Preferred Booking Timeslot Registrar Name Registrar Contact No Registrar Email Accepted* Additional Payment*

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Section 1.a

General information

Accepted* option you agree to print out the forms of the laboratory and Namibian Ministry of Health & Social Service, which are mailed to me after completing the Covid appointment request and bring along a copy of my passport.

Additional Payment* option you are unable to print out the forms, and herewith agree that Rennies Travel Namibia will print them out on my behalf against a fee of N$30.

Section 1.b

Accept the disclaimer of Rennies Travel

COVID-19 Screening Test Disclaimer and Information Release Agreement

Applies to all Rennies Travel Namibia (Pty) Ltd clients/travellers into/out of Namibia

Applies to all clients/travellers of Namibian travel agents subject to meeting the terms and conditions of Rennies Travel Namibia (PTY) Ltd

The screening test carried out for COVID-19 is a PCR test by means of the nasopharyngeal swab samples taken from individuals participating in the test. The samples will be processed by the CERTIFIED LABORATORY in accordance with proper medical procedures and in compliance with relevant medical regulations.

All test results will be supplied and confirmed by CERTIFIED LABORATORY. All information on- and/or follow-up information will be treated confidentially by Rennies Travel Namibia and the CERTIFIED LABORATORY’s medical staff who process the tests.

By paying for this Rennies Travel Namibia facilitation service, you acknowledge that you have read, understood, and agree to all the terms and conditions stated in the COVID-19 TEST DISCLAIMER and INFORMATION RELEASE AGREEMENT below.

By choosing the Rennies Travel COVID-19 screening facilitation services (“Services”):

1. You hereby declare and provide consent for the CERTIFIED LABORATORY and medically trained representatives to collect and process your swab and data (including where applicable or necessary any medical data, pre-existing conditions, past contacts, and other personal data that may be considered sensitive under the applicable laws and regulations) for the COVID-19 test purpose.

2. You hereby agree to undergo the COVID-19 screening test, agree that the test results will remain confidential and only accessible to you, your doctor, the CERTIFIED LABORATORY team, or the government institution handling the COVID-19 pandemic in Namibia.

3. You hereby declare that you understand and agree that to the consequences that may arise from knowing your status if you are tested positive for COVID-19 and will follow the instructions from the relevant government institution(s) handling the COVID-19 pandemic in Namibia.

4. You agree to consult further with local health agencies or government institutions handling the COVID-19 pandemic in Namibia if your COVID-19 test is positive and to take immediate precautions or treatment measures determined for your and public safety to contain the outbreak.

5. If you are ordering the test for another person, you hereby warrant that you have obtained the required written approval from the third-party regarding the facilitation services and that this third-party will abide by and sign Rennies Travel Namibia’s terms and conditions (Test Disclaimer and Information Release Agreement form). The completed and signed form must be returned to Rennies Travel Namibia before the screening test can be booked or undertaken

6. You understand and agree that Rennies Travel Namibia merely facilitates the COVID-19 tests and does not take nor processes these COVID-19 screening tests themselves. Rennies Travel Namibia is a travel agent who now, in addition to its travel related services, facilitates the COVID-19 screening tests at its premises. The CERTIFIED LABORATORY and medical representatives will manage, take and process the COVID-19 screening tests and will release the information to the clients of Rennies and other governmental agencies where relevant.

7. Rennies Travel Namibia (PTY) Ltd is not a health services provider or laboratory, nor does Rennies Travel Namibia provide any medical advice, or equipment and are therefore not responsible for any results or information supplied by CERTIFIED LABORATORY as part of the Covid-19 testing services for travelling purposes.

8. You understand and agree that a negative result does not exclude the possibility of SAR-Cov-2 infection at the time the screening test was taken.

9. You understand and acknowledge that people with COVID-19 can be missed by these swab tests. If you have strong symptoms of COVID-19, it is safest to self-isolate, even if the swab test does not show COVID-19. COVID-19 rules and regulations are country specific and the onus is on each person to follow correct procedures and behaviors.

10. You understand and agree that your test results will be forwarded to your doctor. Bona fide contact details of your doctor must be provided on the relevant forms which accompany this Agreement.

11. Rennies Travel Namibia disclaims any and all liability for all acts or omissions of CERTIFIED LABORATORY, the general risk of travel, government regulations and acts of God.

12. Rennies Travel Namibia is not responsible and incurs no liability for you contracting COVID-19 before, during or after your travels even if the COVID-19 test was negative at the time the swab test was undertaken.

13. Rennies Travel Namibia is not responsible and incurs no liability for COVID-19-related requirements that travel suppliers and governments may impose from time to time, such as health affidavit forms, health screenings prior to departure or upon arrival, face coverings or quarantines. For the latest COVID-19 government travel regulations, the client should review IATA's website at www.iatatravelcentre.com. For the latest travel supplier requirements, check the Rennies Travel Namibia’s website.

14. Rennies Travel Namibia has no special knowledge of the CERTIFIED LABORATORY personnel, testing and laboratory integrity and incurs no liability for any omissions, errors, or defaults committed by the Certified laboratory.

15. You understand and agree that Rennies Travel Namibia will not reimburse any monies paid for the COVID-19 screening tests if the result certificates have not been received within 48 hours after the nasopharyngeal swab has been collected. Rennies Travel Namibia is not responsible for any delays caused or experienced by the CERTIFIED LABORATORY.

16. You understand and agree that Rennies Travel Namibia is not responsible and does not guarantee timeous result certificates nor is Rennies Travel Namibia responsible for any delays in departures/arrivals from/into Namibia or any subsequent expenditure due to a delayed screening test result.

17. Rennies Travel Namibia strongly recommends trip cancellation and medical insurance, but some policies do not protect against cancellation due to pandemics or supplier defaults, so the client/traveller must read all policies.

18. Wash your hands frequently and wipe down high touch surfaces and practice social distancing by adhering to each country’s standard COVID-19 procedures. We recommend you isolate for at least 5 days after arrival at your final destination and avoid large crowds and indoor spaces.