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Military

Appendix I

WAIVER OF LIABILITY STATEMENT

 

Whereby, I           NAME                                                   passport no:_____________ am about to travel with ___________forces, and whereas I am doing so entirely upon my own initiative, risk and responsibility; now, therefore, in consideration of the permission extended to me; I do hereby for myself, my heirs, executors and administrators, remiss, release and forever discharge ________ and its member officers, agents and employees acting officially or otherwise, from any and all claims, demands actions or causes of action, on account of my death or on account of any injury to me or my property which may occur from any cause during my stay, travel as well as all ground, flight or sea operations incidents thereto.

I also agree to withhold any classified information, which may be accidentally disclosed to me, and to respect embargo restrictions, which may be imposed on information which, if disclosed, may jeopardize operational security. During my stay with _______ forces, I will not interfere with operations. I understand that failure to comply with these security restrictions will result in the loss of authorization to accompany _______ and may result in cancellation of my press registration.

 

____________________________ ____________________________
Signature Witness
 
____________________________ ____________________________
Printed Name Nationality
 
Address:_______________________________________________________
 
Please provide the following information for a person to be notified in an emergency (preferably next immediate relative):
 
___________________________________________________________
___________________________________________________________



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